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Y3 paediatrics > child protection and NAI > Flashcards

child protection and NAI Flashcards

1
Q

how common is child protection

A
  • ~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
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2
Q

what is the toxic triad

A
  • parent w/ mental health problem
  • domestic violence
  • substance misuse

these 3 factors together significantly increase the risk of a child coming to harm

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3
Q

legislative protection

A
  • UN rights of the child - all children have a right to be protected from harm and live a life free from abuse and neglect
  • 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
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4
Q

what is physical abuse

A
  • 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
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5
Q

alarm bells in presentation that may indicate intentional harm to a child

A
  • late presentation
  • hx changes on repeating (big changes that are no longer plausible)
  • hx inconsistent w/ finding
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6
Q

what might indicate a hx that is inconsistent w/ findings

A
  • know what is normal and what isn’t
    • growth
    • development
    • common presentations of common problems, injuries and illnesses
    • common presentations of NAI
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7
Q

common sites for accidental injury

A
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8
Q

common sites for non-accidental injury

A
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9
Q

things to think about w/ bruising in children

A
  • 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
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10
Q

types of thermal injuries

A

burns - dry heat

scalds - hot liquid

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11
Q

concerning patterns of burns

A

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

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12
Q

impetigo vs cigarette burns

A

both circular

burns often infected

look for distribution

look for burnt hair

stages of healing

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13
Q

fractures in children

A
  • ⅓ sustain fracture <16yrs
  • most unintentional
  • most in <18mths
  • consider mechanism, age, developmental status
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14
Q

why are rib fractures concerning in children

A

very difficult to break ribs in children - very bendy and compliant

requires high force injury, unlikely to be accidental

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15
Q

spiral fractures in children

A

concerning

indicate twisting motion - is it consistent w/ hx of injury

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16
Q

callus formation on x-ray - why is this concerning

A

injury is at least a 5-10 days old

late presentation

consider NAI

17
Q

abusive head trauma

A
  • 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
18
Q

injuries resulting from shaking a baby (shaken baby syndrome) - check this on recording

A

brain injury - haemorrhage and haematoma

rib and limb fractures

growth plate fractures?

19
Q

what is neglect

A
  • 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
20
Q

categories of neglect

A

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

21
Q

emotional abuse and other types of abuse

A
  • encompasses all other forms of abuse - physical and NAI, FTT, sexual abuse
    • can’t have these w/o emotional abuse becoming a component
22
Q

what is emotional abuse

A
  • 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
23
Q

recognising emotional abuse

A
  • 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
24
Q

what is sexual abuse

A
  • 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
25
Q

what is contact abuse

A
  • sexual touching of any part of a child’s body, whether they’re clothed or not
  • using a body part or object to rape or penetrate a child
  • forcing a child to take part in sexual activities
  • making a child undress or touch someone else
  • can including touching, kissing and oral sex
26
Q

what is non-contact abuse

A
  • can be in person or online
  • exposing or flashing
  • showing pornography
  • exposing a child to sexual acts
  • making them masturbate
  • forcing a child to make/view/share child abuse images or videos
  • making/viewing/distributing child abuse images/videos
  • forcing a child to take part in sexual activities or conversations online or through a smartphone
27
Q

indicators of sexual abuse

A
  • disclosure - always believe the child, never make a promise not to tell anyone else
  • sexualised behaviour
  • STI
  • pregnancy
28
Q

forensic examination in child sexual abuse

A
  • interview - video recorded, highly trained social worker and police officer; do not repeat interview when examining the child
  • joint paediatrician and forensic medical examiner
  • video colposcope - external inspection of sphincter, genitalia and hymen, no internal examination
  • general physical examination
  • developmental assessment
29
Q

what is FII

A
  • fabricated or induced illness
  • fabrication - making up the symptoms of an illness
  • induction - causing a child to become unwell
30
Q

how common is FII

A
  • rare form of child abuse, likely underestimated in prevalence studies
  • spectrum of behaviour - slightly exaggerate symptoms in order to receive medical attention → inducing illness in the child
  • 90% mother, motivation unclear
  • multi-agency issue, GP must be involved if FII suspected
31
Q

what to do when there is a concern of child abuse

A
  • hx
  • examine the child
  • joint examination w/ forensic examiner if forensic evidence requried
  • clinical investigations if needed

→ reach a preliminary opinion

→ consult w/ other agencies

→ give a revised opinion if needed

32
Q

bigger picture and involvement of social work

A
  • detection of child abuse and neglect requires a jigsaw of shared information from multiple individuals
  • social services must be informed when there are grounds for concern that a child is being at risk of being abused/neglected
  • anyone can make a referral to social work
33
Q

what happens after a referral has been made to police/social work

A
  • response depends on the level or risk/harm identified
  • initial assessment made to gather info and understand the risks to the child
  • can include: joint visit (health visitor, social work, police); child protection case conference; immediate place of safety (CPO); children’s panel may need compulsory measures of supervision; looked after child (accommodated or at home w/ additional safety measures)

Y3 paediatrics (45 decks)

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