Child Protection

Question 1

What are the different types of child abuse?

Answer 1

Physical injury
Neglect
Sexual abuse
Emotional abuse

Question 2

What is the process of the ‘forensic medical’?

Answer 2

Referral
Interagency referral discussion (IRD)
Examination if indicated
Investigations/photography if indicated
Forensic report

Question 3

Who is involved in the interagency referral discussion (IRD)?

Answer 3

Police
Social work/education
Health

Question 4

Who carries out the examination in a case of suspected child abuse?

Answer 4

Paediatrician (either child protection paediatrician on call or general paediatrician)
AND forensic medical examiner

Question 5

Which factors are indicators of risk of child abuse?

Answer 5

Domestic abuse
Parental alcohol or drug misuse
Mental health problems
Disability
Non-engaging families
Harmful or problematic sexual behaviour

Question 6

If you think a child is at risk of harm, what should you do?

Answer 6

Discuss with a senior colleague and/or the Child Protection Team

Question 7

What is “factitious/induced illness”?

Answer 7

Form of abuse –> parent or caregiver fabricates/induces illness in the child

Previously known as –> Munchausen Syndrome by proxy

Question 8

What are the features of accidental injuries?

Answer 8

Involve bony prominences
Match the history
Are in keeping with the development of the child

Question 9

Which features would raise concerns about NAI?

Answer 9

Injury to both sides of the body
Injuries to soft tissue
Injuries with particular patterns
Any injury that doesn't fit the explanation
Delays in presentation
Untreated injuries

Question 10

When considering NAI for a bruise, which 4 things should you think about?

Answer 10

Mobility of child
Area
Type of mark
Explanation

Question 11

How would mobility of child affect accidental vs NAI bruises?

Answer 11

Accidental bruises are common in walking children

Bruising in baby not yet crawling –> red flag for NAI

Question 12

Which areas of the body do accidental bruises commonly occur?

Answer 12

Knees, shins + elbows
Foreheads in infants who can pull to stand
Bony prominences

Question 13

Bruises in which areas should raise suspicion of NAI?

Answer 13

Soft parts of body:
- upper arm, inner or outer aspect of thigh, buttocks, lower back, trunk
External ear
Neck
Eyes
Intra-oral
Triangle of safety = ears, side of face, neck, top of shoulders

Question 14

How might the type of mark differ between accidental + non-accidental bruises?

Answer 14

Accidental: edges not clearly defined
NAI: implement/cord mark, slap mark

Question 15

How might the explanation differ between accidental + NAI?

Answer 15

Accidental: bruise pattern fits explanation given
NAI: pattern of bruising does not fit explanation given

Question 16

Which features of a fracture would make you suspicious of NAI?

Answer 16

Non mobile child
Multiple fractures
Fractures of different ages
Fracture of: ribs, vertebrae, hands + feet, pelvis, scapula, clavicle

Question 17

Which specific fractures should raise suspicion of NAI?

Answer 17

Spiral fracture humerus –> twisting
Metaphyseal fractures –> pulling or swinging injury
C spine fractures –> shaking
Skull fractures in a fall less than 3 feet, or with associated intracranial injury –> esp if occipital/depressed fracture