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SCR exam > paediatric scenario > Flashcards

paediatric scenario Flashcards

1
Q

child protection

A

activity undertaken to protect specific children who are suffering or are at risk of suffering significant harm

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2
Q

children in need

A

those who require additional support or potential to achieve their full potential

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3
Q

safeguarding children

A

measures taken to minimise the risks of harm to children

  • protecting children from maltreatment
  • preventing impairment of children’s health or development
  • ensuring that children are growing up in a safe and caring env
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4
Q

child abuse and neglect

A

anything which those entrusted with the care of children do, or fail to do, which damages their prospects of safe and healthy development into adulthood

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5
Q

definition of child abuse

A

all 3 elements must be present
significant harm to child
carer has some responsibility for that harm
significant connection between carer’s responsibility for child and harm to child

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6
Q

National Guidance Scotland

A

National Guidance for Child Protection in Scotland 2021 (2014) Scottish Gov
Children and Young People’s Act 2014
GIRFEC (not statutory)

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7
Q

The Children and Young People’s Act 2014

A 
13 parts - covers wide range of children's policy
4 major themes
 - children's rights (parts 1 and 2)
 - GIRFEC (parts 3,4,5,13)
 - early learning and childcare (part 6)
 - 'looked after' children (parts 7-11)
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8
Q

issues with The Children and Young People’s Act 2014

A

aim of act “unquestionably legitimate and benign”

specific proposals about info sharing “are not within the legislative competence of the Scottish Parliament”

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9
Q

GIRFEC in CYPA 2014 - staff and plans

A

named person for every child as a single point of contact to provide advice and support to families and to raise and deal with concerns about a child’s wellbeing
- now voluntary schemes only not mandatory
lead professional where particularly complex needs or where different agencies need to work together
- not legislated for, will remain a matter or policy and guidance only
single child’s plan - single planning process for individual children who have wellbeing needs
- legislated for in part 5

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10
Q

4 major themes of CYPA 2014

A
  • children’s rights (parts 1 and 2)
  • GIRFEC (parts 3,4,5,13)
  • early learning and childcare (part 6)
  • ‘looked after’ children (parts 7-11)
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11
Q

Glasgow city council named person

A

on website
preschool - HV
school age - teacher

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12
Q

GIRFEC in CYPA 2014 - national practice model

A

creates a shared language and approach to identifying and meeting concerns
- the well-being wheel’ (SHANARRI)
- ‘my world triangle’
- ‘resilience matrix’
shared approach to
- organising and recording info about a child
- discussing ways of addressing concerns about wellbeing
recommend - used by all agencies, inc when recording routine info
GIRFEC - emphasis on way that info is shared and recorded by different professions
the SHANARRI indicators and a concept of ‘wellbeing’

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13
Q

SHANARRI

A 
Safe
Healthy
Achieving
Nurtured
Active
Respected
Responsible
Included
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14
Q

outer cog of SHANARRI wheel

A

responsible citizens
successful learners
confident individuals
effective contributors

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15
Q

my world triangle

A

how I grow and develop
what I need from people who look after me
my wider world

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16
Q

when is the resilience matrix used?

A

when required for more complex situations

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17
Q

resilience matrix

A 
resilience
                          ^
adversity     ---- l  -- >    protective env
                          l
                 vulnerability
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18
Q

national practice model

A 
1 - wellbeing concerns
 - observing and recording 
 - events/observations/other info
 - SHANARRI model
2 - assessment - appropriate, proportionate, timely
 - gathering info and analysis
 - my world, resilience matrix
3 - well-being desired outcomes
 - planning action and review
 - SHANARRI model
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19
Q

CYPA and info sharing

A

if safety is at risk
where benefits outweigh the public and individual’s interest in keeping info confidential
good practice to get consent where possible and safe to do so
share what you need to and keep a note of what and why you have shared the info
not restricted to instances where sig risk of harm

