Safeguarding Flashcards
categories of abuse (5)
- physical
- emotional
- sexual
- neglect
- inducing injury
signs of abuse
- behavioural changes
- clothes ill fitting/dirty
- poor hygiene
- not wanting to change clothes in public
- frequent unexplained injuries
- lack concentration @ school
- reaching developmental milestones late
- use of sexual language
- sexual health problems
what is SENCO
Special Educational Needs Coordinator
- support and identify children with special educational needs
differentials for a 5 month old presenting with a full fontanelle, irritability, refusing feeds, vomiting, tachycardic, cool peripheries
- meningitis
- sepsis
- viral encephalitis
- shaken baby syndrome
- metabolic syndrome: disruption of urea cycle
management of a 5 month old presenting with irritability, no fever, full fontanelle, tachycardia
- iv access
- fluid bolus
- blood tests
- CT head
CT head in shaken baby syndrome shows:
subdural haematoma
who requests a Child protection Medical assessment
social services
Glutaric acidaemia
- an inherited disorder whereby the body lacks an enzyme and is unable to break down amino acids into energy
- risk of subdural haematoma
symptoms and testing for
Ehlers Danlos syndrome
- joint hypermobility
- stretchy skin
- fragile skin: bruises/bleeds easily
Osteogenesis imperfecta
- fragile bones: fracture easily
- blue sclera
- dental fragility
- hearing loss
management by social services when contacted regarding a safeguarding issue
- interview parents
- social care home visit
- investigate for hx of domestic violence
- involve police
- request child protection medical assessment for siblings
- seek to place children with extended family if assessed and found to require safeguarding from impending harm
- multi disciplinary child protection strategy meeting
who decides where a child goes once the child is deemed to be medically fit for discharge
social services
Triad of symptoms for shaken baby syndrome
- retinal haemorrhages
- subdural haematoma
- encephalopathy
symptoms of shaken baby syndrome
- irritability
- poor feeding
- increased head circumference
- seizures
- reduced GCS
- full fontanelle
- anaemia
- retinal haemorrhages
questions when raising a safeguarding issue
Are there any known safeguarding issues?
Is the child on a child protection plan?
Does the child need a Place of Safety?
differentials for multiple bruises
- Leukaemia
- Aplastic anaemia
- Post viral aplastic anaemia
examination findings of respiratory distress
- widespread expiratory wheeze
- intercostal recession
- harrisons sulcus
horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm
Harrisons sulcus
when should the Child Protection Team be involved when there is poor care for a child from a patient?
When the poor care is putting the child’s health at serious risk and there have been repeated attempts by the team to engage with parent that have not resulted in adequate improvement
Management for a mother that is unintentionally neglecting her child’s health?
- Calling a “child in need” meeting to help train mother
- Core group of professionals: identified to monitor how well the implantation of the plan goes
Last resort = fostering of child
household risk factors for abuse: relating to child
- being the younger child
- increased needs e.g. disability
- low birth weight
- multiple births
household risk factors for abuse: relating to parents
- younger parental age
- mental illness
- drug/alcohol abuse
- parental crime
- parents: vulnerable, unsupported
- known mistreatment of animals
- domestic violence
- lower socio economic class
- parents themselves were abused
History of an accidental injury
- mechanism consistent with injury
- consistent stories
- no delay in seeking medical attention
- appropriately concerned parents
- one off injury
- injury consistent with childs age/development/mobility
History of a non accidental injury
- no mechanism offered or is inconsistent with injury
- delay in reporting the injury
- inconsistent history from parents
- inappropriate reaction from parents e.g. unconcerned/aggressive
- recent injuries
- injuries inconsistent with childs age
accidental fractures
- linear skull fractures
- long bone fractures (in children > 5 years)
type of fracture that is more commonly due to abuse
non-supracondylar fractures
non accidental fractures (5)
- metaphyseal fractures
- posterior rib fractures
- fractures of different ages
- complex skull fractures
- long bone shaft fractures (in a non mobile child)
non accidental bruises
- face
- buttock
- back
- bruise outlines a particular object
- pattern e.g. fingertips
features of accidental burns
- asymmetrical
- flexures are spared
- geographical splash marks
features of non accidental burns
- uniform shape (cigarette burn)
- glove + stocking distribution
what doe a Child Protection Medical Assessment consist of?
- child must be questioned away from carers
- growth chart: body map
- Observations: photography
e. g. for ?shaken baby syndrome
- skeletal survey
- ophthalmology review
- metabolic testing: glutaric acidaemia
- detailed clotting screen
- genetic test for Ehlers Danlos
who carries out a Child Protection Medical Assessment
at least registrar level Paediatrician and there must be a named consultant
differentials for a child presenting with fractures
- accidental injury
- osteogenesis imperfecta
- copper deficiency
- Vit D/C deficiency
- Ehlers Danlos syndrome
- JOBs syndrome
differentials for a child presenting with Burns/scolds
- Accidental
- Bullous impetigo
- Staphylococcal Scalded Skin Syndrome
differentials for a child presenting with bruising
- accidental injury
- ITP
- meningococcal septicaemia
- HSP
- Mongolian blue spot
- vWD
- leukaemia
- Haemophilia A + B
- Ehlers Danlos
- Vasculitis
- Petechiae
- Coagulopathy
presentation of a child from neglect
- failure to thrive
- inadequate hygiene
- poor emotional development
- delay in speech/language development
- poor school attendance
