Child Protection Flashcards
What are the different types of child abuse that can be inflicted?
- Emotional abuse
- Physical abuse
- Sexual abuse
- Neglect
- Fabricated and induced illness
What is a section 47 investigation?
Joint investigation carried out by both police and social services
What is a section 46?
- Police protection order - most immediate form of protection, no need for reference to court.
- Lasts 72 hours
- Still need consent from parents for medical examination
What is a section 44?
- Emergency protection order - social worker must apply to the court
- Lasts 7 days
- Social worker can gain parental responsibility when necessary
What factors may increase suspicion of physical abuse?
- Inappropriate delay in presenting
- History does not match the bruising seen
- Injury not in keeping with child development
- Inconsistent history
- Multiple visits to different EDs
- Parents unconcerned
Where is intentional bruising normally seen?
- Cheeks
- Ears
- Trunk
- Arms
- Hands and feet
- Posterior thigh
What differentials need to be ruled out in investigation of physical abuse?
- Bleeding disorders - need to do clotting profile
- Accidental trauma
- Non-pathological bruising e.g. bruising from scratching
What is an immersion injury?
Child is immersed in scalding hot water as punishment.
How can intentional and unintentional thermal injuries be distinguished?
Intentional thermal injury:
- Symmetrical
- Clear margins
- Equal depth
Unintentional thermal injury:
- Typically affect upper body
- Irregular margins
- Irregular depth
Differences between intentional and unintentional head trauma…
Unintentional:
- Single
- Linear
- Parietal
- No intracranial haemorrhage
Intentional:
- Complex, bilateral
- Spread across suture lines
- Occipital mainly
- Associated subdural haemorrhage
What is the main cause of multifocal subdural haemorrhage, and how may they present?
Vigorous shaking can lead to tearing of the the bridging veins, leading to hypoxic-ischaemic injury and retinal haemorrhage.
May present in acute encephalopathy - apnoea and seizures
What are the most likely sites of fracture?
- Rib - especially posterior
- Metaphyseal fracture = highly specific for NAI
- Scapular
- Sternal
- Pelvic
What is the definition of neglect?
Persistent failure of individual with parental responsibility to meet the physical and/or psychological needs of their child
When should neglect be suspected
- Unkempt, unwashed
- Skin infections
- Faltered growth
- Malnourished
- Frequent non-attenders for routine health appointments
- Dental caries
What are the different forms of emotional abuse?
- Negativity, hostility, rejection
- Emotional unavailability for the child’s needs
- Exposure to frightening scenarios
