Safeguarding Flashcards
What is neglect?
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
Examples of neglect
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
Possible indicators of neglect
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
Examples of physical abuse
Shaking Throwing Poisoning Burning/scalding Drowning Hitting Suffocating
When are non-accidental injuries suspected?
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
Areas of non-accidental injury
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
Physical indicators of physical abuse
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
Behavioural indicators of physical abuse
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
Sexual abuse is forcing or enticing a child to take part in
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
Physical indicators of sexual abuse
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
Behavioural indicators of sexual abuse
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
Emotional abuse
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
Physical indicators of emotional abuse
Failure to grow or to thrive, child thrives away from home
Sudden speech disorders
Delayed development, either physical or emotional
Behavioural indicators of emotional abuse
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
What are some specific types of violence towards children?
Honour based violence Forced marriage Trafficking Prostitution Domestic servitude Spirit possession Female genital mutilation
Factors which raise concern
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
Response to concerns
Observe
Record
Share: speak to designated child protection officer, lead professional, key worker, allocated social worker
Protect: monitor, discuss with parents, share information
Refer
My Responsibility
Recognise
Report: document, use child/carer’s words, write in detail
Refer
Child risk factors for abuse
Being unwanted Prematurity Children under 4 Crying persistently Unable to meet parental expectations Chronic ill health Low birth weight Disability
Adult risk factors for abuse
Criminal activity Learning disability Alcohol misuse Own child abuse Drugs Lack of social support Post-natal depression Mental illness Financial difficulties
DD of bruising
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
DD of fractures
Birth injury (clavicular fracture) Infection (osteomyelitis) Malignancy Osteogenesis imperfecta Nutritional- vitD deficiency Copper deficiency
Full skeletal surgery
CT scan
Bone biochemistry
Presentation of physical abuse in <2
Investigations needed
Full skeletal survey
CT head
Expert opthalmological examination
Coagulation screen
Types of neglect
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
Neglect
Failure to supervise
Frequent A&E attendances
Injury that suggests lack of care such as sun burn, scalds and burns, falls, significant injury
Ingestion of harmful substances
What influences severity of consequences of abuse
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
Consequences of child abuse
Antisocial personality Drug abuse Alcohol misuse Self-harm Emotional disorders Sexual dysfunction Somatic symptoms PTSD Attachment disorder Aggressive behaviour
What to do if you have abuse concerns
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
What is the HEADSSS assessment?
Home Education/employment Activities Drugs Sex and relationships Self harm and depression Safety and abuse
Home HEADSSS
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
Education and employment HEADSSS
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
Activities HEADSSS
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
Drugs, smoking and alcohol HEADSSS
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?
Sex and relationships HEADSSS
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?
Self-harm, depression and self-image HEADSSS
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?
Safety and abuse HEADSSS
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?
