Child Protection Flashcards
who is responsible for chid protection
everyone
shared responsibility
- The responsibility of every member of the dental team
Everyone in health board has a responsibility of looking out for vulnerable child
Team work – communication, all staff need to know what to do
GDC states on child protection
all members of the dental team “must raise any concerns you may have about the possible abuse or neglect of children” and “must know who to contact for further advice and how to refer concerns to an appropriate authority”
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 or vulnerable adult might be at risk because of abuse or neglect.
Mirrors GMC
abused Vs non-abused dental care needs
bused children have higher levels of untreated dental disease than their non-abused peers
child is
Any person under 16 years
Any person under 18 if subject to a supervision requirement or looked after by the Local Authority
3 things that can make you concerned for child protection
Something you SEE
Something you HEAR
Something you’re TOLD
examples of things you could see that would be concerning
Injury
Mark
Bruise
Presentation – dirty, clothing
Parent behaviour – hostile, aggressive to you, staff, child
examples of things that you could hear that would be concerning
Parent interacts with child
- Common in waiting rooms
examples of things that you can be told that would be concerning
Third hand
- Not told directly
But if given cause for concern – minimum to seek advice for situation
- E.g. sexual abuse
4 pieces of legislative framework in place to protect children
UN Convention on the Rights of the Child 1989
Age of Legal Capacity Act 1991
The Children (scotland) Act 1995
Protection of Children (scotland) act 1995
3 parts to UN Convention on the Rights of the Child 1989
Protection
- From abuse, neglect and exploitation
Provision
- Of services to promote child’s survival and development
Participation
- In matters which affect the child, express views, be heard
what does the age of legal capacity act entail for children
age which children can Enter legal commitments, give/refuse consent treatment
- scotland 16 (18 if under supervision requirement or looked after by LA)
what did the protection of children (scotland) act 2003 bring in
PVG - list individuals unsuitable to work with children
what is the CPR
children protection register
ratio for children on the CPR
- 0 children in every 1,000 children under 16 were on the CPR
- Regional variation – 0.2 to 6.3 per 1000
2 ways a child can be harmed
child may be harmed
by an action such as violence or a sexual attack or mental cruelty or physical attack, including poisoning or suffocation
or
through a failure to act – for example through a parent/carer not feeding a child or neglecting a child in other ways, including emotionally or through the child not being given appropriate health care
what can result in significant harm
Significant harm can be as a result of a ‘one off’ incident, a series of ‘minor’ incidents or as a result of an accumulation of concerns over a period of time.
Complex (subject to professional judgement based of the assessment of child and family circumstances)
Certain elements must always be assessed when deciding whether a child appears at risk of significant harm:-
what elements must always be assessed when deciding whether a child appears at risk of significant harm (4)
Seriousness of the concerns, actual or potential.
Level of risk to future safety, development & welfare of child.
Level of professional confidence that either abuse has occurred, is likely to re- occur or that the child is at risk of abuse
The most effective form of intervention to address the needs of the child.
what can make a child vulnerable/at risk
Do not have basic needs met
Parental issues – mental health, substance misuse, neglect, domestic violence, criminal activity, resistance to professional intervention, unrealistic expectations
Environmental issues- socio-economic problems, poverty unemployment, social isolation, exploitation, frequent changes of address, male in the household not biology father
are disabled children more or less likely to be neglected and/or abused
Children with disability are 3 times more likely to be neglected or abused
Delay in staff seeking help
Level of care perceived to be less – should not be
how can a professional recognise child neglect/abuse (6)
Direct disclosure
Physical harm/abuse
-Orofacial trauma occurs in at least 50% of children diagnosed with physical abuse
Neglect
-Failure to attend appointments when the child is experiencing pain or discomfort, or failure to adhere to a recommended treatment plan should prompt a full investigation of the explanation for this
Failure to engage/was not brought/disguised compliance
Harmful parent child interactions
Harmful parental behaviours
types of abuse (5+)
Physical injury
Neglect
Sexual abuse/child sexual exploitation/non-recent sexual abuse
Emotional abuse
FII – Fabricated Induced Illnesses
FGM, trafficking, forced marriage, fabricated or induced illness and exploitation
what are fabricated induced illnesses
Perplexing paediatric presentation
Symptoms – ill health, pain – no physical cause or diagnosis for this
defintion of physical abuse
may involve hitting, shaking, throwing, biting, 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 fractures, intra-oral injuries
site, size, patterns
delay in presentation
does not fit the explanation given
if you spot head or neck injuries what do you require
strong history
- ask many Qs
especially under 5s
prevalence of dental injury in physically abused children
1 in 4
prevalence of dental injury in sexually abused children
1 in 6
NAI
non accidental injury
orofacial signs suggesting NAI (7)
Intra/extra oral bruising
Pinch marks/bruising to ears
Bites/Burns
Head/facial injuries particularly in non ambulant
Injury out with bony prominences associated with accidental injuries
Teeth displaced or broken
May complain of pain or difficultly eating
lip injuries common
Common in abuse-commonest recorded abusive injury to the mouth
types of lip injuries
Contusions, lacerations, abrasions, burns -to lips, roof of mouth, tongue and lingual frenum (under tongue).
