Non Accidental Injury and Child Protection Flashcards
What are some suspicious features of bruises
Location - head, ears, neck, soft areas (upper arm, thigh) , defensive areas (arm, back of hands etc)
Any bruises in non-mobile infants
Bruises in the shape of pattern or object
Bruise pattern not matching the explanation
What is a tramline bruise
Occurs when a linear object hits the skin
Blood vessels either side of impact tear but ones at site are compressed
Bruise forms with central clearing (2 lines)
What is the difference between a burn and a scald
Burns are caused by dry heat - e.g. flame
Scalds are caused by moist heat - oil or steam
What are suspicious features of burns
In a child that isn’t mobile
Areas that wouldn’t normally be exposed to heat - buttocks etc
In a shape or pattern ]
Glove or stocking distribution suggesting immersion
What is a skeletal survey
A series of X-rays taken from a child with suspected NAI
It detects previous fractures
List suspicious features of a fracture
Rib fractures in kids
Posterior rib fractures are highly specific to abuse - caused by a crush injury to chest
Metaphyseal fracture -caused by pulling or swinging
C spine fracture - caused by shaking
Skull fractures - if fell less than 3ft or associated with brain injury
Any fracture in a non-mobile child
Femoral fracture in a child who doesn’t yet walk
Multiple fractures or fractures of different ages
Fracture that doesn’t fit the story
What can cause NAI of the head in a child
Shaking
Hitting
Throwing the child
What are the classic triad of symptoms of a shaken child
Bilateral retinal haemorrhages
Subdural haemorrhage
Encephalopathy
List symptoms of NAHI
Skull fracture
Extradural haemorrhage
Confusion and decreased consciousness
(also retinal, subdural haemorrhages and encephalopathy if shaken)
What are abrasions
Areas where the epidermis has been crushed or scraped due to contact with a blunt object
Tend to be superficial and heal quickly
How can crush abrasions identify mechanism of injury
May leave a pattern, identifying the object used
How can scrape abrasions identify mechanism of injury
Leave skin tags and lines showing direction of injury
What are some suspicious features of abrasions
Present on non-mobile child
Symmetrical arrangement
On areas usually covered e.g. back, axilla
On areas unlikely to be hit when playing - ears etc
Around the ankles/wrists - ligature marks
Shape or pattern
List the different types of abuse
Physical Sexual Emotional Neglect Special cases - non-organic failure to thrive, fabricated or induced illness and child trafficking
List risks of abuse
Domestic abuse Parental drug and alcohol misuse Parent's being abused as children Mental health problems Lack of support - e.g single parent Disabilities or additional needs Non-engaging families Poverty Harmful or problematic sexual behaviour
What are the main child protection guidelines/principles in Scotland
GIRFEC and the SHANNARI
What is the threshold for interfering in a patient’s private family life
If you believe they are at risk of significant harm
The psychological impact of abuse is often related to the severity of the injury - true or false
False
It doesn’t have to be a severe injury to cause a big psychological effect
Often more related to chronicity - how frequently it happens
List some possible signs of emotional abuse in a child
Over-reaction to mistakes Sudden speech disorders Neurotic behaviour e.g. rocking, hair-twisting, thumb sucking Self mutilation Extremes of passivity or aggression
List some possible signs of neglect in a child
poor growth/ faltering growth inappropriate clothing frequent injuries ingrained dirt developmental delay withdrawn or attention seeking behaviour failure to respond to a known significant medical/ dental problem Irregular attendance and repeatedly failed appointments Failure to complete planned treatment
List some possible signs of sexual abuse in a child
Disclosure/ direct allegation
Sexually explicit behaviour, drawings, etc
Pregnancy
Emotional and behavioural signs e.g. anxiety and depression, self-harm, drug, solvent or alcohol abuse
Major changes in behaviour
What investigations would you do on a child < 1 year old with suspected NAI
CT Brain
Skeletal survey - with repeat x-rays 2 weeks later
Ophthalmology exam
Plus any others which are clinically indicated
What investigations would you do on a child < 2 year old with suspected NAI
Skeletal survey - with repeat x-rays 2 weeks later
Plus any others which are clinically indicated
What investigations should be performed on a child with suspicious fractures
Bone profile
Skeletal survey - with repeat x-rays 2 weeks later
Phosphate, PTH, Vit D
Copper and caeruloplasmin - rule out Menke’s disease
