Community - Safeguarding/CAMHS/Other

Question 1

What features suggest physical abuse?

Answer 1

physical abuse - bruises, burns, bites, fractures

listen to history, plausibility of explanation, inconsistent stories, inappropriate reaction by parents, previous abuse

Question 2

What features suggest neglect?

Answer 2

neglect - think about it if children are consistently misses medical appointments, lacks glasses or immunisations, seems ravenously hungry, is dirty, is wearing inadequate clothing, is abusing drugs/alcohol etc

Question 3

What features suggest emotional abuse?

Answer 3

hard to identify
clues in behaviour can help
babies: apathetic, non-demanding, delayed development, described as spoiled
Toddlers - violent, apathetic
School children - wetting/soiling, non-attendance, antisocial behaviour
Adolescents - self harm, depression, oppositional, aggressive

Question 4

What features suggest sexual abuse?

Answer 4

child may tell someone about the abus 
be identified in porn 
be pregnant 
have an STI 
have vaginal bleeding, itching, discharge/rectal bleeding 

Behavioural symptoms include soiling, regression, poor school performance, sexualised behaviours etc

Question 5

What are the key professionals involved in its management?

Answer 5

police, doctors, specialist paediatric doctors in each hospital

Question 6

What is fabricated or induced illness?

Answer 6

80% cases is mother
verbal fabrication or the induction of illness (suffocating, poisoning, excessive)
organic illness may coexist which makes things difficult
clues = frequent presentations that only occur in carers presence

Question 7

What are the diagnostic criteria for anorexia and eating disorders and its management?

Answer 7

• low body weight (BMI<17.5)
• self induced weight loss
• overvalued idea
• endocrine disturbances (failure to make expected development if prepubertal)

Question 8

What are the diagnostic criteria for bulimia?

Answer 8

• binge eating
• methods to counteract weight gain
• overvalued data

Question 9

What is Russel’s sign?

Answer 9

calluses on the back of hands when the hand has been used to induce vomiting

Question 10

How is anorexia managed?

5 aspects listed

Answer 10

hard to treat due to thoughts and consequences of starvation

1) education bout nutrition and monitoring of weight
2) outpatient psychotherapy (CBT, IPT, family therapy, psychoeducation)
3) low threshold for entering specialist eating disorder unit with those resistant to OP treatment and with severe cases
4) hospitalisation considered with v low weights - patients may need to be treated against their will
5) use of medication is limited. SSRIs can be used for comorbid conditions.

Question 11

What are the impacts of chronic disease on growth?

Answer 11

• common cause of abnormal growth
• children can be short and underweight
• inadequate nutrition due to chronic condition (eg coeliac, crohns etc)

Question 12

What are the impacts of chronic disease on development?

Answer 12

psychological responses vary
if illness takes over life –> anxiety about slight symptoms
if denial –> warning signs ignored and treatment may be poorly adhered to

when stressed regression in behaviour is common in younger children

Question 13

What are the psychological impacts of chronic disease in childhood?

Answer 13

children are more susceptible to MH problems but this is related to nature of illness, the stage, age of child, temperament, intellectual capacity, family factors

Question 14

How does adolescence impact compliance?

Answer 14

adherence in adolescents with chronic disease is poor and leads to greater complications and admissions

Question 15

What is school refusal?

Answer 15

an inability to attend school due to overwhelming anxiety
anxiety presentation is limited to school days, clearing up by midday
usually due to anxiety about separation from parent or anxiety because of a particular aspect of school

Question 16

How is school refusal managed?

Answer 16

• advice and support for parents
• treat underlying emotional disorder
• plan and facilitate an early and graded return to school
• reward children for going to school
• address any bullying

Question 17

Who is involved in school refusal management?

Answer 17

doctors
psychologist
teachers
parents

Question 18

How should a history be taken of tantrums?

Answer 18

normal in toddlers
can demoralise parents
analyse with ABC approach
Antecedents - what happens minutes before
Behaviour - what did the episode consist of
Consequences - what happened as a result
Check for medical reason (such as global language delay)

Question 19

How should tantrums be managed?

