Lecture Day 2: Child Protection (safeguarding) Flashcards
Types of abuse
Emotional Physical Neglect Exploitation Sexual
How to detect abuse
General: appearance, hygiene, growth: HT WT HC, interaction with carer.
Types of injury
- Bruises/petechiae
- Burns
- Fractures
- Intra abdominal trauma
- suffocation/poisoning
Hx
- ask child & carer
- development
- Failure to thrive
- time delay
- family crisis
- parental abuse/deprivation
- previous hx
- risk factors: multiple move, domestic violence, parental (mental health, drugs, poverty), disability.
Examination: features of abuse or neglect.
Look head/ears/mouth, all over body & anogenital
Investigation (Skeletal surgery (looking for fractures), CT head (sub-dural), ophthalmology(rental haemorrhage))
Background/Risk
Which bruising point towards abuse?
Normal bruises bony prominence concern if: - head, face, cheek, behind ears - inside thigh or arm - genitalia type shape, mark, patterned ages number
Differentials
Meningococcal sepsis Bleeding disorder Drugs Birth marks mongolian blue spot Dirt ! Dye
Fractures
Very hard to fracture children bones. Been concerned about abuse.
- Spiral
- Bucket handle
- Age < 1 yr
- > high suspension
Differentials for fractures
Other causes - Thin bones
Premature
Rickets
Osteogenesis imperfecta (brittle bones)
Worrying signs for children with burns?
Delayed presentation
Lack of pain
Injury does not fit the history
Repeated burns ( neglect)
Non accidental head injury
Parent shakes baby with frustration. “shaken baby syndrome”
- sub-dural haemorrhage
- retinal bleed
- rib fractures
- long bone fracture
- brain injury
Sexual abuse presentation
History Behaviour changes Wetting / Soiling Vaginal discharge / bleeding Self harm Disclosure Exam Bruises on inner thighs / abnormal anogenital Infections/ discharge
Signs of emotional abuse
Medical conditions Eating disorders Depression / mental health issues Dental Irritable bowel Chronic pain
What to do if suspect
- Ask someone
- Social services
How many per 1000 under the age of 4 suffers severe physical abuse e.g. fractures, brain haemorrhage
1 per 1000
A&E 4 month old, lump on head & brushing to his cheek. The skull x-ray has a skull fracture. The parents are professionals. Mum has given job up as solicitor, no other children.
How do you approach this?
What do you need to do?
What do you say with the parent.
Hx:
Very detailed Hx of mechanism of action. EXACTLY what happened, WHAT time.
Do the injuries fit story: cheek does not fit fall Hx.
Examination of child:
Head & toe
Photos: part of policy, normal procedure for this type of injury at this age.
Call senior.
Tell parents:
I understand your baby has a very bad injury, its unusual, the explanation you give does not seem to fit with these injuries, I would like my senior colleague to come and review.
If you go home I’ll call police & social services
You need to reviewed by senior colleague.
In OP 12 yr old boy with his professional parents. His asthma is interfering with his elite athletics. He is continually criticised & put down by his parents.
They believe he is lazy, and could do better if he trains harder. He does not seem to respond to inhalers. How do you tackle this?
Could ask to see child to them by themselves.
Hx:
Asthma Hx
Taking medications?
Any other problems you want to tell me about.
‘Continually criticised’
- Contact school & athletics to find out about parents & GP
- I am not worried about his asthma, but I will be contacting the school and his school to find out more information about how his asthma is affecting his athletics.
- Ask coach: ‘parents think asthma is effecting his training’
- GP can ask if there is any worry for emotional abuse.
4 yr old boy in A & E.
Chronic cough, dental caries, weight is on 0.4th gentile, she clings to her mother.
Mum is single with little support. She appears to be low mood, but does not accept there are problems & does not want help.
Examination is otherwise normal
Can go home (no immediate risk). But worrying as mother does not want help.
