Safe-Guarding Children

Question 1

What 3 elements must be present for it to be classified as child abuse?

Answer 1

Significant harm to the child

Carer has some responsibility for that harm

Significant connection between carer’s responsibility for child and harm to child

Question 2

Why legislation exists for child welfare?

Answer 2

The Children and Young People’s Act 2014.

Question 3

What does the CYPA state with regards to information sharing?

Answer 3

Information can be shared when safety is at risk or where the benefits of sharing the information outweigh the public and individual’s interest in keeping info confidential.

Good practice to get consent where possible and if safe to do so.

Question 4

What etiological factors may be present in child abuse?

Answer 4

Parental drug abuse
Poverty
Unemployment
Marital stress
Mental health
Domestic violence
Abused as a child

Crying
Soiling
Disability
Unwanted pregnancy
Wrong gender

Question 5

What are the big three concerns when it comes to child abuse?

Answer 5

Domestic abuse

Drug and alcohol misuse

Mental health problems

Question 6

Which children are most vulnerable?

Answer 6

Under 5’s

Irregular attenders

Medical problems and disabilities

Question 7

What is dental neglect?

Answer 7

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.

Question 8

What are some of the consequences of dental neglect?

Answer 8

Toothache
Infection
Disturbed sleep
Time off school
Difficulty eating
teasing due to poor dental appearance
Repeated antibiotics
Repeated GA

Question 9

What are the signs of dental neglect?

Answer 9

Obvious dental disease

Irregular attendance, repeated failed appointments despite the knowledge that something is wrong
Returning in pain at repeated intervals
Repeated GA for dental extractions
Practical care has been offered but the child has not returned for treatment.

Question 10

Describe the procedure of managing dental neglect.

Answer 10

1. Preventive dental team management
   - Raise concerns with parents, explain your clinical findings, offer support, set targets, keep records and monitor.
2. Preventive multi-agent management
   - liaise with other professionals- GMP, school nurse, health visitor, social worker.
   - Check if the child is the subject of a child protection plan.
3. Child protection referral to social services- usually by telephone and in writing.

Question 11

What injuries to the head and neck are not likely to be accidental?

Answer 11

Difficult to injure the triangle of safety- ears, side of face, neck and top of shoulders.

Any groin injury or injury to the inner aspect of the thigh.

Soft tissue injury without injury to the underlying bone.

Question 12

What oro-facial signs would suggest abuse?

Answer 12

Bruising of the face and ears
Abrasions and alterations
Burns and bites
Choke marks on neck
Eye injury
Fractures of bone
Intracranial lesions from shaking
Bruising in different stages of healing
Hair pulling
Gripping or slap marks
Tooth trauma
Frenal injuries

Question 13

What would cause you to be suspicious of abuse?

Answer 13

Recall of how the injury happened doesn’t add up tot he injuries you see in front of you

Recall of the injury doesn’t fit with the child’s age or physical status

Story changes every time the parent recalls it

Delay in presentation for healthcare following the injury

Bruising of different healing status

Parents behaviour gives a cause for concern

Patient’s behaviour around parents is not normal

Child may say something contradictory

History of violence within the family

Question 14

What is expected of the dental team with regards to child abuse?

Answer 14

Observe
Record
Communicate
Refer for assessment

Question 15

Who would you share your concerns with?

Answer 15

Named person for the child/family.

Named safeguarding nurse

Child protection advisor

GMP

Social work

Question 16

How would you refer a child that you suspect is being abused?

Answer 16

Tell the parent and patient about your concerns and that you wish to investigate it further.
Telephone social services and explain situation and that you will be filling in a NOC for the patient.
Follow this up in writing (must be within 48 hours of telephone call to SWS)- notification of concern form/shared referral form.
- Also send a copy to CPS and document this form in the child’s medical records.

After referral if the child is in immediate danger- phone the police.

Question 17

Under what circumstances would you not want to tell the parent/guardian that you are going to complete a NOC?

Answer 17

If you believe that you yourself would be at risk or that the child would be at risk.

Question 18

What happens if you don’t agree with the outcome of the investigation following a NOC submission?

Answer 18

You can discuss with social work or line manager.

Should contact NHSGGC child protection service for advice and support.