Child protection Flashcards
What is child protection?
Activity undertaken to protect specific children who are suffering or at risk of suffering significant harm
What are the aims of measures taken to safe guarding children? - trying to minimise the risk of harm to children
Protect children from maltreatment
Preventing impairment of children’s health or development
Ensuring that children are growing up in a safe and caring environment
What does the law say about children’s rights?
Article 19:
Children should be protected from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation
Article 24:
Children have a right to enjoyment of the highest attainable standard of health and to facilities for treatment of illness and rehabilitation of health
Why are dentists well placed to recognise signs?
Skilled at examining the head and neck and recording findings
Head and neck are frequent site of injury in physical abuse
untreated dental decay may be a sign of neglect
Children often attend regularly
Often treat more than one family member
what are the different forms of physical abuse?
May involve hitting, shaking, throwing, poisoning burning or scalding, drowning, suffocating
Includes fabricated and induced illness
How do you recognise child physical abuse?
Bruising, abrasions, lacerations, burns bite marks, eye injuries, bone fractures, intra-oral injuries
Site, size, patterns
Delay in presentation - delayed care for a bit
Does not fit the explanation given
Which bruises are suggestive of abuse?
In non-mobile infants
Over soft-tissue areas
Carry an imprint of an implement
Large, multiple in clusters
What are the different patterns of accidental, intentional burns?
Accidental scalds - spill injuries - irregullar edge
or child reaching to grab - palm of hand
Intentional scalds - immersion - glove or stocking pattern
Are fractures a sign of abuse?
Fractures frequently seen in abused children
May present at different stages of healing
what medical conditions may be misdiagnosed as a child being at risk?
Birth marks Infections - scabies impetigo unintentional injury Bleeding disorders Leukaemia Osteogenesis imperfecta
Which oral injuries do you need to look out for?
Accidental are common
Lips most common 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 blow to face - abusive or accidental
What are the different types of abuse?
Physical
Sexual
emotional
Neglect
What is sexual abuse?
Forcing or enticing a child or young person to take part in sexual activites; including prostitution, whether or not the child is aware of what is happening
How do you recognise sexual abuse?
Direct allegation
STI
Pregnancy
Emotional and behavioural signs e.g. anxiety and depression, self-harm, drug, solvent, alcohol abuse
What is emotional abuse?
Persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development
How do you recognise emotional abuse?
Poor growth Developmental delay Educational failure Social immaturity Aggression or indiscriminate friendliness Challenging behaviour Attention difficulties Concerning parent-child interaction
What is neglect?
the persistent failure to meet a childs basic physical and/or psychological needs, likely to result in serious impairment of the child’s health or development
Includes failing to ensure access to appropriate medical care or treatment
how do you recognise neglect?
Failure to thrive Short stature inappropriate clothing Frequent injuries Ingrained dirt Developmental delay Withdrawn or attention seeking behaviour An underdeveloped child that starts to grow when placed in care
What is the short-term impact of neglect?
Emotional health
Social development
Cognitive development
Physical health
What is the long-term impact of neglect?
Arrest Suicide attempts Depression Diabetes Heart disease
How can neglect kill?
child under 1 deprived of food and drink
Older child inadequately supervised
What is the impact of dental disease
Toothache crying and not playing Disturbed sleep difficulty eating or change in food preferences absence from school Repeated antibiotics Dental GA Lower body-weight, growth and quality of life Poor dental appearance Severe infection
What are features of particular concern when doing a dental assessment?
Obvious dental disease
impact on child
Acceptable care has been offered, yet child recieving no treatment
What is dental neglect?
The persistent failure to meet a childs basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development
What are the parental risk factors for the vulnerable group/
Young parents Single parents Mental health problems Parents with learning difficulties Alcohol and drug abuse
What are the social risk factors for the vulnerable group?
Poverty Social isolation poor housing family violence Asylum seekers and refugees Homeless families
What are the children risk factors for the vulnerable group?
Babies and toddlers- physical abuse/neglect
Older children - sexual abuse
Children with disabilities
Children with behavioural problems
Children looked after in residential or foster care
children missing from education
What is the toxic trio?
Domestic violence
Mental health problems
Alcohol and substance abuse
What are the key ways to regocnise abuse?
Direct allegations Physical signs Pointers in history parent-child interaction the wider picture
Barriers to dentist referral to get help?
Lack of certainty about diagnosis Fear of consequences to the child from intervention Fear of violence to the child Fear of violence to the professional Lack of knowledge of referral procedures Fear of litigation
Where do you go for help if think patient being abused?
LSCB/ACPC procedures Experienced dental colleague Consultant paediatrics Child proteciton nurse Social services Childs heakth visitor, GP
After got help and still have concerns, what do now?
Provide the urgent dental care to the chils
Talk to child and parents and explain concerns
Inform your intention to refer, need to seek consent to sharing information unless puts child at immediate risk
Refer for medical examination
Keep clinical records
What do you do after immediate action if have concerns?
Refer to children’s services
By telephone
Follow up in writing within 48 hours
Children’s services acknowledge receipt of referral, decide on next course of action withing one working day and feedback to you
What further action can be done later on ?
Confirm that referral has been received and acted upon
arrange dental follow up as indicated
Be prepared to write case report for case conference if requested
Talk your experiences through with a trusted colleague or seek counselling if needed
What do you do if no longer have concerns
No further child protection action
Other action needed:
Provide necessary dental care keep full clinical records
Provide information/referral to local support services for children
Arrange dental follow up
What are the 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
What do you do if have a new patient DNA and and on child protection plan
Contact social worker and document agreed action
What do you do if have a new patient DNA and has history of child protection plan?
Clinician to judge whether to contact through safeguarding net or discharge to referrer with copy to GP
What do you do if have a new patient DNA and no record of child protection plan?
Discharge to referrer with copy to GMP
If patient DNA follow-up appointment and under child protection plan or history of child protection plan what needs to happen?
CPP - contact social worker by copying appointment letter and document action
if HCPP - refer to paediatric liasion nurse - for support in contacting patients
What are 6 tips for good practice?
- Identify a member of staff to take the lead on child protection
- Adopt a child protection policy
- Work out a step-by-step guide of what to do if have concerns
- Follow best practice in record keeping
- Undertake regular team training
- Practice safe staff recruitment
