Maltreatment in children

Question 1

What is maltreatment

Answer 1

abuse and neglect occurring to children <18

Question 2

What is neglect

Answer 2

ongoing failure to meet a child’s basic needs

Question 3

What are types of abuse

Answer 3

Physical abuse 
Emotional abuse 
Sexual abuse 
Neglect
Fabricated/facticious induced illness aka Munchausen's by Proxy

Question 4

What are adverse childhood experiences

Answer 4

wide range of stressful traumatic experiences that babies, children or young people are exposed to while growing up

Question 5

What is the impact of adverse childhood experiences

Answer 5

negative impact lifelong

• affects brain growth and development
• affects social abilities / moods etc

Question 6

What are. indications of sexual abuse

Answer 6

Going missing for long periods of time / comes back late
Skips school, disruptive in class
Unexplained gifts and possessions
STIs
Drugs and alcohol use.
Inappropriate sexualised behaviour, overfamiliarity with strangers

Question 7

How is harm caused by Munchausen’s by Proxy=

Answer 7

Harm is caused by:

• frequent invasive. examinations
• unnecessary treatments
• missed school
• limitations in dailly life
• child anxiety

Question 8

What are indications of physical abuse

Answer 8

• Bruises (esp in infants and immobile children)
• Broken / fractured bones
• Burns or scalds (feet or bottom)
• Lacerations
• Scarring
• effects of poisoning (e.g. vomiting, drowsiness, seizures)
• Breathing problems from drowning, suffocation, or poisoning
• Head injuries in babies and toddlers may be signalled by the following symptoms: swelling, bruising, fractures, being extremely sleepy, breathing problems, vomiting seizures, being irritable or not feeding properly
• frightened of parents, reluctant to return home after school
• Displays frozen watchfulness
• Constantly asking in words/actions what will happen next
• Shrinks away at the approach of adults

Question 9

What are indications of neglect

Answer 9

1. Poor appearance and hygiene
   
   • smelly/dirty
   • unwashed clothes
   • wrong clothes e.g. for winter
   • nappy rash in babies
2. Health and development problems
   
   • always hungry, poor weight or growth.
   • anaemia
   • poor muscle tone, prominent joints
   • missed medical appointments, e.g. vaccinations
   • poor language or social skills
   • regular illness or infections
   • repeated accidental injuries ( lack of supervision)
   • skin issues, such as sores, flea bites, scabies, ringworm
   • thin or swollen tummy
3. Family / housing environment
   
   • left at home alone for longtime
   • unsuitable home environment e.g. low heating
   • unsuitable carer of family members
4. Unusual behaviour
   
   • drugs, alcohol
   • misses school
   • self harm

Question 10

What are risk factors for maltreatment

Answer 10

CHILD: failure to meet parental expectation

• born from forced. / commercial sex
• “wrong” gender
• difficult child
• disabled

PARENT/CARER

• young parental age
• drugs and alcohol use
• mental health problems
• parental indifference, intolerance

FAMILY

• step parents
• domestic violence
• multiple closely spaced babies
• social isolation and lack of support

ENVIRONMENT

• poverty
• poor housing

Question 11

What are next steps for maltreatment

Answer 11

1. Further exploration of hx, social hx + speak to child alone if appropriate
2. Talk to consultant paediatrician on call / responsible for safeguarding
3. Explain your concerns to parents and safeguarding procedure i.e. I am concerned that this baby has significant injuries we have no explanation for. As doctors we have a duty of care towarrds the child so we would like to do some more investigations and get some involvement from social services to see how they can help …

Question 12

What is management of maltreatment

Answer 12

• Physical management - treat and investigate
• social services involvement
• safeguarding team

Question 13

What is part of the physical management / monitoring you must do for a child with maltreatment

Answer 13

Pysical examination as required

Skeletal survey +/- CT head as per guidelines

Question 14

What additional investigation must you do if concerned about shaken baby syndrome

Answer 14

fundoscopy (retinal haemorrhages)

Question 15

What are the guidelines. for skeletal survey in chidlren

+ what actually is it

Answer 15

Set of X rays to long bones and ribs, looking for present or past fractures

any suspicion of physical abuse: <2yo: skeletal survey, <1yo: skeletal survey + CT

sibling in same household if <2 must also undergo skeletal survey

Question 16

Who must you refer a child to if concerned about sexual abuse / to gather forensic evidence

Answer 16

refer to the Havens

Question 17

what is the function of social services=?

Answer 17

protect the child’s best interest and offer support

hold strategy meeting, liase with police, can draw up a child protection plan

Question 18

what do you do if a parent disagrees with you/ does not let you assess or treat child as per best interest?

Answer 18

Police protection plan

Question 19

What do you do with a child if home is an unsafe place

Answer 19

Admit to ward

OR social care needs to find a place for them and sibilings

Question 20

What are bruising patterns suggestive of abuse

Answer 20

• on babies
• on not independently mobile children
• -away from bony prominences

Question 21

What key things must you ask in a social hx for adolescents

Answer 21

HEADS

• Home
• Environment, education
• Activities
• Drugs and alcohol
• Sex

Question 22

what can police do if the parents keep refusing investigations that are in the childs best interest

Answer 22

emergency protection order (siomeone shares parental responsibility so can consent to examinations e.g. skeletal survey, photos etc)