Answer 19

• distract the child
• if this doesn’t work then let the tantrum burn out and leave the room for a few minutes
• time out (1 min per age of child)
• Star charts to acknowledge good behaviour

Question 20

Who are the key professionals involved in managing conduct behaviour and difficult behaviour?

Answer 20

Psychiatrist
Teacher
Police
Parents

Question 21

What qualifies as difficult behaviour?

Answer 21

range of problems including aggressive behaviour and antisocial behaviour
same rules as tantrums should apply here

Question 22

What is conduct disorder?

Answer 22

occurs before the age of 18
characterised by repetitive and persistent pattern of aggression to people and animals, destruction of property, deceitfulness or theft and major violations of age appropriate social expectation
many go on to develop antisocial behaviour personality disorder

Question 23

What are the key clinical features of depression in children?

Answer 23

low motivation, judgement, apathy, boredom, separation anxiety, decline in school performance, social withdrawal, hypochondriac ideas, irritable mood, antisocial mood

diagnosis should be mage after interviewing a child on their own

Question 24

What is psychosis?

Answer 24

a breakdown in the perception and understanding of reality and lack of awareness that the person is unwell
can affect ideas and beliefs
resulting in delusional thinking where abnormal thoughts have an unshakeable quality

Question 25

What are the psychotic disorders?

Answer 25

schizophrenia (rare before puberty)
bipolar affective disorder (rare before puberty)
organic psychosis (delirium, substance induced disorders)

treat organic causes promptly
urgently refer to psychiatrist when psychosis is suspected

Question 26

How should you elicit a self harm history in adolescents?

PATHOS tool

Answer 26

P – Have you had problems for longer than a month?

A – Were you alone in the house at the time?

T – Did you plan the overdose for longer than three hours?

HO – Are you feeling hopeless about the future?

S – Were you feeling sad for most of the time before the overdose?

Score 1 for yes and 0 for no. Child is a high risk of >2.

Question 27

What are the illicit drugs categories?

Answer 27

Class A – ecstasy, LSD, heroin, morphine, cocaine and methadone

Class B – amphetamine, cannabis and dihydrocodeine

Class C – GHB, temazepam, valium, temgesic, ketamine

Question 28

What is chronic fatigue syndrome?

Answer 28

• Persisting high levels of subjective fatigue, leading to rapid exhaustion on minimal physical or mental exertion.
• The term is broader and more neutral than the specific pathology or aetiology implied by myalgic encephalopathy or post-viral fatigue syndrome, which follows an apparently viral febrile illness

Question 29

What are the clinical features of chronic fatigue syndrome?

Answer 29

Myalgia, migratory arthralgia, headache difficulty getting off to sleep, poor concentration and irritability are virtually universal.
Stomach pains, scalp tenderness, eye pain and photophobia and tender cervical lymphadenopathy are frequently encountered.
Depressive symptoms are in the picture

Question 30

How should chronic fatigue syndrome be managed?

Answer 30

Recommended treatment involved graded exercise therapy and/or cognitive behavioural therapy.

Graded exercise therapy is physiotherapy lead to increase exercise tolerance

Question 31

What are the different types of sleep disorder?

Answer 31

difficulty in settling to sleep at bedtime

waking at night

nightmares

night terrors

Question 32

How is difficulty in settling at bedtime managed?

Answer 32

common in toddlers
may be an example of separation anxiety -

cannot sleep if parent leaves room

other reasons should be explored in a history e.g. too much sleep in the afternoon, overstimulation in the eve, kept awake by sibling

regular bedtime routine can help

Question 33

What are night terrors?

Answer 33

• different from nightmares and occur about 1.5 hours after settling
• The parent finds the child sitting up in bed with eyes open, seemingly awake but obviously disorientated, confused and distressed and unresponsive to their questions and reassurances
• The child then settles to sleep after a few minutes and has no recollection the next morning.