Community: Child Protection Flashcards
The children act 1989 emphasises that…
The needs of the child are paramount
The children act of 2004 emphasises that the needs of the child are paramount and declares that…
Everyone has a statutory duty to safeguard children
What risk factors are the for child abuse?
Domestic violence Mental illness of parent or carer Drug and/ or alcohol misuse Parental/ carer learning difficulties Others: housing issues, unemployment, poverty, crime, history of carer abuse as a child, single parent
What types of abuse are there?
Neglect Physical Emotional Sexual Mixed Fabricated or induced illness
What does physical abuse include?
Fabricated or induced illness
Female genital mutilation
What are the characteristics of abusive bruises?
Bruising in babies
Bruising in children who are not independently mobile e.g disabled child
Bruising that are seen away from bony prominences
Bruises to face, ears, neck, trunk, arms, hands, buttocks
Bruises over soft tissue areas
Multiple bruises in clusters
Multiple bruises of uniform shape
Bruises that carry imprint of an implement or a ligature
Larger than non abusive bruises
What is neglect?
The persistent failure to meet the child’s basic physical and/ or psychological needs, likely to result in serious impairment of child’s health and development
Where is the commonest site of abusive bruises?
Head
Describe non abusive bruising
Increases with age
Characteristically small
Directly correlates with increase mobility
In a non mobile baby is very uncommon
What are the common locations of non abusive bruising?
Knees and shins - 45% of walkers have shin bruises
Bony prominences 93-100% of cases
Front of body most common - those on head usually on forehead
What types of physical abuse are there?
Bruising Lacerations Head injury Fractures Burns Bites
What is the commonest cause of death in physical abuse?
Non accidental head injury (NAHI)
What percentage of severe head injury in the first year of life is inflicted?
95%
NAHI is most commonly seen in what age group?
Under 6 months but can occur in older children
What is the mortality rate for NAHI?
Up to 30%
Half the survivors have residual disability of variable severity
Do there have to be external signs of abuse to have a NAHI?
No
A child can sustain life threatening injuries without showing any of little evidence of external injury
What type of haemorrhage is typically seen with NAHI?
Subdural haemorrhage - usually along falx, peritentorial, subtemporal
Subarachnoid usually present
Extradural is rare in NAI
What symptoms are associated with NAHI?
Range from poor feeding and lethargy
Fits
Respiratory difficulties
Sudden death
Enlarged head circumference
What should be considered in any child who suddenly and inexplicably collapses?
NAHI
Does child sexual abuse include non contact sexual activity?
Yes
Sexual activity with a child under 13 is..
Statutory rape
What are some examples of emotional abuse?
Rejecting Isolating Terrorising Ignoring Corrupting Cyber bullying
Present in all other types of abuse
What in the history makes you suspicious?
Lack of explanation Inconsistent explanation Does not fit with developmental age of child Inappropriate child/carer response Previous history of unusual injury Known to children’s social care Repeated attendance due to neglect or abuse Repeated DNAs Social history
A child under 2 should have what investigations?
Skeletal survey
CT head
Paediatric ophthalmology assessment
Blood tests including clotting
What are some differential diagnoses of fractures?
Accidental
Metabolic bone disease - particularly if born prematurely and had TPN
Osteogenesis imperfecta
What is abuse?
Inflicting harm or failing to act to prevent harm
Children may be abused in…
In a family
In an institution or community setting
By those known to child
Rarely by a stranger
What are some examples of neglect?
Substance misuse in pregnancy
Failing to provide adequate food/shelter/clothing/protection from danger and abandonment
Failure to ensure adequate supervision
Failing to provide appropriate medical care
Failing to respond to child’s basic emotional needs
What are some possible indicators of neglect?
Dirty bedroom, no sheets on bed, inappropriate sleeping place Being unkept, dirty, smelly Loss of weight or constantly underweight Dressed inappropriately for weather Learning disabilities Untreated medical conditions Tired all the time Frequently missing school or being late Failing to keep medical appointments A baby who never cries Being left unsupervised regularly Depression, psychiatric illnesses, PDs
