Fraser Guidance, Consent And Safeguarding

Question 1

What guidance is available for consent in children?

Answer 1

patients less than 16 years old may consent to treatment if they are deemed to be competent (an example is the Fraser guidelines), but cannot refuse treatment which may be deemed in their best interest

between the ages of 16-18 years it is presumed patients are competent to give consent to treatment

patients 18 years or older may consent to treatment or refuse treatment

Question 2

Give some examples of types of child abuse

Answer 2

physical, emotional and sexual abuse, neglect and fabricated or induced illness.

Question 3

What features should make you consider neglect? (NICE guidance)

Answer 3

Severe and persistent infestations (e.g. Scabies or head lice)
Parents who do not administer essential prescribed treatment
Parents who persistently fail to obtain treatment for tooth decay
Parents who repeatedly fail to attend essential follow-up appointments / engage with child health promotion
Failure to dress the child in suitable clothing
Animal bite on an inadequately supervised child

Question 4

What features should make you consider sexual abuse?(NICE guidance)

Answer 4

Persistent dysuria or anogenital discomfort without a medical explanation
Gaping anus in a child during examination without a medical explanation
Pregnancy in a young women aged 13-15 years
Hepatitis B or anogenital warts in a child 13-15 years

Question 5

What features should make you consider physical abuse? (NICE guidance)

Answer 5

Any serious or unusual injury with an absent or unsuitable explanation
Cold injuries in a child with no medical explanation
Hypothermia in a child without a suitable explanation
Oral injury in a child with an absent or suitable explanation

Question 6

Children may disclose abuse themselves. Other general factors which point towards child abuse include:

Answer 6

story inconsistent with injuries
repeated attendances at A&E departments
delayed presentation
child with a frightened, withdrawn appearance - ‘frozen watchfulness’

Question 7

Possible physical presentations of child abuse include:

Answer 7

bruising
burns or scalds
fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
torn frenulum: e.g. from forcing a bottle into a child’s mouth
failure to thrive
STIs

Question 8

What key features may be present in a sexually abused child?

Answer 8

pregnancy
STIs, recurrent UTIs
sexually precocious behaviour
anal fissure, bruising
reflex anal dilatation
enuresis and encopresis
behavioural problems, self-harm
recurrent symptoms e.g. headaches, abdominal pain

Question 9

What is shaken baby syndrome?

Answer 9

triad of retinal haemorrhages, subdural haematoma, and encephalopathy

caused by the intentional shaking of a child (0-5 years old)

Question 10

With regards to the provision of contraceptives to patients under 16 years of age the Fraser Guidelines state that all the following requirements should be fulfilled:

Answer 10

the young person understands the professional’s advice

the young person cannot be persuaded to inform their parents

the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment

unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer

the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent