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ICA > Child safe guarding and child death reviews > Flashcards

Child safe guarding and child death reviews Flashcards

1
Q

Define child abuse

A
  • Maltreatment of a child (<18)
  • Infliction of harm
  • Failure to prevent harm
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2
Q

What is significant harm?

A
  • Ill treatment or impairment of health or development
  • Legal justification for LA intervention into family life
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3
Q

What are the categories of child abuse?

A
  • Neglect
  • Physical (includes Fabricated or Induced Illness/perplexing presentations and FGM)
  • Sexual
  • Emotional
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4
Q

Define neglect

A
  • Persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in serious impairment of the child’s health or development
  • May occur during pregnancy as a result of maternal substance abuse
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5
Q

What might neglect involve once a child is born?

A

Carer/parent fails to:
- Provide adequate food, clothing, shelter (including exclusion from home or abandonment)
- Protect a child from physical and emotional harm or danger
- Ensure adequate supervision (includes inadequate care-givers)
- Ensure access to appropriate medical care or treatment
- Neglect of/unresponsiveness to a child’s basic emotional needs

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6
Q

How are doctors supposed to document children missing appointments?

A
  • Was Not Brought instead of Did Not Attend
  • Prevents blame being placed on child
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7
Q

What are some red flags for neglect that may be noted during taking a child’s history?

A
  • Recurrent non attendance at appointments/non-adherence to medication
  • Missed routine screening/immunisations
  • Faltering growth
  • Delay in development
  • Recurrent infestations/infections/injuries
  • Poor school attendance
  • History of injury where explanation suggests inappropriate supervision
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8
Q

What may be seen on examining a neglected child?

A
  • Poor nutritional status/poor growth
  • Dental decay
  • Signs of recurrent/chronic infection or infestation
  • Dirty/unkempt/smelly
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9
Q

What may physical abuse of a child involve?

A
  • Hitting, shaking, throwing, poisoning, burning, scalding, drowning, suffocating etc.
  • May also be caused when a parent/carer fabricates symptoms of/deliberately induces illness in a child
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10
Q

What are some red flags for physical abuse that may be noted during taking a child’s history?

A
  • Lack of/inadequate explanation for injury
  • Delay in seeking medical attention/inappropriate response
  • Inconsistent accounts
  • Presence of multiple risk factors/child or family known to Social Care
  • Direct disclosure
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11
Q

What may be seen on examining a child suffering from physical abuse?

A
  • Unexplained bruising in a vulnerable child
  • Unexplained fractures/burns/scalds/head injury
  • Patterns: implement/sparing/bites/handprints
  • Injury not consistent with history/developmental age
  • The younger the child is, the more vulnerable they are
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12
Q

What needs to be done if physical abuse to a child is suspected?

A
  • Bloods
  • Vitamin D, calcium bone profile
  • Skeletal survey
  • Ophthalmology assessment
  • CT head
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13
Q

Define sexual abuse

A
  • Forcing or enticing a child or young person to take part in sexual activities, not necessarily involving high levels of violence, whether or not the child is aware of what is happening
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14
Q

What may sexual abuse involve?

A
  • Physical contact (including assault by penetration or non-penetrative acts)
  • May be non-contact activities e.g. children looking at/producing sexual images, grooming
  • Can take place online and technology used to facilitate offline abuse
  • Perpetrators not solely adult males
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15
Q

Outline what child sexual exploitation involves

A
  • An individual or group takes advantage of power imbalance to coerce, manipulate a child <18 years into sexual activity
  • In exchange for something the victim wants/needs
  • Or for financial advantage/increased status of perpetrator
  • Victim may have been exploited even if sexual activity appears consensual
  • Does not always involve physical contact - can occur through use of technology
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16
Q

What are some red flags for sexual abuse that may be noted during taking a child’s history?

A
  • Disclosure
  • Pregnancy/signs of sexual activity in a child under 13 years
  • STIs
  • Anogenital injury/unexplained bleeding
  • Recurrent vaginal discharge
  • Soiling/wetting - differential diagnosis
  • Behavioural change
17
Q

What should be done in response to identifying that a child may have been sexually abused?

A
  • Immediate health needs are paramount
  • Referral to social care
  • Forensic assessment undertaken at specialist Sexual Assault Referral Centre by staff with appropriate skills and expertise
18
Q

Give examples of emotional abuse

A
  • Rejecting
  • Isolating
  • Terrorising
  • Ignoring
  • Corrupting
  • Cyberbullying
19
Q

Define emotional abuse

A
  • Persistent emotional maltreatment of a child causing severe and persistent adverse effects on the child’s emotional development
20
Q

What may emotional abuse involve?

