Child Safeguarding

Question 1

What is chid protection?

Answer 1

activity undertaken to protect children who are suffering or are at roof suffering, significant harm

Question 2

Who are children in need?

Answer 2

those who require additional support or services to achieve their full potential

Question 3

What does safeguarding children involve?

Answer 3

• measures taken to minimise the risks of harm to children
  
  • protecting children from maltreatment
  • preventing impairment of children’s health or development
  • ensuring children grow up in a safe or caring environment

Question 4

What is child abuse and neglect?

Answer 4

anything which those entrusted with the care of children do, or fail to do, which damages their prospects of safe and healthy development into adulthood

Question 5

What is the definition of child abuse?

Answer 5

• significant harm to child
• carer has some responsibility for that harm
• significant connection between carer’s responsibility for child and harm to child

Question 6

What national guidance and legislation is used in Scotland regarding child protection?

Answer 6

• National Guidance for Child Protection in Scotland 2014
  
  • Scottish Government
• Children and Young Peoples Act 2014
• Getting It Right For Every Child (GIRFEC)

Question 7

What does the Children & Young People’s Act 2014 detail?

Answer 7

• 13 parts covering a wide range of children’s policy
• 4 major themes
  • children’s rights (1-2)
  • GIRFEC (3, 4, 5, 13)
  • early learning and childcare (6)
  • looked after children (7-11)

Question 8

What does GIRFEC detail?

Answer 8

• named person for every child
  
  • single point of contact to provide advice and support to families
  • raise and deal with concerns about a child’s wellbeing
  • not mandatory
• lead professional
  
  • in case of complex needs
  • different agencies need to work together
• single child’s plan
  
  • single planning process for individual children
• national practice model
  
  • shared language to identify and meet concerns
    - SHANARRI
    - world triangle
    - resilience matrix
• shared approach to
  
  • organise and record information about a child
  • discuss ways of addressing concerns about wellbeing

Question 9

What does SHANARRI stand for?

Answer 9

• Safe
• Healthy
• Achieving
• Nurtured
• Active
• Respected
• Responsible
• Included

Question 10

What is SHANARRI used for?

Answer 10

• observing and recording
• gathering information and analysis
• planning action and review
• well-being concerns
• assessment
• well-beong desired outcome

Question 11

What international guidance is used regarding child protection?

Answer 11

• Children and Young Peoples Charter
  
  • UNCRC
  • based on the needs of children

Question 12

What are possible contributing factors to child abuse?

Answer 12

• adult aetiology
  
  • drugs
  • alcohol
  • poverty
  • unemployment
  • marital stress
  • mental illness
  • disability
  • domestic violence
  • step parents
  • isolation
  • abused as a child
  • unrealistic expectation
• child aetiology
  
  • crying
  • soiling
  • disability
  • unwanted pregnancy
  • failed expectation
  • wrong gender
  • product of forced, coercive or commercial sex
• community/environmental aetiology
  
  • dwelling place and housing conditions
  • neighbourhood
• family violence and dysfunctional family
  
  • intergenerational cycle
  • violence towards pets
  • social isolation
  • poverty

Question 13

What are the big three concerns for parenting capacity?

Answer 13

• domestic violence
• drug and alcohol misuse
• mental health problems

Question 14

What are the 5 categories of child abuse?

Answer 14

• physical
• emotional
• neglect
• sexual
• non-organic failure to thrive

Question 15

What constitutes a vulnerable child?

Answer 15

• under 5s
• irregular attenders
  
  • repeatedly do not attend
  • return in pain
  • exposed to risks of general anaesthetic
• medical problems and disabilities
  
  • more at risk of experiencing all kinds of abuse
  • serious impairment of health or development
    - more likely as a result of untreated dental disease
  • ‘looked after’ children

Question 16

How many deaths are caused by child abuse in Scotland and the UK

Answer 16

• Scotland: 10 children a year
• UK: 1-2 children a week

Question 17

What are the markers of neglect?

Answer 17

• nutrition
  
  • failure to thrive
  • short stature
• warmth, clothing, shelter
  
  • inappropriate clothing
  • cold injury
  • sunburn
• hygiene and healthcare
  
  • ingrained dirt (finger nails)
  • head lice
  • dental caries
• stimulation and education
  
  • developmental delay
• affection
  
  • withdrawn
  • attention seeking behaviour

Question 18

What are the most common ways can neglect kill?

Answer 18

• child under 1 year old
  
  • deprived of food and drink
• older children
  
  • independently mobile
  • child inadequately supervised

Question 19

What damage does neglect cause?

Answer 19

• short term
  
  • physical health
  • emotional health
  • social development
  • cognitive development
• long term
  
  • adults neglected as children at higher incidence of:
    - arrest
    - suicide attempts
    - major depression
    - diabetes
    - heart disease

Question 20

What is the definition of dental neglect?

Answer 20

• persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development
  -BSPD (2009)

Question 21

What can dental disease cause leading to general neglect?

Answer 21

• toothache
• disturbed sleep
• difficulty eating/change in food preferences
• absence from school
• teasing due to poor dental appearance
• repeated antibiotics
• repeated general anaesthetic extractions
• severe infection

Question 22

What dental neglect can be considered wilful neglect?

Answer 22

• after dental problems have been pointed out
  
  • irregular attendance
  • repeated failed appointments
  • repeated late cancellations
  • failure to complete treatment
  • returning in pain at repeated intervals
  • repeated general anaesthetic for dental extractions

Question 23

What are indicators of dental neglect?

