Paeds Flashcards
What is safeguarding?
The action that is taken to PROMOTE THE WELFARE of all children and young people (CYP) and PROTECT THEM FROM HARM/MALTREATMENT.
What are the 4 forms of maltreatment?
- Physical.
- Emotional.
- Sexual.
- Neglect.
What is child protection?
- A PART of safeguarding.
- and includes activities undertaken to PROTECT CYP WHO HAVE BEEN HARMED or are at SIGNIFICANT RISK OF BEING HARMED.
What do the GDC standards outline regarding child protection responsibility? (3)
- The ENTIRE DENTAL TEAM have an ethical responsibility to FIND OUT ABOUT & FOLLOW LOCAL PROCEDURES involved in RAISING CONCERNS about possible abuse and neglect of children.
- This is NOT just the dentist’s responsibility but shared by all team members.
- NOT responsible for MAKING A DIAGNOSIS but to SHARE CONCERNS appropriately.
What is child abuse/ neglect? 4 examples
Anything which those entrusted with the care of children do or fail to do which DAMAGES THEIR PROSPECTS OF SAFE & HEALTHY DEVELOPMENT INTO ADULTHOOD.
- physical, emotional, sexual, neglect.
How common is child abuse?
1 child per 1000 under 4 suffer from severe physical abuse.
4 categories of contributing factors to the aetiology of child abuse?
- Adult.
- Child.
- Community/ environmental.
- Family violence and dysfunctional family.
12 adult contributing factors to aetiology of child abuse?
- Drugs, alcohol.
- Poverty.
- Unemployment.
- Marital stress.
- Domestic violence
- Mental illness.
- Disability.
- Step parents.
- Isolation.
- Abused as a child.
- Unrealistic expectations.
7 child contributing factors to aetiology of child abuse?
- Crying.
- Soiling.
- Disability.
- Unwanted pregnancy.
- Product of forced/coercive/commercial sex.
- Wrong gender.
- Failed expectations.
2 community/environmental contributing factors to aetiology of child abuse?
- Dwelling place & housing conditions.
- Neighborhood.
3 family contributing factors to aetiology of child abuse?
- Violence towards pets.
- Social isolation.
- Poverty
3 major parenting factors that can increase risk of child abuse?
- Parental substance misuse.
- Parental mental ill-health.
- Domestic abuse.
3 characteristics of accidental injuries?
Typically:
- Involve bony prominences.
- Match the history.
- Are in keeping with the development of the child.
7 characteristics that raise concern of non-accidental injury?
- Injuries to both sides of the body.
- Injuries to soft tissue.
- Injuries with particular patterns.
- Injuries that don’t match the explanation.
- Delays in presentation.
- Untreated injuries.
- Injuries in triangle of safety.
What is the triangle of safety?
Ears, side of face and neck, top of shoulders.
Accidental injuries in this areas are unusual.
4 children considered “VULNERABLE CHILDREN”?
- Under 5s.
- Irregular attenders.
- Medical problems and disabilities.
- Looked after children.
Why are irregular attenders considered vulnerable? (3)
- Repeatedly DNA.
- Return in pain.
- Exposed to risks of GA.
Why are children with medical problems/ disabilities considered vulnerable (2)?
- More at risk of experiencing abuse of all kinds.
- Serious impairement of health/ development more likely as a result of untreated dental disease.
What children are considered “looked after children” (2)?
- Children who are subject to compulsory measures of care are deemed as looked after by their local authority.
- Children accommodated by the local authority on a voluntary basis with consent from parents (includes children receiving respite care).
Where may looked after children be living (4)?
- Foster homes.
- Their own homes.
- In the care of relatives.
- Residential establishments.
Define dental neglect?
PERSISTENT failure to meet a CYP’s basic oral health needs likely to result in the SERIOUS IMPAIREMENT of their ORAL or GENERAL HEALTH or DEVELOPMENT.
3 legislative frameworks on child protection?
- National guidance for child protection Scotland (2021).
- Scottish approach (GIRFEC policy and practice model).
- Engagement with children in child protection - Children Scotland act 2020.
What does the national guidance for child protection Scotland 2021 state?
The most effective protection of children involves early support
What are the SHANARRI principles?
- Safe.
- Healthy.
- Achieving.
- Nurtured.
- Active.
- Respected.
- Responsible.
- Included.
What would be considered dental neglect?
- OBVIOUS DENTAL DISEASE with an IMPACT on CYP, particularly if CARE has been offered.
- Number of carious teeth in itself is not an indicator.
