Child Protection

Question 1

Shaken baby syndrome inflicted head injury NAI

Answer 1

Most common cause of death in Child abuse
High mortality and has severe neurological outcomes
See intracranial hemorrhages and retinal hemorrhages
No ext pathology
50% have # on full skeletal survey
Multiple rib and CML # classical
Nuclear bone scan may be helpful
Rpt the skeletal survey in 2 weeks see more lesions

Question 2

Red flags in Child abuse

Answer 2

1 delay in presentation
2 history
Does not explain the injuries
Changes with time
Inconsistent with the child’s developement ability
Suspicious sibling did it / tripped whilst carrying the infant
Resuscitation efforts caused the injuries

Question 3

Domestic violence effects children

Answer 3

Impacts on child’s physical and emotional wellbeing
Children born into DV home
Small for birthweight
Small or decreasing HC

Question 4

Child sexual abuse

Answer 4

1 in 4 women and 1 in 7 men report CSA

Only 10% ever reported it

Question 5

Child abuse presentation to gps

Don’t forget to screen for DV

Answer 5

A medical problem or somatisation
2 behavior problems poor concentration toileting issues
3 numerous minor injuries /accidents

Question 6

Abuse disclosed

Answer 6

Believe them 
Listen to the story 
Remain calm
Adults sometimes to the wrong thing
Report 
I know other children this has happened to

Question 7

Bruising is the most common observed injury in child abuse cases

Answer 7

True 90% have them 
Clue to other injuries eg #
Distribution of bruising not definite suggestive 
Not on lower legs and on the T of the face normal 
Types of bruising 
Imprint from the object 
Tram line bruising 
Bite marks 
Finger tip bruising

Question 8

Sites of bruises rare except CA

Answer 8

Sites ears eyes cheeks and genitalia and neck
Other sites more likely in CA
Abdomen buttocks

Question 9

Burns 86% accidental 8% CA

Answer 9

Sites usually bilaterally and buttocks/ perinuem
Dorsum of thehand
Do a full skeletal X-ray other injuries 33% in one study had healing #

Question 10

Fractures in child abuse

Answer 10

Younger child more likely to have shaken baby syndrome
Metaphysical Fractures Corner # no bruising overlying it rare in falls likely twisting /shaking = shaken baby syndrome
Rib fractures Don’t happen in CPR
Spinous process
Sternum Fractures

Question 11

Dd for Fractures in child abuse

Answer 11

Subperiosteal
OI
Ricketts

Question 12

Child neglect most common of all Child abuse 26%

Answer 12

Morbidity effects physical health , cognitive
Social and emotional health

Mortality
Drowning and fires house lack of supervision
Medical neglect

Question 13

Traumatic brain injury

Answer 13

Most common cause of death in CA
Associated with shaken baby syndrome 
Subdural subarchnoid hemorrhage and intracranial trauma 
See retinal haemorrhages 
Other fractures ribs skull CML