A
  • Conveying worthlessness/unloved/inadequate
  • Deliberately silencing or making fun of a child’s voice
  • Imposing age/developmentally inappropriate expectations on children
  • Over protection and limiting exploring or learning
  • Preventing participation in normal and social interaction
  • Serious bullying/exploitation/corruption
  • Some level involved in all types of abuse but may occur alone
21
Q

What are some red flags for emotional abuse that may be noted during taking a child’s history (baby)?

A
  • Infants: feeding difficulties, crying, poor sleep patterns, delayed development. Parents describe baby in negative terms
22
Q

What are some red flags for emotional abuse that may be noted during taking a child’s history (toddler)?

A
  • Toddler/preschool: behavioural spectrum from overactive to apathetic, noisy to quiet, developmental delay
23
Q

What are some red flags for emotional abuse that may be noted during taking a child’s history (school aged)?

A
  • School aged: wetting and soiling, relationship difficulties, poor school performance, non-attendance, anti-social behaviour
24
Q

What are some red flags for emotional abuse that may be noted during taking a child’s history (adolescent)?

A
  • Adolescents: self-harm, substance misuse, eating disorders, oppositional, aggressive, delinquent behaviours
25
Q

What may be seen on examining a child who is being emotionally abused?

A
  • Growth (underweight)
  • Emotional signs (non-specific)
  • Behavioural (wide range)
  • Development (failure to achieve milestones, academic failure)
26
Q

What else do we need to safeguard children against?

A
  • Online abuse and grooming
  • Child criminal exploitation/county lines
  • Trafficking
  • Radicalisation
  • Modern slavery
  • FGM/cutting
  • Forced marriage
  • Honour based violence
  • Discriminatory abuse
27
Q

What is the triad of vulnerability for child abuse?

A
  • Domestic abuse
  • Mental illness of parent or carer
  • Parental drug and/alcohol misuse
28
Q

What else makes children vulnerable to abuse?

A
  • Under 2 years
  • Pre-verbal babies and children
  • Those with additional needs/disability
  • Vulnerable/ marginalised young people
29
Q

Give examples of Adverse Childhood Experiences

A
  • Physical abuse and neglect
  • Sexual abuse
  • Emotional abuse and neglect
  • Domestic violence
  • Mental ill-health
  • Incarceration
  • Substance misuse
  • Parental separation
30
Q

What are the consequences of ACEs?

A
  • Disrupted neurodevelopment and allostatic load
  • Social, emotional and cognitive impairment
  • Adoptions of high risk behaviours and crime
  • Disease, disability, social problems, low productivity
  • Early death
31
Q

What happens after you raise concerns about a child?

A
  • Referral to local authority (Social care/ MASH)
  • Reasonable cause to suspect that child is suffering or is likely to suffer significant harm
  • Duty to make enquiries under Section 46 of the Children Act 1989
32
Q

What interventions/support are carried out when child abuse is suspected?

A
  • Universal services
  • Early help
  • Children in Need - consent required
  • Child protection - consent not required
33
Q

What needs to happen in order to effectively safeguard children?

A
  • Interagency communication and information-sharing
  • See bigger picture and have a family focus
  • Listen to and see child
  • Be aware of disguised compliance, voice of child, overreliance on parental accounts
  • Following up missed appointments and linking incidents
  • Recognising abuse
  • Process for escalation/challenge
34
Q

What should you do if a child discloses abuse or you are concerned for their welfare?

A
  • Don’t ask leading questions
  • Document verbatim what was said
  • Don’t promise confidentiality
  • Talk immediately to one of the professionals you are working with - they will escalate appropriately
35
Q

Why review child deaths?

A
  • To establish, where possible, a cause or causes of child death
  • To identify any potential contributory and modifiable factors
  • To provide ongoing support to family
  • To learn lessons in order to reduce risk of future child deaths
36
Q

What happens once a child dies?

A
  • Immediate decision making
  • Investigation and information gathering
  • Child death review meeting
  • Independent review
  • National child mortality database
37
Q

Who is involved in the child death review process?

A
  • CDR team: designated Dr, nurses, manager, admin
  • Immediate response: health, social care, police
  • Review process: all agencies involved in care of child in life or investigating death

ICA (5 decks)

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