S1 - Child Safeguarding Flashcards
Wh at is child abuse?
Maltreatment of a child (<18yrs)
• Infliction of harm OR
• Failing to act to prevent harm
• ‘Significant harm’
– Ill-treatment or impairment of health or
development
Legal justification for LA intervention in family life
Categories of Child Abuse
1- Neglect
• Physical
– Including FII/perplexing presentations
– Including FGM
2- Sexual
3- Emotional
What is neglect ?
The persistent failure to meet a child’s basic
physical and / or psychological needs, likely to
result in the serious impairment of the child’s
health or development.
- May occur during pregnancy as a result of
maternal substance abuse.
Examples of neglect ? (Once a child is born)
Failure of parent to -
Provide adequate food, clothing, shelter
Protect a child from physical and emotional harm or danger
Ensure adequate supervision
Ensure access to appropriate medical care or
treatment
neglect of, or unresponsiveness to,
a child or young person’s basic emotional need
Examples of neglect based on history ?
Neglect based on patients history
Recurrent non-attendance at appointments/non-adherence to medication
Missed routine screening/immunisations Faltering growth
Delay in development
Recurrent infestations/infections/injuries
Poor school attendance
History of injury where explanation suggests inappropriate supervision
Examples of neglect based on examination ?
Neglect based on patients examination
Poor nutritional status/poor growth
Dental decay
Signs of recurrent/chronic infection or infestation
Dirty/unkempt/smelly
Define Physical abuse ?
May involve hitting, shaking, throwing,
poisoning, burning or scalding, drowning,
suffocating or otherwise causing physical
harm to a child.
Physical harm may also be caused when a
parent or carer fabricates the symptoms of illness OR
deliberately induces, illness in a child
Examples of physical abuse based in child’s history ?
Lack of or inadequate explanation for injury
Delay in seeking medical attention / inappropriate response
Inconsistent accounts
Presence of multiple risk factors/Child or family known to SocialCare
Direct disclosure
What should you investigate if a child’s examination reveals unexplained bruises ?
If under age of 2 = concerning
Under 1 = very concerning
Check for medical reasons - FBC , look at clotting factors
Do heat CT - any brain bleeds
Retinopathy - eye bleeds from shaking child
Examples of physical abuse based on child’s examination ?
Unexplained bruising in vulnerable child
Unexplained fractures/burns/scalds/head injury
Patterns: Implement/sparing/bites
Injury not consistent with history developmental age
Examples of sexual abuse in children ?
Forcing or enticing a child or young person to take part in
sexual activities, not necessarily involving high levels of
violence, whether or not the child is aware of what is
happening.
• May involve physical contact (including assault by penetration
or non-penetrative acts)
• May be non-contact activities (involving children looking at or
producing sexual images, watching sexual activities,
encouraging children to behave in sexually inappropriate
ways, grooming.
• Can take place online, and technology used to facilitate offline
Child sexual exploitation - what is it ?
An individual or group takes advantage of power imbalance to coerce, manipulate or deceive a CYP (<18 yrs) into sexual
activity
a) In exchange for something the victim needs / wants, and / or
b) For financial advantage / increased status of the perpetrator.
Does child sexual exploitation always have to involve physical contact ?
No - can occur through technology
In child sexual exploitation , the child appears consensual - is it still child sexual exploitation then ?
Yes , Victim may have been exploited even if sexual activity
appears consensual.
Sexual abuse , examples of it seen in child’s history ?
Disclosure
Pregnancy/signs of sexual activity in child under 13yrs
STIs
Anogenital injury/unexplained bleeding Recurrent vaginal discharge
Soiling/wetting ( in child who has previously potty trained) differential diagnosis
Behavioural change
What should you do if you see Sexual abuse in child’s examination ?
STEPS you would take
Immediate health needs are paramount
Referral to Social Care
Forensic assessment undertaken at specialist
Sexual Assault Referral Centre by staff with appropriate skills & expertise
What is child emotional abuse ?
Persistent emotional maltreatment of a child causing severe and persistent adverse effects on the child’s emotional development.
Broad Examples of child emotional abuse ?
Rejecting
Isolating
Terrorising
Ignoring
Corrupting
Cyberbullying
Specific examples of emotional abuse ?
Conveying worthlessness/unloved/inadequate Deliberately silencing or making fun of child’s voice
Imposing age/developmentally inappropriate expectations on children
Ex - Overprotection & limiting of exploration or learning
Ex- Preventing participation in normal social interaction
– Serious bullying/exploitation/corruption
Child emotional abuse based on history (non specific ) in infants ?
Feeding difficulties
crying
poor sleep patterns
delayed development.
Child emotional abuse based on history (non specific ) in toddlers / pre school
Behavioural spectrum from overactive to apathetic, noisy to quiet, dev delay
Child emotional abuse based on history (non specific ) in school aged
Wetting & soiling, relationship difficulties, poor school performance, non-
attendance, antisocial behaviour
Child emotional abuse based on history (non specific ) in Adolescents ?
Depression, self-harm, substance misuse, eating disorders, oppositional,
aggressive, delinquent behaviours.
Child emotional abuse based on history (non specific ) across all ages
Growth (underweight)
emotional signs (non-specific)
behavioural (wide range),
development (failure to achieve milestones, academic failure)
What is the wider context of safeguarding?
Online abuse & grooming
Child Criminal exploitation/County lines
Trafficking
Radicalisation
Modern slavery Female genital mutilation/cutting
Forced marriage
Honour based violence
Discriminatory abuse
Risk factors for child abuse - what is the triad of vulnerability ?
Domestic abuse
Mental illness of parent or carer
Parental drug and / alcohol misuse
What are some risk factors for child abuse ?
Triad of vulnerability
Under 2 years
Pre-verbal babies & children
Those with additional needs/disability
Vulnerable/marginalised young people
What are ACE’s (adverse childhood experiences)
Any child who’s Been exposed to :
Physical abuse & neglect
Sexual abuse
Emotional abuse & neglect
Domestic violence
Mental ill-health
Incarceration
Substance misuse
Parental separation
What are some interventions and support mechanism for children undergoing abuse ?
Universal services
Early Help
Child in Need – consent required.
Section 17 Children Act 1989
Child Protection – consent not required.
Section 47 Children Act 1989
If you have concerns about a child , what should your next steps be ?
1 - Refer to local authority (social care / MASH)
2 - Re asonable cause to suspect that a child who lives or is found in their area is suffering, or is likely to suffer, significant harm
3 - Duty to make enquiries under Section 47(1) of the Children Act 1989
If you have concerns about a child’s safety what should you do ?
If a child discloses abuse or you are concerned
for their welfare:
(Not next steps, think how would you treat child)
Don’t ask leading questions.
Document verbatim what was said.
Don’t promise confidentiality.
Talk immediately to one of the professionals you are working with – they will escalate
appropriately.
Advantages of reviewing child deaths ?
To establish, where possible, a cause or causes of child deaths (with the coroner)
To identify any potential contributory &
modifiable factors
To provide ongoing support to the family
To learn lessons in order to reduce the risk of
future child deaths
Who is involved in Child Death Review process?
Health (ICB) & Local Authority funded
CDR Team: Designated Dr, Nurses, Manager, Admin
Immediate response:
– Health, Social Care, Police
Review process: all agencies involved in the care of the ex - public health
child in life or investigating the death
