Child Protection and Non-Accidental Injury Flashcards
are there laws that allow us to protect children?
yes
who is responsible for reporting any concern about child care?
Member of the public - See and hear aspects of child care that cause concern, Social media, Volunteering
Professional duty - General Medical Council, Contract, Public role to protect and prevent harm
When you have a concern about a child you must break confidentially if it is in the best interest of the child
It is everyone’s responsibility to safeguard against child abuse and neglect.
ALL doctors have a DUTY to act upon any concerns they have about the safety or welfare of a child or young person.
what are the categories of abuse?
Physical Abuse
Sexual Abuse
Emotional Abuse
Fabricated and Induced Illness
Neglect
what is the defintion of physical abuse?
To hurt or harm a child or young person on purpose IN ANY WAY. It includes: hitting with hands or objects, slapping and punching, kicking, shaking, throwing, poisoning, burning and scalding, biting and scratching, breaking bones, drowning
How do you know when a child has been intentionally harmed? :
when a child presents, what are some alarm bells?
Late presentation
History changes on repeating
History inconsistent with findings
“History inconsistent with findings”
Know what is normal and what is not - such as what?
Growth
Development
Common presentations of common problems, injuries and illnesses
Common presentations of NAI
what are common sites for accidental injury and what are common sites for NAI?
Should always be asking questions when there is injury that isn’t overlying a bony prominence
whats important to note when a child presents with bruising?
Any bruise in non mobile infant
Petechiae (See petechiae in sepsis but in the absence of sepsis you need to ask about this)
Clusters
Extensive injuries with no explanation
Injury not consistent with history or developmental level
Location of bruise
any pattern of bruising is a concern
what is a thermal injury?
Burns - Dry heat
Scalds - Hot liquid
Impetigo v. Cigarette burn - how can you tell the difference?
Both circular
Burns often infected
Look for distribution
Look for burnt hair
Healing
what would oyu want to know baout fractures?
1/3 sustain fracture<16 yrs
Most unintentional
Most in <18 months
Mechanism
Age
Developmental status
Abusive Head Trauma - who does it occur in and what does it result in?
Commonest cause of death in physical abuse
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 is the defintion of neglect?
Neglect is the ongoing failure to meet a child’s basic needs
The most common form of child abuse
A child might be left hungry or dirty, or without proper clothing, shelter, supervision or health care. This can put children and young people in danger. And it can also have long term effects on their physical and mental wellbeing
what are the categories of neglect?
Emotional
Abandonment
Medical
Nutritional/FTT
Educational
Physical
Failure to provide supervision
how common is neglect and how commonyl is it related to FFT?
If you see a child with faltering growth, ask the question – could this be abuse or neglect?
what is the definition of emotional abuse?
any type of abuse that involves the continual emotional mistreatment of a child
sometimes called psychological abuse
can involve deliberately trying to scare, humiliate, isolate or ignore a child
(Emotional abuse encompasses all other forms of abuse)
how do you recognise emotional abuse?
There may not be any physical signs of emotional abuse
Recognition of concerning behaviours, including behavioural or developmental difficulties, wary or anxious child, placid non-demanding baby, self harm in teenagers, etc
Noting down observed harmful caregiver-child interactions
what is the deifntion of sexual abuse?
When a child or young person is sexually abused, they’re forced or tricked into sexual activities
They might not understand that what’s happening is abuse or that it’s wrong. And they might be afraid to tell someone
Sexual abuse can happen anywhere – and it can happen in person or online
how may contact sexual abuse occur?
sexual touching of any part of a child’s body, whether they’re clothed or no
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
Contact abuse can include touching, kissing and oral sex – sexual abuse isn’t just penetrative
how many non-contact sexual abuse occur?
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 or share child abuse images or videos
making, viewing or distributing child abuse images or videos
forcing a child to take part in sexual activities or conversations online or through a smartphone
what are some indicatiors that sexual abuse may be happening?
Disclosure
Sexualised Behaviour
STI
Pregnancy
how is a CSA/Forensic Examination done?
Joint Paediatrician/Forensic Medical Examiner
Do not repeat interview
Video Colposcope - It’s a video camera, magnifying glass and a light, Don’t do internal examinations, Its an external inspection of the external genitalial and the behind
General Physical Examination
Developmental Assessment
what is the definition of FII (Fabricated or Induced Illness)
Fabrication: making up the symptoms of an illness
Induction: causing a child to become unwell
Fabricated or Induced Illness - how does it occur?
Rare form child abuse
Spectrum
90% mother
Likely underestimated in prevalence studies
Motivation unclear
Multi-agency issue
GP must be involved if FII suspected
so what do we do when a child presents with a child protection issue?
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 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
Can include:
- 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
Summary:
Possibility of child abuse is often recognized by non-medics: we help to confirm or exclude
Paediatricians do not decide who goes on Child Protection Register or is taken into care: Social Services have statutory responsibility for child protection
Multi-agency process, including Children’s Panel and courts if necessary
Take Home Messages - Child Protection:
Everyone’s civil responsibility
Professional duty to child
Doctor’s role is to raise, allay or confirm concerns: “start the ball rolling”
Your action may save a life
Your inaction may lead to further harm or death