Answer 23

• obvious dental disease
  
  • to someone not dentally trained
• impact on the child
  
  • pain
  • problems with eating and sleeping
• practical care has been offered but no return for treatment

Question 24

How is dental neglect managed?

Answer 24

• 3 stages
  
  • preventive dental team management
    - raise concerns with parents
    - offer support
    - set targets
    - keep records
    - monitor progress
  • preventive multi-agency management
    - lease with other professions
    - ascertain if concerns are shared
    - common assessment framework (CAF)
    - check if subject to child protection plan/register
    - agree on joint plan of action with all professionals
    - letter to health visitor asking if child is known
    - lease with health visitor
  • child protection referral
    - in complex or deteriorating situations
    - follow local guidelines
    - referral to social services
• patient/carer offered treatment and sent reminder

Question 25

What elements are involved in assessment framework for safeguarding and promoting child welfare?

Answer 25

• child’s developmental needs
  
  • health
  • education
  • emotional and behavioural development
  • identity
  • family and social relationships
  • social presentation
  • self-care skills
• parenting capacity
  
  • basic care
  • ensuring safety
  • emotional warmth
  • stimulation
  • guidance and boundaries
  • stability
• family and environmental factors
  
  • family history and functioning
  • wider family
  • housing
  • employment
  • family’s social integration
  • community resources

Question 26

What are the types of physical abuse?

Answer 26

• over chastisement
  
  • can be cultural
• acute/compassionate (shaking)
  
  • spontaneous uncalculated reaction
  • remorse, take action appropriately
  • children’s needs are priority
• chronic/pathological (way of life)
  
  • help sought but not actively
  • no remorse
  • children’s needs are not a priority

Question 27

What does the law state about physical abuse in Scotland?

Answer 27

• illegal to hit a child with an object or on the head
• illegal to physically punish a child

Question 28

What types of injuries are seen as a result of physical abuse?

Answer 28

• head
  
  • 95% serious head injuries in first year of life
• body
  
  • 10% of 5 year olds attending A&E
• burns
  
  • 10-12% are non-accidental

Question 29

What are common examples of accidental injuries?

Answer 29

• accidental injuries typically involve bony prominences, match the history and are in keeping with the development of the child
• head injuries
  
  • parietal bone
  • occipital bone
  • forehead
• elbows
• nose
• chin
• palm of hand
• knees
• shins

Question 30

What are common examples of non-accidental injuries?

Answer 30

• concerns are raised by injuries to both sides of the body, injuries to soft tissues, injuries with particular patterns, injury which does not fit explanation, delays in presentation, untreated injuries
• ears
  
  • especially both
  • pinch marks
• triangle of safety
  
  • ears,
  • side of face and neck
  • top of shoulders
• inner aspects of arms
• back and side of trunk
  
  • except directly over spine
• black eyes
  
  • especially bilateral
• soft tissues of cheeks
• intra-oral injuries
• forearms
• chest and abdomen
• any groin or genital injury
• inner aspects of thighs
• sole of feet

Question 31

What signs of physical abuse can be seen extraorally?

Answer 31

• bruising of face
  
  • punch
  • slap
  • pinch
• bruising of ears
  
  • pinch
  • pull
• abrasions and lacerations
• burns and bites
• neck
  
  • choke or cord marks
• eye injuries
• hair pulling
• fractures
  nose>mandible>zygoma

Question 32

What are major clinical features of physical abuse?

Answer 32

• skin lesions
  
  • bruises
  • burns
  • bites
  • lacerations
• bone lesions
  
  • fractures
• intracranial lesions
  
  • from shaking
• visceral lesions
  
  • intra-abdominal
  • from blunt trauma

Question 33

What signs of physical abuse can be seen intraorally?

Answer 33

• contusions
• bruises
• abrasions and lacerations
• burns
• tooth trauma
• frenal injuries
  
  • very suspicious if not mobile

Question 34

What makes an injury suspicious?

Answer 34

• delay in seeking help
• story vague, lacking detail, varies story telling
• account not compatible with injury
• parent mood abnormal, preoccupied
• parents behaviour gives cause for concern
• child’s appearance and interaction with parents is abnormal
• child may say something contradictory
• history of previous injury
• history of violence within family

Question 35

What is expected of the dental team regarding child abuse and neglect?

Answer 35

• observe
• record
• communicate
• refer for assessment
• not expected to diagnose

Question 36

How can dental professionals help children experiencing abuse and neglect?

Answer 36

• share concerns
  
  • named person
• know where to go for help and advice
  
  • experienced colleague
  • named safeguarding nurese
  • child protection adviser
  • named doctor for safeguarding
  • social work/social services
  • children’s services department
  • NSPCC helpline
• know what to do is concerns still stand following initial discussion
• know hoe to refer/share concerns
  
  • telephone initially, followed up in writing
  • facts
  • statement of concern

Question 37

What details are included in a notification of concern form/shared referral form

Answer 37

• referral details
• designated contact person
• referral to
• subject of referral
• preferred language
• child affected by disability
• family details
• principle carer’s details
• other adults in household
• any other significant adults
• siblings
• summary of concerns
• reason for referral/request for services
• agreed actions
• agency involvement

Question 38

What happens after a referral is made?

Answer 38

• if child in immediate danger
  
  • child protection order
  • exclusion order
  • child assessment order
  • removal by police or authority of a JP
• if child not in immediate danger
  
  • investigation
  • initial assessment
  • decide if child is at risk of significant harm
  • no further child protection action, may get additional support
  • joint investigation