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20
Q

International - UNCRC

A

UN Convention on the Rights of the Child

based on the needs of children

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21
Q

UNCRC - Children and Young People’s Charter

A 
right to respect
right to info about yourself
right to be protected from harm
right to have a say in your life
right to a good start in life
right to be and feel secure
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22
Q

areas UNCRC criticised UK

A 
protection
 - physical abuse and violence 'reasonable chastisement'
 - teenagers penal system
 - asylum seeker children
participation
 - disabled children
 - access to info
provision
 - poverty
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23
Q

child abuse aetiology - contributing factors

A

adults: drugs, alcohol, poverty, unemployment, marital stress, disabled, domestic violence, mental illness, step parents, isolation, abused as child, unrealistic expectations
child: crying, soiling, disability, unwanted pregnancy (born at wrong time). failed expectations, wrong gender, product of forced, coercive or commercial sex
community/env: dwelling place and housing conditions, neighbourhood
family violence and dysfct family: intergenerational cycle, violence towards pets, social isolation, poverty

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24
Q

parenting capacity - the 3 big concerns

A

domestic violence
drug and alcohol misuse
mental health problems
= cumulative problems increase likelihood of a negative outcome

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25
Q

categories of child abuse

A 
physical
emotional
neglect
sexual
(non-organic failure to thrive)
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26
Q

vulnerable children groups

A

U5s (not at school, less interaction w other adults)
irregular attenders
- repeatedly not brought, return in pain, exposed to risks of GA
medical problems and disabilities
- more at risk of experiencing abuse of all kinds
- serious impairment of health or development is more likely as a result of untreated dental disease
- ‘looked after’ children

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27
Q

UK child abuse deaths

A

1-2 per week

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28
Q

Scotland child deaths by parent/sub

A

10 pa

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29
Q

child’s needs

A 
nutrition
warmth, clothing, shelter
hygiene and healthcare
stimulation and education
affection
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30
Q

effects of neglect - S+S

A

FTT/short stature
inappropriate clothing, cold injury, sunburn
ingrained dirt (finger nails), head lice, caries
developmental delay
withdrawn/attention seeking behaviour

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31
Q

neglect of neglect

A

possible as neglect is less incident focused/less shared understanding of what is meant by neglect and how it should be responded to

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32
Q

typical cases where neglect can kill

A

child <1yr deprived of food and drink

older independently mobile, inadequately supervised

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33
Q

short-term damage caused by neglect

A

physical health
emotional health
social development
cognitive development

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34
Q

long-term damage caused by neglect

A

adults neglected as children - higher incidence of:

- arrest, suicide attempts, major depression, diabetes, heart disease

35
Q

BSPD dental neglect

A

the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development

36
Q

how does dental neglect link to general neglect?

A 
severe dental neglect can cause:
 - toothache
 - disturbed sleep
 - diff eating/change in food preferences
 - absence from school
dental disease may put child at risk of
 - teasing due to poor dental appearance
 - repeated ABs
 - repeated GA exts
 - severe infection
37
Q

when is neglect wilful?

A

after dental problems have been pointed out:

  • irregular attendance, repeated failed appts, repeated late cancellations
  • failure to complete tx
  • returning in pain at repeated intervals
  • repeated GA for dental exts
38
Q

indicators of dental neglect

A

obvious dental disease (lay person can see)
impact on child
practical care has been offered, yet the child has not returned for tx

39
Q

where is guidance for managing dental neglect from?

A

child protection and the dental team

40
Q

stages of managing dental neglect

A

preventive dental team management
preventive multi-agency management
child protection referral

41
Q

preventive dental team management

A 
raise concerns with parents
offer support
set targets
keep records
monitor progress
send reminder of tx
42
Q

preventive multi-agency management

A

liase with other professionals (e.g. HV, School nurse, GP, social worker) to see if concerns are shared
a child may be the subject of a CAF at this level
check if child subject to a child protection plan (which replaced the child protection register)
agree joint plan of action, review at agreed intervals

43
Q

dental neglect - child protection referral

A

in complex or deteriorating situations
follow local guidelines
referral is to SS
- usually by phone followed up in writing

