Safeguarding Flashcards

1
Q

What is neglect?

A

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

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2
Q

Examples of neglect

A

Substance misuse in pregnancy
Failing to provide adequate food/shelter/clothing/protection from danger and abandonment
Failing to ensure adequate supervision
Failing to provide appropriate medical care
Failing to respond to child’s basic emotional needs

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3
Q

Possible indicators of neglect

A

Dirty bedroom, no sheets on bed, inappropriate sleeping place
Being tired all the time
Being unkempt, dirty or smelly
Frequently missing school or being late
Failing to keep medical appointments
A baby who never cries
Loss of weight or constantly being underweight
Dressed inappropriately for the weather conditions
Learning disabilities due to poor brain development
Psycho-social development, depression, psychiatric illnesses and personality disorders
Untreated medical conditions
Being left unsupervised regularly

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4
Q

Examples of physical abuse

A
Shaking 
Throwing
Poisoning
Burning/scalding 
Drowning
Hitting
Suffocating
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5
Q

When are non-accidental injuries suspected?

A
Injuries to both sides of the body
Injuries to soft tissue
Injuries with particular patterns
An injury that doesn’t fit the explanation given 
Delays in presentation
Untreated injuries
Bruising on pre-mobile babies
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6
Q

Areas of non-accidental injury

A
Ears- pinch marks
Triangle of safety: ears, side of face, neck, top of shoulders
Soft tissues of cheeks
Black eyes
Intra-oral injuries
Forearms when raised to protect self
Chest and abdomen 
Any groin or genital injury 
Inner aspects of thighs 
Soles of feet
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7
Q

Physical indicators of physical abuse

A

Unexplained injuries
Untreated injuries
Injuries on parts of body where accidental injury is unlikely
Hand or finger-marked bruising; cigarette burn or bite marks
Scalds, esp. with upward splash marks, or rings where made to sit or stand in very hot water
Broken bones

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8
Q

Behavioural indicators of physical abuse

A
Reluctant for parents to be contacted
Aggressive behaviour and temper
Child who shoes fear of going home or runs away
Child flinches when approached/ touched
Reluctance to get undressed for sporting activities
Covering arms/legs even when hot
Depression
Overly compliant to parents/carers
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9
Q

Sexual abuse is forcing or enticing a child to take part in

A

Physical contact including penetrative and non-penetrative acts
Sexual activities, including prostitution, whether the child is aware of what is happening or not
Non-contact activities including children looking at or being involved in the production of pornographic material, watching sexual activities, encouraged to behave in sexually inappropriate ways, and verbal sexual abuse

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10
Q

Physical indicators of sexual abuse

A

Pain, itching, bruising or bleeding in genital or anal areas
Any STI
Recurrent genital discharge or UTI without apparent cause
Stomach pains
Discomfort when child is walking or sitting down
Pregnancy
Bowel prblems, enuresis
Rectal/vaginal discharge or bleeding
Any child in close proximity with an adult identified as a risk to children

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11
Q

Behavioural indicators of sexual abuse

A

Sudden unexplained changes in behaviour
Apparent fear of someone
Being sexually coercive with other children
Nightmares or bed wetting
Self-harm, self-mutilation, suicide attempts, abuse of drugs/alcohol, eating problems
Sexualised behaviour or knowledge, drawings, language
Running away from home

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12
Q

Emotional abuse

A

Persistent emotional ill-treatment of a child causing severe and persistent adverse effects on child’s emotional development

Conveying that children are worthless/unloved
Imposing age-inappropriate expectations on children
Seeing/hearing the ill-treatment of another
Serious bullying
Exploiting and corrupting children

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13
Q

Physical indicators of emotional abuse

A

Failure to grow or to thrive, child thrives away from home
Sudden speech disorders
Delayed development, either physical or emotional

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14
Q

Behavioural indicators of emotional abuse

A

Compulsive nervous behaviours such as hair twisting or rocking
An unwillingness or inability to play
Excessive fear of making mistakes
Self-harm or mutilation
Excessive deference towards others, especially adults
Excessive lack of confidence, and need for approval, attentions and affection
Inability to cope with praise

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15
Q

What are some specific types of violence towards children?

A
Honour based violence 
Forced marriage
Trafficking
Prostitution 
Domestic servitude
Spirit possession
Female genital mutilation
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16
Q

Factors which raise concern

A

Parent (and/or child) misusing alcohol or drugs
Domestic abuse within the household
Parents with learning difficulties and/or mental health problems
Children with disabilities
Grooming and sexual exploitation (including online)
Teenage pregnancy and parenthood
Child trafficking
Highly mobile families and families without recourse to public funds
Bullying
Female genital mutilation
Self-harming behaviours

17
Q

Response to concerns

A

Observe
Record
Share: speak to designated child protection officer, lead professional, key worker, allocated social worker
Protect: monitor, discuss with parents, share information
Refer

18
Q

My Responsibility

A

Recognise
Report: document, use child/carer’s words, write in detail
Refer

19
Q

Child risk factors for abuse

A
Being unwanted
Prematurity
Children under 4
Crying persistently 
Unable to meet parental expectations
Chronic ill health
Low birth weight
Disability
20
Q

