child protection and NAI Flashcards
how common is child protection
- ~39 000 babies <1y/o will have a parent who has experienced domestic violence in the last year
- 109 000 babies <1y/o have a parent who is a hazardous drinker or user of class A drugs
- 14% of mothers suffer PND
- at least 1 child dies every week from cruelty
what is the toxic triad
- parent w/ mental health problem
- domestic violence
- substance misuse
these 3 factors together significantly increase the risk of a child coming to harm
legislative protection
- UN rights of the child - all children have a right to be protected from harm and live a life free from abuse and neglect
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scottish legislation
- children (scotland) act 1995
- children and young people (scotland) act 2014
- named person was to be a point of contact for all agencies to refer to when there is a concern about a child
- from birth to school attendance - health visitor
- school age - head teacher
- equal protection from assault (scotland) 2019
what is physical abuse
- to harm/hurt a child/young person on purpose in any way
- includes: slapping and punching, kicking, shaking, throwing, poisoning, burning and scalding, biting and scratching, breaking bones, drowning
alarm bells in presentation that may indicate intentional harm to a child
- late presentation
- hx changes on repeating (big changes that are no longer plausible)
- hx inconsistent w/ finding
what might indicate a hx that is inconsistent w/ findings
- know what is normal and what isn’t
- growth
- development
- common presentations of common problems, injuries and illnesses
- common presentations of NAI
common sites for accidental injury
common sites for non-accidental injury
things to think about w/ bruising in children
- any bruise in non-mobile infant (<4mths)
- petechiae - can occur in sepsis but also high force and blunt force trauma
- clusters
- pattern of bruising - e.g linear, specific shapes
- extensive injuries w/ no explanation
- injury not consistent w/ hx or developmental level
- location of bruise
types of thermal injuries
burns - dry heat
scalds - hot liquid
concerning patterns of burns
sharply demarcated lines rather than splash marks - indicated held in hot water rather than fell in
palmar sparing/burns down chest can indicate child grabbed pot/hot liquid in container and spilt in down themselves
linear lines and patterned burns are concerning
impetigo vs cigarette burns
both circular
burns often infected
look for distribution
look for burnt hair
stages of healing
fractures in children
- ⅓ sustain fracture <16yrs
- most unintentional
- most in <18mths
- consider mechanism, age, developmental status
why are rib fractures concerning in children
very difficult to break ribs in children - very bendy and compliant
requires high force injury, unlikely to be accidental
spiral fractures in children
concerning
indicate twisting motion - is it consistent w/ hx of injury
callus formation on x-ray - why is this concerning
injury is at least a 5-10 days old
late presentation
consider NAI
abusive head trauma
- commonest cause of death in physical abuse
- predominantly <2y/o
- mortality up to 30%
- ½ have residual disability
- presentation variable
- retinal haemorrhages seen in 80%
- neck and cervical spine injury
injuries resulting from shaking a baby (shaken baby syndrome) - check this on recording
brain injury - haemorrhage and haematoma
rib and limb fractures
growth plate fractures?
what is neglect
- ongoing failure to meet a child’s basic need
- most common form of child abuse
- child may be left hungry or dirty, w/o proper clothing, shelter, supervision or health care
- can put children/young people in danger
- can also have long term effects on physical and mental wellbeing
categories of neglect
emotional
abandonment
medical
nutritional/FTT - 5% of all chiildren have FTT, of whom 5% are also abused and neglected; 1% of all children are abused and neglected, of whom 25% also have FTT
educational
physical
failure to provide supervision
emotional abuse and other types of abuse
- encompasses all other forms of abuse - physical and NAI, FTT, sexual abuse
- can’t have these w/o emotional abuse becoming a component
what is emotional abuse
- any type of abuse that involves the continual emotional mistreatment of a child
- aka psychological abuse
- can involve deliberately trying to scare, humiliate, isolate or ignore a child
recognising emotional abuse
- recognition of concerning behaviours
- includes behavioural/developmental difficulties, wary or anxious child, placid non-demanding baby, self-harm in teenagers etc
- noting down observed harmful caregiver-child interactions
what is sexual abuse
- when a child/young person is sexually abused, they’re forced or tricked into sexual activities
- they may not understanding that what’s happening is abuse or that it’s wrong, may be afraid to tell someone
- can happen in person or online
- can be contact or non-contact abuse