44
Q

Common Assessment Framework

A

lower level early intervention to provide support
- not at a child protection/safeguarding report level

child’s developmental needs
family and env factors
parenting capacity

45
Q

types of physical abuse

A 
over chastisement (cultural)
acute/compassionate (shaking)
 - spontaneous uncalculated reaction
 - remorse, takes appropriate action
 - child's needs are priority
chronic/pathological (way of life)
 - help sought but not actively
 - no remorse
 - child's needs not a priority
46
Q

Scotland and physical abuse

A

already illegal to hit a child with an object or to hit them anywhere on the head
2019 - Children (Equal Protection From Assault) (Scotland) Bill was passed - removes “reasonable chastisement” excuse from law
- from 7th Nov 2020 it is illegal to physically punish a child

47
Q

what law in Scotland removes “reasonable chastisement” from law?

A

2019 Children (Equal Protection From Assault) (Scotland) Bill

48
Q

physical abuse types of injuries and %s

A

head - 95% of serious head injuries in first year of life
body - 10% of 5yr olds attending A and E
10-12% of childhood burns non-accidental
approx 60% of injuries in abuse cases are on H+N

49
Q

typical accidental injuries

A 
head injuries tend to involve parietal bone, occipuit, or forehead
forehead
nose
chin
palm of hand
elbows
knees
shins
typically
 - involve bony prominences
 - match the hx
 - are in keeping with the development of child
50
Q

non-accidental injuries locations

A 
ears - esp pinch marks involving both sides of ear
"triangle of safety" - ears, side of face and neck, top of shoulders
inner aspects of arms
back and side of trunk, except directly over bony spine
black eyes (esp if bilateral)
STs of cheeks
IO injuries
forearms when raised to protect self
chest and abdomen
any groin/genital injury
inner thighs
soles of feet
51
Q

types of injury that raise concerns

A

injuries to both sides of body
injuries to STs (without bony prominences also)
injuries with particular patterns
any injury that doesn’t fit the explanation
delays in presentation
untxed injuries

52
Q

orofacial EO signs of abuse

A 
bruising of face - punch, slap, pinch
bruising of ears - pinch, pull
abrasions and lacerations
burns and bites
neck - choke and cord marks
eye injuries
hair pulling
fractures - nose > mandible > zygoma
53
Q

when can bruising be suspicious?

A

different vintages
tattoo bruising - matches instrument
shape of slap, grip etc

54
Q

orofacial IO signs of abuse

A 
contusions
bruises
abrasions and lacerations
burns
tooth trauma
frenal injuries
 - in a non-mobile child v suspicious
55
Q

approx prevalence of IO injuries in physical abuse

A

33%

56
Q

medical equivalents of physical abuse

A

impetigo - similar to cigarette burns
birthmarks - mistaken for bruises
facial infection - mistaken for trauma
coagulation problems - bruise easily

57
Q

Index of Suspicion

A

delay in seeking help
story vague, lacking in detail, vary with each telling and person to person
account not compatible with injury
parent’s mood abnormal, preoccupied
parent’s behaviour gives cause for concern
child’s appearance and interaction with parents is abnormal
child may say something contradictory
history of prev injury
history of violence within the family

58
Q

final checklist

A

could injury have been caused accidentally and if so how?
does explanation for injury fit age and clinical findings?
if explanation is consistent with the injury, is this itself within normally acceptable limits of behaviour?
if there has been a delay in seeking help/advice, are there good reasons for this?

59
Q

what is expected of the dental team?

A 
observe
record
communicate
refer for assessment
 = not expected to diagnose
60
Q

who can you share concerns with?

A

named person

61
Q

where to go for help and advice

A 
experienced colleague
named safeguarding nurse
child protection advisor
named doctor for safeguarding
social services
children's services department (e.g. First Contact)
NSPCC helpline
Paeds department
62
Q

reasons for not telling parent about a referral

A

would put child in danger

unable to contact them

63
Q

how to complete a child protection referral

A

telephone initially, follow up in writing
- facts, statement of concerns
notification of concern form/shared referral form

64
Q

components of shared referral form

A 
referrer details
designated contact person (if not you)
referral to (who you spoke to on phone)
subject of referral
family details (leave blank if don't know)
 - inc other adults in household and siblings not subject to referral
summary of concerns
reason for referral/request for services
 - reason for concern
 - alleged abuser (if applicable)
 - any actions you have taken
agreed actions (during phone call)
agency involvement e.g HV/GP/school
sign and date
65
Q

what should you get after referral?

