Child Protection Flashcards
who is child safeguarding responsibility
All areas of medical practice (not just paediatrics)
All staff in the hospital
Students often have a special role
what does the children act in 1989 do
Defines abuse and neglect and states it is wrong to abuse or neglect a child or young person.
Defines a child as anyone until they reach their 18th birthday
Defines ‘Significant Harm’ as “ill treatment or the impairment of health or development…”
Defines ‘Significant Harm’ as the threshold for compulsory intervention in family life
who is a child
Defines a child as anyone until they reach their 18th birthday
what is significant harm
Defines ‘Significant Harm’ as “ill treatment or the impairment of health or development…”
what is the threshold for compulsory intervention in family life
Defines ‘Significant Harm’ as the threshold for compulsory intervention in family life
who are the two groups of children that are most likely to die at the hands of their carers
- vulnerable children and children in need
what is child protection
Child protection is the protection of children from violence, exploitation, abuse and neglect
what is safeguarding
Safeguarding refers to the process of protecting children (and adults) to provide safe and effective care
what is vulnerable children
A vulnerable child is defined as being under the age of 18 years and currently at high risk of lacking adequate care and protection.
what is children in need (CIN)
CIN Plan is drawn up following a Single Assessment which identifies the child as having complex needs and where a coordinated response is needed in order that the child’s needs can be met.
What is looked after children (LAC or CLA)
Children who are cared for on a voluntary basis are ‘accommodated’ by the local authority. Both these groups are said to be ‘looked after children’ (LAC) or children in care or ‘children looked after’ (CLA) by the local authority.
What are children with a child protection plan
Every local authority us required by law to provide child protection plans for children who need special protection because they are at risk of physical, emotional or sexual abuse or neglect
name some examples of vulnerable children
Disabled Chronic illness Looked after Children Known to CSC Private fostering Trafficked Children Lack of parental support and/or guidance Not in education Substance abuse
name some examples of vulnerable adults
- Drug and alcohol misuse
- Family violence (past & present) including abuse
- Homelessness, Poverty, Unemployment
- Non-compliance with professionals
- Physical & mental health issues
- Young & Lone parents
- Learning difficulties
what is the highest type of child abuse
- neglect at 41.9
- then emotional at 28.4
- multiple at 12.4
- physical at 12.2
- sexual at 5.1
when do children gain the right to consent
Children gain the automatic right to consent to medical treatment at the age of 16 years.
describe the rights of a child in regard to consent
- But cannot refuse lifesaving treatment below 18 years.
- Below 16 years, consent can be given either:
- By the child if they are Gillick competent
- By an adult with Parental Responsibility on behalf of the child.
Who can have parental responsibility
Family
- Child’s biological mother.
Child’s biological father, if:
- Parents are married at the time of the child’s birth.
- Father is named on the child’s birth certificate (after Dec 2003) – England & Wales only
- Father has applied for and been granted a parental responsibility order.
Other relatives (e.g. Grandparent) can also apply for a parenting responsibility order.
Who else can have parental responsibility
Local Authority
- If a child is subject to a Emergency Protection Order, Interim or Full Care Order then PR is shared with the family.
- Consent is normally obtained by agreement but if needed LA can apply for family to be over-ruled.
- If child is subject to Freeing Order then only LA has PR (until child is adopted)
Adoptive parents
what happens when carers and medical progression disagree
In a medical emergency:
- care should always be provided in the best interests of the child.
In a non-emergency but essential case:
- Consent is only required from a single parent.
- Care should proceed on that basis and is the responsibility of the disagreeing parent to seek judicial review if they choose.
In a completely elective case (e.g. cultural circumcision)
- Judicial review must be sought before proceeding with treatment.
If parents disagree with a Gillick competent child
- The child’s wishes should be respected (if the child is consenting to treatment) over the parents.
describe confidentiality and safeguarding to deal with children
- The primary duty of care is to the child, not to the parents
- The child’s right to protection over-rides the adult’s right to confidentiality
- The child’s needs must come first
- Reporting concerns is not ‘telling tales’ but upholding the rights of the child
what are the 4 categories of abuse
- physical
- emotional abuse
- neglect
- sexual abuse
What is physical absue
Hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child.