5 reasons why the number of carious teeth does not indicate the severity of dental neglect?
- Multi-factorial aetiology of dental caries.
- Variation in individual susceptibility.
- Inequalities in dental health (regional, social class).
- Inequalities in access to dental treatment.
- Differences in treatment philosophies.
What are 3 ways to manage dental neglect?
- A preventive dental team response (raise concerns with parents, offer support, set targets and monitor progress).
- A preventive multi agency response (contacting other professions who you know are involved with the family ex. named person, social worker, GP, school nurse).
- Child protection referral.
What is involved in a preventive dental team approach to dental neglect?
- Raise concern to parents.
- Offer support.
- Set targets.
- Monitor progress.
What is involved in a preventive multiagency approach to dental neglect?
- Contacting other professions who you know are involved with the family.
- GP, social worker, school nurse, named person.
What does ACE stand? What is it?
- Adverse childhood events.
- Stressful or traumatic experiences that occur during childhood.
What do ACEs increase the risk for (5)? How many ACEs are needed?
- Heart disease.
- Type 2 diabetes.
- Mental illness.
- Commit violence.
- Imprisonment.
- Risk increases with 4 or more ACEs.
Examples of ACEs (9)?
- Verbal abuse.
- Physical abuse.
- Domestic abuse.
- Parental separation.
- Household mental illness.
- Household alcohol abuse.
- Sexual abuse.
- Household drug abuse.
- Incarceration of household member.
What must be done regarding ACEs?
Identify early and support mechanisms in place.
4 things that would raise concerns of neglect?
- Dirty.
- Child small/ failing to thrive (no explanation in MH).
- Atypical behavior (ex. anxious, watchful, agression).
- **Presentation of parent/ child).
What is expected of the dental team regarding neglect (5)?
- Observe.
- Report.
- Communicate.
- Refer for assessment.
- NOT expected to diagnose.
What do you do if you have concerns about a child’s welfare even after consulting with experienced colleagues?
Contact one of the CORE AGENCIES with a NOTIFICATION OF CONCERN FORM.
(social work, police, health education).
What are the 3 different possible responses to a notification of concern from?
Decision of core agencies:
1. No action, concerns noted.
2. Single agency response.
3. Joint action.
What do you do if you have concerns about a child’s welfare but you NO LONGER DO after consulting with experienced colleagues?
- No further child protection action.
- Other actions needed: provide necessary dental car, keep full clinical records, arrange dental follow-up as indicated.
6 local contacts for when you have a child protection concern?
- Child protection policy.
- Paediatric consultant on call.
- Lead person for child protection.
- Social work.
- Police public protection unit (101).
- Child protection advice line.
What happens when the core agencies decide the concern “not progressed as child protection concern”?
Other services may be needed/ provided
What happens when there is a single agency response?
- Further assessment.
- Single agency support.
What happens when there is inter-agency reponse?
- Investigation.
- Medical.
- Immediate emergency action - CP case conference (child protection register, child protection plan).
3 key outcomes of the Children’s Act 2020 document?
- Any child irrespective of their
age can have their views heard in court. - Children can express their views
through art or a letter whichever way they feel comfortable and able. - All decisions
from a children’s hearing have to be explained in a manner they can
understand.
What should you do if you have a welfare concern (2)?
- Initial referral by telephone.
- Follow up in writing in 48 hour - Notification of concern form (proforma).
What is the course of action taken after a welfare concern has been made?
- Investigation.
- Initial assessment.
- Discussion to assess if CYP is at risk of significant harm.
What happens if there is immediate danger?
Child protection order is issued to remove CYP from their parents/ carers.
What is the difference between safeguarding and protection?
- Safeguarding: a PREVENTIVE approach to child protection by minimising or eliminating harm to a child.
- Protection: a REACTIVE approach to address suspected/ known cases of abuse or neglect.
3 things neglect may involve?
Failure to:
- Provide adequate food, clothing, shelter.
- Protect a child from physical/ emotional harm.
- Ensure adequate supervision.
What is often a key indicator of neglect? (2)
- DENTAL neglect often a key indicator of neglect.
- 60% of child victims of physical abuse show signs in the H and N region.
What is Gillick competence?
In Scotland under 16s can consent to medical or dental treatment if a doctor believes they understand THE PROCEDURE, ITS RISKS and ALTERNATIVES.
What is done when an under 16 is deemed to not have gillick competence?
- Children (Scotland) Act 1995 applies.
- Whoever has PARENTAL RESPONSIBILITY can provide consent.