A

a form back

66
Q

in GGC what should be done with the referral forms?

A

keep one in pt records
one to child protection unit
one to SS

67
Q

what happens after referral if child is in immediate danger?

A

child protection order
exclusion order
child assessment order
removal by police or authority of a justice of the peace - emergency police powers

68
Q

child protection order

A

can be issued to immediately remove a child from circumstances that put them at risk, or to keep a child in a place of safety.

69
Q

exclusion order

A

can be issued to remove a suspected abuser from the family home. Only the local authority can apply for an exclusion order.

70
Q

child assessment order

A

requires parents to allow their child’s needs to be assessed by a social worker. A CAO can only be applied for by the local authority.

71
Q

when can emergency police powers be used?

A

If a sheriff isn’t available, the police or someone authorised by a justice of the peace can remove a child to a place of safety for up to 24 hours, allowing time for a CPO.

72
Q

what happens routinely after a child protection referral?

A

investigation, initial assessment, discussion
- begin to decide if child is at risk of significant harm

outcome
1 - no further CP action, may get additional support
2 - joint investigation - child protection planning meeting
- decide if put on CP Register
- draw up child protection plan
- may need to be referred to Children’s Reporter and any court proceedings
- get review meetings every 6m

73
Q

Glasgow City Council CP contacts

A 
emergency - 999
office hours - Social Care Direct
out of office hours - Glasgow and Partners Emergency Social Work Services
Police 101
health professionals

mygovscot - choose council to get numbers

74
Q

GDC standards

A

must raise any concerns
know who to contact for advice and how to refer concerns
find out about local procedures
follow these procedures

if you make a professional judgement and decide not to share your concern with the appropriate authority, you must be able to justify how you came to this decision
- contact your defence organisation for advice

75
Q

NHS GGC raising a notification of concern

A

can cover until 18
inform local SWS snd/or Police Scotland by phone initially, clearly stating they are raising a possible child protection concern
immediate danger 999
a NOC must be completed and submitted within 48hrs following initial telephone call
- support from line manager and/or child protection service
share relevant and proportional info
- if not known don’t delay NOC
document concerns and actions at earliest opportunity within child’s health record and within chronology of significant events

76
Q

NOC form NHS GGC

A 
electronic via clinical portal, EMIS, Corporate Services tab
once completed NOC form
 - 1 - child's record
 - 2 - SWS
 - 3 - notify CPS
77
Q

when wouldn’t you notify family of NOC?

A

in exceptional circumstances e.g. staff felt at personal risk, or by doing so puts the child at extra risk

78
Q

whose responsibility?

A

everyone’s responsibility
shared responsibility
responsibility of every member of the dental team

79
Q

when not to inform parents

A

where discussion might put the child at increased risk
where discussion would impede a police investigation or social work enquiry
where sexual abuse by a family member, or organised or multiple abuse is suspected
where fabricated or induced illness is suspected
where parents or carers are being violent or abusive, and discussion would place you or others at risk
where it is not possible to contact parents/carers without causing undue delay in referral

80
Q

6 tips for GDPs

A 
identify staff member to take lead on CP
adopt a CP policy
work out a step-by-step guide of what to do if you have concerns
follow best practice in record keeping
undertake regular team training
practice safe staff recruitment
81
Q

how often should you do CP training?

A

Royal College of Paediatrics and Child Health - recommend CP training minimum every 3 years
on GDC recommended CPD topics

82
Q

GIRFEC approach

A

child-focused
based on an understanding of the wellbeing of a child in their current situation
based on tackling needs early
requires joined up working

83
Q

Named Person Service - now optional for LAs

A

every <18 in Scotland will have a ‘named person’
under school age - duty HB
school age and over - duty LA
exceptions
- child in secure accommodation - manager of secure unit
- attend independent schools - manager of school
? who within LA for those leaving school at 16

SCR exam (2 decks)

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