Physical harm may also be caused when a parent or carer feigns the symptoms of, or deliberately causes ill health to a child whom they are looking after. Known as fabricated or induced illness.
what are the risk factors for physical abuse
Unrelated adult male in the house
Single, young, unsupported parents
Mental health problems
Domestic violence
Drug and or alcohol Abuse
Previous parental police records
Disabled child
how does physical abuse show in babies
Bruising and fractures Suffocation Scalds & Burns Forced feeding Poisoning
how does physical abuse show in toddlers
Bruising and fractures
Biting
Scalds & Burns
Fabricated or Induced Illness
how does physical abuse show in school age kids
Bruising and fractures Wetting/Soiling Wearing clothes to cover up Non-attendance/Poor behavior Fabricated or Induced Illness
how does physical abuse show in adolescents
Bruising and fractures
Branding
when should you suspect physical abuse in children younger than 4
History fails to explain the injury
Vague history/ un-witnessed accident
History keeps changing
Not appropriate to child’s developmental level
Inappropriate delay in seeking medical help
Repeated attendance to A&E with injuries
when should you suspect physical abuse in older children
Disclosure of abuse – to teacher, trusted adult, doctor (May disclose to protect younger sibling)
When sibling is identified
Injuries spotted at school – eg in PE
what are the type of non accidental injuries
- head is the commonest site of bruising in child abuse
- other commonly buried sites in abuse include the ear, face, neck, trunk, buttocks and arms
- Bruises in child abuse commonly seen on soft parts of the body
- Bruising to the ear, neck, hand, right arm, chest and buttocks is predictive of abuse
- Abused children have significantly more bruising
- Petechiae with bruising more
- Clusters of bruises are common. These are often defensive injuries
- Abusive bruises often carry the imprint of the implement used
What is the neglect
Neglect is the 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.
Neglect may occur in ..
pregnancy
what can neglect include
Failure to provide adequate food, shelter and clothing
Failing to protect a child from physical harm or danger
Failure to provide adequate supervision
Failure to ensure access to appropriate medical assessment and treatment
Unresponsive to a child’s basic emotional needs
how does neglect present in babies
Poor Growth
Developmental Delay
Failure to attend routine health appointments e.g. vaccination
Severe nappy rash
how does neglect present in toddlers
Behavioral problems
Frequent visits to ED with accidents
Witnessed unacceptable care
Language delay
how does neglect present in school age
Left unattended Frequent visits to ED with accidents Behavioral problems Witnessed unacceptable care Poor school attendance/ performance
how does neglect present in adolescents
Alcohol / substance misuse
Mental health problems
Criminal activity
what is emotional abuse
Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development.
what can emotional abuse involve
It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person.
It may feature age or developmentally inappropriate expectations being imposed on children.
It may involve seeing or hearing the ill-treatment of another.
It may involve serious bullying (including cyber-bullying), causing children frequently to feel frightened or in danger
what are signs of emotional abuse in babies
Feeding difficulties
Demanding
Irritable
In control of mother
what are signs of emotional abuse in toddlers
Behavioral problems
Developmental delay
Poor growth
Short stature
what are signs of emotional abuse in school age
Wetting /soiling
Behavioral problems
Poor school attendance/ performance
what are signs of emotional abuse in adolescents
Depression Eating Disorders DSH Behavioral problems Acting in adult role (care for younger sibs/parents)
what is child sexual abuse
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
what can sexual abuse can include
Physical contact
Engaging children in looking at, or in the production of, pornographic material orwatching sexual activities, or encouraging children to behave in sexually inappropriate ways.’
