Child Protection and NAI Flashcards
What legislation is there surrounding child protection?
- Untied nation rights of the child
- Children (Scotland) Act 1995
- Children and Young people (Scotland) Act 2014
- Named person
In what way may the public be aware of cases of child abuse?
- See and hear aspects of child care that cause concern
- Social media
- Volunteering
In what way are we obligated through our professional duty to protect children?
- GMC
- Contract
- Public role to protect and prevent from
Who’s responsibility is it to safeguard children?
Everyone’s responsibility
What duty to all children have?
All doctors have a duty to act upon any concerns they have about the safety or welfare of a child or young person
What happens after a referral has been made to police or social work?
After a referral is made the response depends on the level of risk or harm identified. An initial assessment will be made to gather information and understand the risks to the child
What could be included in an initial assessment of a child referred to the police or social work?
- Joint Visit health , social work, police
- Child Protection Case Conference
- Immediate place of safety- Child Protection Order
- Children’s Panel may need compulsory measures of supervision
- Looked after Child -Accommodated or at home
Who must ALWAYs be informed if a child is at risk?
Social services
What are the categories of abuse?
- Physical abuse
- Sexual abuse
- Emotional abuse
- Fabricated and induced illness
- Neglect
What are the alarm bells for the presentation of physical abuse?
- Late presentation
- History changes on repeating
- History inconsistent with findings
How do you identify a history that is inconsistent with findings?
Know what is normal and what is not
- Growth
- Development
- Common presentations of common problems, injuries and illnesses
- Common presentation of NAI
What types of thermal injury can children sustain?
- Burns by dry heat
- Scalds by hot liquid
What patterns of burns/scalds suggest NAI?
Burns with spared areas
How can you distinguish cigarette burns from impetigo?
- Both circular
- Burns often infected
- Look for distribution
- Look for burnt hair
- Healing
- Patches of impetigo tend to vary in size
What distinguishes accidental from NA fractures?
- Mechanism (spiral suggests NAI)
- Age
- Developmental status
What is the commonest cause of death in physical abuse?
Abusive head trauma
What are the features of abusive head trauma?
- Predominantly < 2 years of age.
- Mortality upto 30%
- Half have residual disability
- Presentation variable
- Retinal haemorrhages seen in 80%
- Neck and cervical spine injury
What are the categories of neglect?
- Emotional
- Abandonment
- Medical
- Nutritional/FTT
- Educational
- Physical
- Failure to provide supervision
What are the indicators for sexual abuse?
- Disclosure
- Sexualised behaviour
- STI
- Pregnancy
What is involved in a CSA/forensic examination?
- Joint Paediatrician/Forensic Medical Examiner
- Do not repeat interview
- Video Colposcope
- General Physical Examination
- Developmental Assessment
What are the features of FII?
-Rare form child abuse Spectrum 90% mother -Likely underestimated in prevalence studies -Motivation unclear -Multi-agency issue
Who needs t be involved in FII is suspected?
GP
What do we do as a doctor with a child we suspect is being abused?
- Take a history
- Examine the child
- Clinical investigations, if needed
- Reach a preliminary opinion
- Consult with other agencies
- Give a revised opinion, if needed
What 3 investigations should be carried out?
- Skeletal survey
- CT head
- Ophthalmology