Adult risk factors for abuse

A
Criminal activity
Learning disability
Alcohol misuse
Own child abuse
Drugs
Lack of social support
Post-natal depression 
Mental illness
Financial difficulties
21
Q

DD of bruising

A
Bleeding disorder
Birth marks: Mongolian blue spot, capillary haemangioma, congenial melanocytic naevi 
Vasculitis disorders
Infection: meningocccal septicaemia, HSP
Drug related: NSAIDs
Erythema nodosum
Malignancy 
Striae
Contact dermatitis 

Need FBC and coagulation screen

22
Q

DD of fractures

A
Birth injury (clavicular fracture)
Infection (osteomyelitis)
Malignancy
Osteogenesis imperfecta 
Nutritional- vitD deficiency
Copper deficiency 

Full skeletal surgery
CT scan
Bone biochemistry

23
Q

Presentation of physical abuse in <2

Investigations needed

A

Full skeletal survey
CT head
Expert opthalmological examination
Coagulation screen

24
Q

Types of neglect

A

Medical: unimmunised, failure to attend appointments, poor compliance with medication, failure to seek appropriate and timely medical advice
Nutritional: faltering growth, obesity due to failure to control diet and lifestyle
Emotional
Educational: poor school attendance
Physical: inadequate hygiene, severe and persistent infestations/infections, inappropriate clothing for child’s size and weather

25
Q

Neglect

Failure to supervise

A

Frequent A&E attendances
Injury that suggests lack of care such as sun burn, scalds and burns, falls, significant injury
Ingestion of harmful substances

26
Q

What influences severity of consequences of abuse

A

Type and form of abuse
Childs developmental stage at the time of the abuse
Duration and frequency of abuse
Relationship to the perpetrator
Support the child received following disclosure

27
Q

Consequences of child abuse

A
Antisocial personality
Drug abuse
Alcohol misuse
Self-harm 
Emotional disorders 
Sexual dysfunction 
Somatic symptoms
PTSD
Attachment disorder 
Aggressive behaviour
28
Q

What to do if you have abuse concerns

A

Document everything clearly in the patients notes. Clearly attribute who said what/when plus actions taken – including any discussions at handover
Sign, date and time all entries
Seek advice from senior colleague/consultant on how to proceed
If you are unhappy with the advice given consult further – go up a level of seniority or contact the named doctor/nurse for safe guarding.
Communicate with nursing staff
Keep the child safe
DON’T DO NOTHING
Responding to disclosure

Try not to look shocked
Let the child know you believe them
Tell them they are not in trouble
Listen to what they have to say, don’t make an excuse to leave
Don’t ask leading questions – this may affect the case if it goes to court
Don’t make promises you cant keep
Be honest at all times
Inform your senior
29
Q

What is the HEADSSS assessment?

A
Home
Education/employment
Activities
Drugs
Sex and relationships
Self harm and depression
Safety and abuse
30
Q

Home HEADSSS

A
Who lives at home?
Do you have your own room?
Do you fight with anyone at home?
Is there anyone you particularly get on with
Who do they turn to when upset
31
Q

Education and employment HEADSSS

A

Do you go to school/college ?
What subjects do you enjoy? What subjects don’t you like?
Do you have a job? What sorts of hours do you work?
What’s the best thing about working? What don’t you like so much?
What would you like to do in the future?
Who are your friends at school/work?
Does anyone bully you?

Factual and personal information: friendships and bullying

32
Q

Activities HEADSSS

A

What do you do in your spare time?
How do you relax?
What do you like doing with your friends?
Do you participate in any sports/physical activity/exercise?

Rapport/ obesity

33
Q

Drugs, smoking and alcohol HEADSSS

A

Some people your age try smoking, alcohol and drugs, is that something you’ve experienced?
How much? How often?
What does taking drugs/drinking alcohol do for you?
Where do you get the money?
Where/who do you get your drugs from?
Does your alcohol use cause you any problems?
Are you interested in cutting down or stopping?
Is there anything I could do to help you with that? Would you like to see someone about that specifically?

34
Q

Sex and relationships HEADSSS

A

Are you seeing anyone at the moment?
Is that relationship with a boy or a girl?
Some people your age start having sex, have you ever had sex?
What contraception are you using?
How do you handle intimate relationships? Do you feel pressure to go along with things that you’d rather not do?
Does your partner give you things in exchange for sex or other physical acts?

35
Q

Self-harm, depression and self-image HEADSSS

A

How is your mood at the moment?
Do you ever feel sad or stressed? What do you do about that?
What sorts of things make you feel low/sad/stressed?
Have you ever thought about hurting yourself?
Have you acted on those thoughts?
Have you thought about ending your life?

36
Q

Safety and abuse HEADSSS

A

Do you ever feel unsafe?
Is there anyone in your life that you don’t feel safe around?
Is anyone doing things to you that you don’t want them to? What sort of things?
Does anyone put pressure on you to do things you don’t want to do?
Is there anyone you can talk to about these things?