Blunt force traps lip between teeth and object e.g.. fist
Injury often mainly visible on under side
Burns: hot food, utensils, cigarettes
what should you check for when see an upper lip frenulum injury
Associated with abuse
Check for recent and healed tears
Usual history of falling
- so Pre-mobile infants – usually abuse
Direct blow or force feeding
Alone or with other injuries
Toddler fall may be accidental
6 check list questions you should go over in suspected child protection case
Could the injury have been caused accidentally and if so how?
Does the explanation for the injury fit the age and the clinical findings?
If the explanation is consistent with the injury, is this itself within normally acceptable limits of behaviour?
If there has been delay in seeking advice, are there good reasons for this?
Refusal to allow proper treatment or hospital admission
Unprovoked aggression towards staff
5 observations you should make to ensure child protection is being upheld
The general demeanour of the child
The nature of the relationship between guardian and child
The child’s reactions to other people
The reaction of the child to any medical or dental examination
Any comments by the child and or guardian that give concern about the child’s upbringing or lifestyle
neglect defintion
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
prevalence of neglect
almost half (43%) of cp plans/CPRs are due to ‘neglect’
what is the lasting impact of neglect like?
Potentially the most damaging maltreatment
- its impact is far reaching and it is difficult to overcome-chronic and overlooked
co-exists with other abuse
what age group suffers the most from neglect
adolescents
20% young adults experienced inadequate supervision as children including being out overnight and their parents not knowing their whereabouts
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
10 Qs to assess in a potential case of dental neglect
How severe is the condition?
What is the impact of dental disease on the child?
Has treatment been sought?
What is the parent’s understanding?
What is the child’s general state?
What is the child’s diet?
Has the child failed to thrive?
Are they underweight for age?
What other information do you need to make a decision?
What records would you make of your observations and decisions?
why is assessing the parent’s understanding of dental health important to assessing a potential dental neglect case
Do parents understand the importance of dental care and upkeep?
Need to explore
- Work with family - Have difficult conversation earlier to establish
5 risk factors for neglect
Social and Environmental
Parental
Children
Harmful parent-child interactions and harmful carer behaviours
Unintentional?
examples of child related factors for neglect (3)
pre-term/LBW babies
disability
age of child
- pre-school and adolescents most at risk
examples of parent related factors for neglect (4)
substance misuse
learning disabilities
maternal ill-health
GBV
- especially in combination. ‘toxic trio’
examples of socio-economic related factors for neglect (3)
poverty
isolation
poor housing/living conditions
5 things a dentist can spot in practice that could indicate neglect
Dental Neglect
General concern for child welfare
Failure to engage
Injuries –including repeat history of dental trauma
General behaviour/ concern re parents
possible long term issues for neglected children (5)
have some of the poorest long term health and developmental outcomes
are at high risk of accidents
are vulnerable to sexual abuse
are likely to have insecure attachment patterns
are less likely than other children to:
- develop the characteristics associated with resilience
- or have access to wider protective factors
4 consequences of severe untreated dental disease in children
toothache
disturbed sleep
difficulty eating or change in food preferences
absence from school and interference with play and socialisation
4 impacts to child of dental neglect on life and wider health
being teased because of poor dental appearance
needing repeated antibiotics
repeated exposure to the morbidity associated with general anaesthesia
severe acute infection which can cause life-threatening systemic illness.
untreated caries in pre-school children is associated with lower body-weight, growth and quality of life
if suspect child neglect what is the minimum a dentist must do
Write down what you have seen, heard or been told using the exact words.
Report the incident to your line manager as soon as possible.
If you have serious concerns about the child’s immediate safety then you should contact the Police.
DOING NOTHING IS NOT AN OPTION.
point of referring and recording child protection concern
Discuss immediately with senior if available
Notification of concern (NOC)
Duty SW (social work)
- Advice and support
- Role of wider health team
Recording of concerns and actions
Outcome from NOC
Dissent form decision made- seek advice
what is the role of social work enquires in child protection cases
Decide whether to respond under child protection procedures.
Discuss referrals with police.
- Joint investigation.
Receive child protection referrals
CP Case Conference
process of child protection joint investigations
Case discussion/planning meeting
Investigative interview
Medical examination
Other interviews/information gathering
CP Case Conference
what is a CP Notification of Concern
Initial referral via telephone
Use NOC to follow up referral by 48 hrs
Copy in child’s record, copy to SW and one to CPS
Moving towards using SCI gateway…
