Safeguarding Flashcards
What are differentials for irritability/constant crying/baby not themselves?
- Meningitis: irritability, full fontanelle
- Sepsis: don’t always need to be pyrexic, tachycardia
- Viral encephalitis: anyone in family with a cold sore
- Shaken baby syndrome: finger tip bruises
What is the management for a baby who is crying a lot/not themselves?
- IV access
- Fluid bolus (in tachycardia)
- Bloods - FBC, U+Es, bone, clotting screen, glucose
- CT head
What is shaken baby syndrome?
- Severe shaking (serious form of abuse) causes the baby’s head to move violently back and forth, resulting in serious and sometimes fatal brain injury
- These forces are exaggerated if the shaking is interrupted by the baby hitting a surface
What complications can occur from shaken baby syndrome?
- Subdural haematoma (rupture of small vessels)
- SAH
- Direct trauma to brain substance itself
- Shearing off or breakage of nerve cell branches (axons) in the cortex and deeper structures of the brain
- Further irreversible damage to brain from lack of oxygen if child stops breathing during shaking
- Further damage to brain cells when injured nerve cells release chemicals that add to oxygen deprivation in the brain
- Retinal haemorrhages
- Skull or other (ribs/clavicles/limbs) fracture
- Bruising to face, head and entire body
What is the average age for shaken baby syndrome?
Average age is 3-18 months - babies have weak neck muscles that cannot fully support their proportionately large heads.
What are the symptoms of shaken baby syndrome?
May appear immediately after and reach a peak within 4-6 hours.
- Altered level of consciousness
- Drowsiness accompanied by irritability
- Coma, convulsions or seizures
- Decreased appetite
- Vomiting
- Posture - head is bent back and back arched
- Breathing problems and irregularities
- Abnormally slow and shallow respiration
What are the signs of shaken baby syndrome?
- Retinal haemorrhages
- Closed head injury bleed
- Lacerations
- Contusions
- Concussions
- Bruises, soft tissue swelling
- Abdo/chest injuries
- Tense fontanel (soft spot)
What further investigations can be done for child protection purposes?
- Skeletal survey: to look for fractures. Finger tip bruising may suggest that there are posterior rib fractures (suggests NAI).
- Ophthalmology review: to assess for retinal haemorrhage
- Metabolic testing: to exclude glutaric aciduria (associated with intracerebral haemorrhage)
- Coagulation testing: e.g. von Willebrand’s factor (should be repeated later as can rise to normal levels in the acute phase) (widespread bruising can point to blood disorder)
- Consider other conditions that are associated with intracerebral bleeding e.g. Ehlers Danlos Syndrome (genetic testing available)
How would social services get involved if suspecting NAI?
- Interview parents/partners/siblings/grandparents
- Social care»_space; home visit
- Hx of domestic violence»_space; correlates with child abuse
- Involve Police if appropriate
- Request child protection assessments for siblings and consider whether they need to be safeguarded from any impending harm by removing to a place of safety. Social care will often seek to place children where possible within extended family.
- MDT child protection strategy meeting before discharge
- Once medically fit for discharge, social services consider whether the child can return home or do other living and contact arrangements need to be put in place
- Child and siblings will be put onto Child Protection Plans
What are the differentials for multiple small bruises, pale, weight loss?
- Bone marrow problems»_space; bone marrow aspirate
- Leukaemia (enlarged liver/spleen»_space; metastasis)
- Aplastic anaemia - viral testing
What investigations need to be done before speaking to family about NAI?
- Platelets
- Coagulation screen
- X-rays - osteogenesis imeprfecta
What is osteogenesis imperfecta?
Brittle bone disease - impaired metabolism of collagen. Causes bone fragility and fractures (autosomal dominant).
What is the responsibility of a parent in managing their child’s chronic disease?
A parent has a duty to reasonably ensure the wellbeing of their child. This includes complying with necessary treatment for chronic disease.
A parent of a child with T1DM deciding not to give insulin in favour of a herbal remedy is clearly not safeguarding their child and if they cannot be persuaded to change then urgent child protection assessment (to prevent DKA) is warranted.
What is FII?
- A parent may deliberately manipulate and fabricate symptoms in a child with chronic disease - the fabricated or induced illness (FII) pathway may be appropriate.
- More common is a somewhat disorganised parent who is not coping adequately.
- Child Protection Team might be necessary if the condition is felt to be putting the child’s health at serious risk and repeated and documented attempts by the team to engage with the parent (s) have not produced an adequate improvement.
What can be done for a parent who is not coping well?
Can involve social care and call a ‘child in need’ meeting which may result in help and training being given to the parent (s). A core group of professionals can monitor how well the implementation of the plan goes. Fostering the child with another family would be the last resort.
