Maltreatment of Children and Raising Concerns Flashcards
Which children are at increased risk of maltreatment / abuse?
- Babies under 1 year
- Disability / special needs
- Domestic violence
- Factors that increase stress / decrease parental capacity:
- Parental alcohol / drug misuse
- Parental mental heaalth issues
- Parental learning difficulties
- Various male partners
- (Teenage parents)
What are the categories of harm?
- Physical abuse
- Sexual abuse (including CSE)
- Neglect
- Emotional abuse
- Fabricated or induced illness
What are the important aspects of hx and clinical examination in physical abuse?
- Age / stage of development of child
- Stated mechanism of injury
- Does it fit?
- Consistency in history
- Unexplained delay in presentation?
- UNwitnessed?
- Overall pattern of injury - anything unusual / cluster of signs?
- Nature of parent / child interaction
- PMHx - previous injuries / admissions
- Risk factors in the family / social background
Maintain ‘respectful uncertainty’
What would you do if you are presented with a non-mobile infant who is bruised?
Those who don’t cruise don’t bruise.
- MUST investigate a non=mobile child with bruising.
- Accidental bruising in non-mobile infants is rare with a prevalence of <1%.
What are the typical fetures of accidental injuries in children?
What are the typical fetures of non-accidental injuries in children that should raise concern?
What are the patterns of bruising which suggest physical child abuse?
- Bruising in children who are not independently mobile.
- Bruises that are away from bony prominences.
- Bruises to the face, back, abdomen, arms, buttocks, ears and hands.
- Multiple or clustered bruising.
- Imprinting and petechiae.
- Symmetrical bruising.
Describe how children get burns and scalds.
- 70% occur in <3s.
- ~10% are abusive.
- Ratio of neglect to intentional injury 9:1.
- Toddlers 12-24m most commonly affected.
- 90% occur in the home.
- Scalds are more common than burns (60%).
- A child can sustain a burn from a contact lasting 1s with a substance at 60°.
What are the characteristics of accidental scalds?
- Anterior surface of the body
- Asymmetric
- Variable thickness
- Irregular margin
- NOT circumferential
- Usually non-tap water
What are the characteristics of abusive scalds?
- Usually affect infants and toddlers.
- Mostly immersion injury (glove and stocking appearance) - tap water.
- Often buttocks and legs.
- Frequently symmetrical and bilateral.
- May be central sparing buttocks if held against cooler bath surface compared to scalding water (doughnut ring appearance).
- Boys to girls affected 3:2.
Describe the characteristics of abusive burns.
- Anywhere on the body although rarely hands and fingers.
- Often sites which child could not reach him / herself.
- Often multiple.
- Typical sites - back, thighs, buttocks, trunk, upper arm, dorsum of hand.
- Often clearly demarcated.
- Often uniform depth across whole area of burn.
- May have shape of hot implement used.
How do you distinguish between abusive and non-abisive fractures?
- NO fractures can distinguish abusive from non-abusive.
- Abusive fractures are a small proportion of all fractures.
- Most common abusive fractures:
- <1 year - 1:2 - 1:4
- <18 months - 1:9
- 19-60 months 1:205
What is the definition of child sexual abuse?
- Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening.
- The activities may involve physical contact, inclusing assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing.
- They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet).
- Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.
What is the incidence rate of child sexual abuse in the UK?
1 in 20 children in the UK have been sexually abused
What are the possible ways that child sexual abuse can present?
- Through spontaneous account by a child.
- Through suspicion of parents, relatives or others about a child.
- Through disturbed behaviour or changes in behaviour exhibited by a child.
- Through discovery of CSA when other maltreatment is investigated.
- Through physical signs and symptoms.
- Through STIs.
Describe the communication of children who are victims of sexual abuse.
- Children are frequently unable to verbalise their experience and try to inform the world of these and their needs in a variety of very subtle ways, for example emotional and behavioural.
Describe the emotional and behavioural manifestations in children who are victims of sexual abuse.
- Sexualised behaviour
- Anxious behaviour
- Running away
- Sleep disruption
- Depressed-withdrawn, avoiding, isolated, sad, poor self-esteem
- Self-injury / overdose / suicide
- Poor school performance
What are the symptoms that a child who has been sexually abused might present with?
- Vaginal bleeding - pre-pubertal
- Genital / anal redness / soreness
- Vaginal discharge - pre-pubertal
- Vaginal foreign body
- Genital pain
- Soiling and wetting
- Urinary burning and stinging
- Pain on defaecation
- Abdominal pain
- Headaches
What is the definition of neglect?
- Neglect is the persistent failure to meet a child’s basic physical or psychological needs likely to result in serious impairment of the child’s health or development. It may involve failure to ensure access to appropriate medical care or treatment.
- In Scotland - emotional abuse, parental substance misuse, domestic abuse and neglect are the main concerns identified at child protection case conferences.
- Some experts assert that neglect is the central feature of all child maltreatment.
What are the different forms of neglect?
- Emotional
- Abandonment
- Medical neglect
- Nutritional
- Educational
- Physical
- Failure to provide supervision
What are the signs which should alert you to and illness in a child fabricated by a parent?
- Something does not add up.
- Reported symptoms and signs not observed independently in their reported context.
- Reported (or observed) symptoms and signs are not explained by child’s medical condition.
- Reported medical interventions and diagnoses not verified.
- Physical examination and results of investigation do not explain reported symptoms or signs.
- Inexplicably poor response to medication.
- Repeated reporting of new symptoms.
- Repeated presentation to different doctors and failed appointments.
- Parent(s) insistent on more, clinically unwarranted, investigations, referrals, continuation of, or new Rx.
- Quest for diagnosis.
- Impairment of child’s daily life beyond any known disorder.
What is the GMC’s stance about confidentiality when it comes to protecting children and young people?
- Falls under the responsibility of all doctors:
- Children, young people and their families hve a right ti receive confidential medical care and advice - but this must not prevent doctors from sharing information if this is necessary to protect children and young people from abuse or neglect.
- This also applies when the parent or carer is the patient.
