Child protection Flashcards
Child protection
activity undertaken to protect specific children
who are suffering, or are at risk of suffering,
significant harm
Safeguarding children
Measures taken to minimise risks of harm to children
-protecting children from maltreatment
-preventing impairment of children’s health/ development
Ensuring that children are growing up in a safe and caring environment
Children’s rights - the law - article 19
Children should be protected from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation
Children’s rights - the law - article 24
Children have a right to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health
Children’s wants
Not to do dangerous work To have water To play To be looked after To not be hurt by other people To have friends To go to school To follow any religion you choose
Children’s needs - assessment framework
Child’s developmental needs
Parenting capacity
Family and environmental factors
Government guidance: emphasis on
Preventing abuse and neglect
Improving multi-agency working
Encouraging early intervention
GDC Standards
You must find out about local procedures for the
protection of children and
vulnerable adults. You must follow these procedures if
you suspect that a child […] might be at risk because of
abuse or neglect
Good practice guidance (5 points)
- Responsibility
- Recognising
- Responding
- Reorganising
- Resources
Dentists are well placed to recognise signs
Skilled at examining head and neck and
recording findings
Head and neck is frequently site of injury in physical abuse
Untreated dental decay may be a sign of neglect
Children often attend the dentist regularly
Often treat more than one family member
Prevalence by age
Total = 43,140 Unborn = 2% <1 = 11.3% 1-4 = 30.3% 5-9 = 28.7% 10-15 = 25.2% >15 = 2.6%
Prevalence by type
Neglect - 41% Emotional abuse - 31.7% Physical abuse - 11.7% Multiple - 10.8% Sexual abuse - 4.8%
Definition of physical abuse
May involve hitting,
shaking, throwing,
poisoning, burning or scalding, drowning,
suffocation or otherwise
causing physical harm to a child
Also includes fabricated and induced illness
How to recognise physical abuse
Bruising, abrasions, lacerations, burns, bite marks, eye injuries, bone #s, intra-oral injuries
Site, size, patterns
Delay in presentation
Does not fir the explanation given
Accidental vs abuse: accidental head injuries
Head injuries tend to involve parietal bone, occiput or forehead
Nose
Chin
Accidental vs abuse: accidental rest of body injuries
Palm of hand
Elbows
Knees
Shins
Accidental injuries: remember that they typically
Involve bony prominences
Match the history
Are in keeping with development of the child
Accidental vs abuse: abusive head injuries
Ears - especially pinch marks involving both sides of ear
“Triangle of safety” (ears, side of face, and neck, top of shoulders)
Black eyes, especially if bilateral
Soft tissues of cheeks
Intra-oral injuries
Accidental vs abuse: abusive rest of body injuries
Inner aspects of arms Back and side of trunk, except directly over the bony spine Forearms when raised to protect self Chest and abdomen Any groin/ genital injury Inner aspects of thighs Soles of feet
Abusive injuries: remember concerns are raised of
Injuries to both sides of body Injuries to soft tissue Injuries with particular patterns Any injury that doesn't fit the explanation Delays in presentation Untreated injuries
Bruises suggestive of abuse
In non-mobile infants
Over soft tissue areas
Carry an imprint of an implement
Large, multiple and in clusters
Can you age bruises accurately?
No
Burns
Accidental scalds – spill injuries - irregular edge
Intentional scalds – immersion - glove or
stocking pattern
Accidental burns – child reaching to grab - palm of hand, often single
Intentional contact burns frequently multiple
Fractures
Multiple fractures are frequently seen in
abused children
May present at different stages of healing
E.g. skull fractures, rib fractures
Differential diagnosis
Birth marks Infections e.g. scabies, impetigo Unintentional injury Bleeding disorders Osteogenesis imperfecta
Differential diagnosis
Birth marks Infections e.g. scabies, impetigo Unintentional injury Bleeding disorders Osteogenesis imperfecta Leukaemia
Oral injuries
Accidental oral injuries are common
Lips are commonest site of oral injury in abuse
Any oral injury in a non-mobile baby is a
concern
Torn labial frenum can occur as a result of a blow to the face – either abusive or accidental
Sexual abuse definition
Forcing or enticing a child or young person to take
part in sexual activities, including prostitution,
whether or not the child is aware of what is happening
How to recognise sexual abuse
Direct allegation (disclosure) Sexually transmitted infection Pregnancy Emotional and behavioural signs e.g. anxiety and depression, self-harm, drug, solvent or alcohol abuse
Definition of neglect
Persistent failure to meet a child’s basic physical and/or
psychological needs, likely to result in the
serious impairment of
the child’s health or
development
Includes failing to ensure access to appropriate
medical care or
treatment
How to recognise neglect
Failure to thrive Short stature Inappropriate clothing Frequent injuries Ingrained dirt Developmental delay Withdrawn or attention seeking behaviour
Short term impact of neglect
Emotional health Social development Cognitive development Physical health
Long term impacts of neglect
Arrest Suicide attempts Depression Diabetes Heart disease
Neglect can kill - typical victim and scenario
Child under 1yr deprived of food and drink
Older child inadequately supervised
Impact of dental disease
Toothache Crying and stopping playing Disturbed sleep Difficulty eating or change in food preferences Absence from school Repeated antibiotics Dental general anaesthesia Lower body-weight, growth and quality of life Poor dental appearance Severe infection
Definition of dental neglect
The persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development
Assessment of dental neglect - features of particular concern
Obvious dental disease
Impact on child
Acceptable care has been offered, yet child is not receiving treatment
Vulnerable groups - parental risk factors
Young parents Single parents Mental health problems Parents with learning difficulties Alcohol and drug abuse
Vulnerable groups - social risk factors
Poverty Social isolation Poor housing Family housing Family violence Asylum seekers and refugees Homeless families
Vulnerable groups - child risk factors
Babies and toddlers - physical abuse/ neglect
Older chilren - sexual abuse
Children with disabilities
Children with behavioural problems
Children looked after in residential or foster care
Children missing from education
Toxic trio
Domestic violence
Mental health problems
Alcohol and substance abuse
Barriers to referral
Lack of certainty about diagnosis Dear of consequences to child from intervention Fear of violence to child Fear of violence to professional Lack of knowledge of referral procedures Fear of litigation
Agencies involved
Children’s Social Care/Children’s Services (social services) Criminal justice (police and probation) Health Education (early years, schools, further education) Voluntary sector organisations (e.g. NSPCC, faith communities)
Recognising - summary
Direct allegations Physical signs Pointers in the history Parent-child interaction The wider picture
CCDH was not brought protocol
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