Child Protection Flashcards

1
Q

who is responsible for chid protection

A

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

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2
Q

GDC states on child protection

A

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

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3
Q

abused Vs non-abused dental care needs

A

bused children have higher levels of untreated dental disease than their non-abused peers

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4
Q

child is

A

Any person under 16 years

Any person under 18 if subject to a supervision requirement or looked after by the Local Authority

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5
Q

3 things that can make you concerned for child protection

A

Something you SEE

Something you HEAR

Something you’re TOLD

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6
Q

examples of things you could see that would be concerning

A

Injury

Mark

Bruise

Presentation – dirty, clothing

Parent behaviour – hostile, aggressive to you, staff, child

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7
Q

examples of things that you could hear that would be concerning

A

Parent interacts with child

- Common in waiting rooms

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8
Q

examples of things that you can be told that would be concerning

A

Third hand
- Not told directly

But if given cause for concern – minimum to seek advice for situation
- E.g. sexual abuse

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9
Q

4 pieces of legislative framework in place to protect children

A

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

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10
Q

3 parts to UN Convention on the Rights of the Child 1989

A

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

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11
Q

what does the age of legal capacity act entail for children

A

age which children can Enter legal commitments, give/refuse consent treatment
- scotland 16 (18 if under supervision requirement or looked after by LA)

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12
Q

what did the protection of children (scotland) act 2003 bring in

A

PVG - list individuals unsuitable to work with children

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13
Q

what is the CPR

A

children protection register

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14
Q

ratio for children on the CPR

A
  1. 0 children in every 1,000 children under 16 were on the CPR
    - Regional variation – 0.2 to 6.3 per 1000
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15
Q

2 ways a child can be harmed

A

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

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16
Q

what can result in significant harm

A

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:-

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17
Q

what elements must always be assessed when deciding whether a child appears at risk of significant harm (4)

A

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.

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18
Q

what can make a child vulnerable/at risk

A

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

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19
Q

are disabled children more or less likely to be neglected and/or abused

A

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

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20
Q

how can a professional recognise child neglect/abuse (6)

A

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

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21
Q

types of abuse (5+)

A

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

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22
Q

what are fabricated induced illnesses

A

Perplexing paediatric presentation

Symptoms – ill health, pain – no physical cause or diagnosis for this

23
Q

defintion of physical abuse

A

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

24
Q

how to recognise physical abuse

A

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

25
Q

if you spot head or neck injuries what do you require

A

strong history
- ask many Qs

especially under 5s

26
Q

prevalence of dental injury in physically abused children

A

1 in 4

27
Q

prevalence of dental injury in sexually abused children

A

1 in 6

28
Q

NAI

A

non accidental injury

29
Q

orofacial signs suggesting NAI (7)

A

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

30
Q

lip injuries common

A

Common in abuse-commonest recorded abusive injury to the mouth

31
Q

types of lip injuries

A

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

32
Q

what should you check for when see an upper lip frenulum injury

A

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

33
Q

6 check list questions you should go over in suspected child protection case

A

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

34
Q

5 observations you should make to ensure child protection is being upheld

A

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

35
Q

neglect defintion

A

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

36
Q

prevalence of neglect

A

almost half (43%) of cp plans/CPRs are due to ‘neglect’

37
Q

what is the lasting impact of neglect like?

A

Potentially the most damaging maltreatment
- its impact is far reaching and it is difficult to overcome-chronic and overlooked

co-exists with other abuse

38
Q

what age group suffers the most from neglect

A

adolescents

20% young adults experienced inadequate supervision as children including being out overnight and their parents not knowing their whereabouts

39
Q

dental neglect

A

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

40
Q

10 Qs to assess in a potential case of dental neglect

A

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?

41
Q

why is assessing the parent’s understanding of dental health important to assessing a potential dental neglect case

A

Do parents understand the importance of dental care and upkeep?

Need to explore
- Work with family - Have difficult conversation earlier to establish

42
Q

5 risk factors for neglect

A

Social and Environmental

Parental

Children

Harmful parent-child interactions and harmful carer behaviours

Unintentional?

43
Q

examples of child related factors for neglect (3)

A

pre-term/LBW babies

disability

age of child
- pre-school and adolescents most at risk

44
Q

examples of parent related factors for neglect (4)

A

substance misuse

learning disabilities

maternal ill-health

GBV

  • especially in combination. ‘toxic trio’
45
Q

examples of socio-economic related factors for neglect (3)

A

poverty
isolation
poor housing/living conditions

46
Q

5 things a dentist can spot in practice that could indicate neglect

A

Dental Neglect

General concern for child welfare

Failure to engage

Injuries –including repeat history of dental trauma

General behaviour/ concern re parents

47
Q

possible long term issues for neglected children (5)

A

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
48
Q

4 consequences of severe untreated dental disease in children

A

toothache

disturbed sleep

difficulty eating or change in food preferences

absence from school and interference with play and socialisation

49
Q

4 impacts to child of dental neglect on life and wider health

A

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

50
Q

if suspect child neglect what is the minimum a dentist must do

A

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.

51
Q

point of referring and recording child protection concern

A

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

52
Q

what is the role of social work enquires in child protection cases

A

Decide whether to respond under child protection procedures.

Discuss referrals with police.
- Joint investigation.

Receive child protection referrals

CP Case Conference

53
Q

process of child protection joint investigations

A

Case discussion/planning meeting

Investigative interview

Medical examination

Other interviews/information gathering

CP Case Conference

54
Q

what is a CP Notification of Concern

A

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…