Also involves grooming and Child Sexual Exploitation (CSE) & Female Genital Mutilation (FGM).
what are the signs of sexual abuse in babies
Vaginal bleeding
Rectal bleeding
Vaginal discharge
what are the signs of sexual abuse in school age
Sexualized behavior
Emotional /Behavioral problems
Disclosure
what are the signs of sexual abuse in toddlers
Emotional/ behavioural problems Masturbation Foreign body Enuresis / Encopresis Recurrent UTIs Vulvovaginitis
what are the signs of sexual abuse in adolescents
STI Pregnancy Alcohol / substance misuse Mental health problems Self-harm Disclosure
what Is the age of consent for sex
The age of consent is 16 for opposite sex and same sex relationships.
At what age can a child not conset for sex
A child under 13 does not under any circumstances have the legal capacity to consent to any form of sexual activity.
Sexual activity with a family member is …
an offence
what does a family member include when talking about sexual activity
Familial extends to more than blood relatives and relates to members of the household or to any person that has been in a position of trust or authority towards the child or young person.
what is an exploitative situation in child sexual exploitation
Exploitative situations, contexts and relationships where young people (or a third persons) receive ‘something’ (e.g.. Food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and or another or others performing on them sexual activities.
what does the explorer have power due to
Exploiter has power due to their age, gender, intellect, physical strength and or economic resources.
what are common aspects of an exploitive relationship
Violence, coercion and intimidation are common aspects of the relationship due young persons limited choices as a result of social/economic and emotional vulnerability.
what are signs of child sexual exploitation
Missing school
Much older boyfriend
Becoming disengaged from friends / family
Becoming secretive
Unexplained money, gifts, phones
Inappropriate sexualised behaviour
STD’s
Self harming
what is female genital mutilation
All procedures involving partial or total
removal of the female external genitalia or other injury to the female genital organs whether for cultural or other non-‐therapeutic reasons’
what are other issues in child safeguarding
- radicalisation
Gang crime & Child Criminal Exploitation (CCE)
Trafficking
Honour violence
Forced marriage
Refugee children
Private fostering
What is radicalisation
This is a process by which an individual or group comes to adopt increasingly extreme political, social, or religious ideals. Radicalization can be both violent and nonviolent.
Who do you need to talk to when raising concerns
Paediatric registrars Paediatric consultants Named doctor for child protection Named nurses Designated doctor & nurse for child protection
what needs to happen when raising concerns
Senior support
Safe environment
Non-confrontational approach
Full history, examination and investigation
Referrals to social services
Multi-disciplinary approach
how do you make a medical assessment on someone you suspect has been abused
Date, time, who was present (Chaperone)
Consent for examination
< 10 years age -‐ from someone with parental responsibility,
Older child check for Fraser competency
History from parent –medical, incident
History from child-‐ Q & A, VERBATIM
Weight , height, hygiene, interaction
“Top to Toe “exam ,
Document on body map –bruises/injuries,
Measure and clearly record injuries
what happens after the concern has been investigated
Safeguarding cases should always be discussed with a consultant before referral.
An immediate telephone referral is made to Children’s Social Care– State concerns clearly. Follow up in writing Make a written referral to social care
Parents are informed that this is being done – unless by doing so you place the child or your self at risk of harm.
Children are not discharged from hospital when there is suspicions s/he may have suffered harm unless agreed with the Consultant that it is safe to do so
Clear documentation is essential
Child will usually need to remain in hospital while investigations are carried out
May require an Emergency Protection Order or Police Protection Order to achieve this
Multi-agency strategy meeting to take place
Followed by multi-agency case conference to establish plans.
what is the role of a doctor in child protection
Complete a child protection report
Opinion-‐ Accidental/Non-‐accidental injury Maintain a holistic approach
Assess for other medical problems
Assess growth and development
Ensure siblings are assessed
Attend Strategy meeting
Contribute to Child Protection Conference
describe legal proceedings that can take place in child protection
Parental responsibility remains with the parents until it is removed by the court
The police can grant police protection orders to keep children safe for a short period while further investigations take place (72 hrs), but this does not grant PR.
Social workers can apply to the courts for longer term orders and to transfer responsibility to the courts.
