Safeguarding Flashcards
Symptoms of meningitis in babies
Temperature Refusing feeds and vomiting Irritable, dislike being handled Bulging soft spot Rapid breathing Pale mottled skin/rash Unusual cry stiff neck dislike for bright lights
What is shaken baby syndrome?
Serious form of abuse
Usually occurs when someone shakes the baby out of anger or frustration
What agencies need to be informed if shaken baby syndrome is suspected?
Social services
They may involve the police if appropriate
Possible diagnoses for widespread bruising
Leukaemia
Aplastic Anaemia
(Wait for platelets and coagualtion screen before speaking to the family)
Normal Hb for a child
11-13 gm/dL
Normal WCC for a child (1-6)
5 - 17
Normal platelets count in children
150-400
What are the different types of Child Maltreatment?
Physical Emotional Neglect Sexual Factitious and Induced Injury
Factors which increase the likelihood of child abuse
Child:
Younger child
Increased needs - disability
Low birth weight
multiple births
Factors which increase the likelihood of child abuse
Adult
Young parental age Mental Illness Drug/alcohol abuse Domestic Violence Lower Socio-economic group Parents were themselves abused Parental criminal history Family chaotic, disorganised, socially isolated Vulnerable and unsupported parent Previous child maltreatment in members of the family Known maltreatment of animal
Recognising a NAI
History:
No mechanism offered/mechanism not consistent with the injury
Delay in reporting/seeking medical attention
Inconsistent histories from parents
Inappropriate reaction of parents e.g vague, elusive, unconcerned, excessively distressed, aggressive
Recurrent injuries
Injuries inconsistent with the child’s age, development, mobility (bruising in non-mobile babies)
Recognising a NAI
Fractures:
Metaphyseal fractures Posterior rib fractures Fractures of different ages Complex skull fractures Long bone shaft fractures in non-mobile child
Recognising a NAI
Bruises:
Normal bruises in toddlers - shins, forehead
NAI - face, back, buttocks
Outline of particular objects - hand, belt
Patter of bruising - fingertips
Recognising a NAI
Burns:
Uniform shape (cigarette) Glove-stocking distribution
Clinical features of a baby with NA head injury
Irritability Poor feeding Increasing head circumference Seizures Reduced GCS Full fontanelle Anaemia Retinal haemorrhages
What is a Child Protection Medical Assessment and what is its function?
Requested by social services
Carried out by at least a reg (must be a Named Consultant)
Full history, examination, growth chart, observations, body map, photography, investigations as appropriate
Meticulously noted
Child must be questioned away from carers
Voice of child crucial
Peadiatrician makes a report about the likelihood of an injury being accidental
What is a body map and what is it used for?
Used to accurately document visible findings on examination
Different types of body map that vary by age and gender
Other investigations used in a Child Protection case:
Clinical photography Bloods Detailed clotting studies Opthalmology review Skeletal Survey - Expert opinion may be used to exclude osteogenesis imperfecta CT Head
Differential Diagnosis for child with bruising
Accidental injury NAI Immune thrombocytopenic purpura (ITP) Meningococcal Septicaemia Henoch Schonlein Pupura Mongolian Blue Spot Leukaemia Haemophilia A Christmas Disease Von Willebrands disease Children with hypermobility syndromes - Ehlers Danlos syndrome Vasculitis
What is mongolian blue spot?
Type of birthmark caused by pigment in the skin
Most commonly seen in the lumbosacral area
What is Henoch-Schonlein Purpura?
Tyope of vasculitis
Causes the small blood vessels in skin, joints, intestines, and kidneys to become inflamed and bleed
Purplish rash typically on lower legs and buttocks
Can cause aching joints and abdo pain
Rarely, serious kidney damage can occur
What is ITP?
Immune Thrombocytopenic Purpura
Bleeding disorder - immune system destroys platelets
In children, can develop after viral infection
Easy/excessive bruising
Superficial bleeding into skin (petechiae)
What is clotting factors are affected in Haemophilia A and Christmas Disease (Haemophilia B)
A - VIII
B - IX
What is Ehlers Danlos Syndrome?
Connective tissue disorder
Characterised by:
- Joint hypermobility, skin hypermobility, skin hyperextensibility, tissue fragility
Differential diagnosis for child with fractures
NAI AI Osteogenesis Imperfecta Copper Deficiency Vit D deficiency Vit C deficiency Ehlers Danlos and other hypermobilty syndromes JOBs syndrome
What is JOBs disease?
Autosomal dominant hyper IgE syndrome
Caused by genetic mutation of chromosome 4
Recurrent infections common
Can cause fracture and scoliosis
Differential diagnosis for child with burns
AI
NAI
Bullous impetigo
Scalded Skin Syndrome
What is Scalded skin syndrome?
Caused by certain types of Staphylococcus
Produces toxin that damages outer layer of the skin and causes it to blister
What is Pierre Robin syndrome?
Underdeveloped lower jaw
A tongue that falls back in the throat
Difficulty breathing
What is the toxic trio?
Domestic Violence and Abuse
Parental Mental Health
Parental Substance Misuse
How can neglect manifest clinically?
Failure to thrive
Inadequate hygiene (nappy rash)
Poor development of emotional attachment to child’s caregiver
Delay in development and speech and language
Poor attendance for school and health appointments
Unsupervised young children at home (law unclear)
Emotional Impact of physical/psychological abuse on a child
Sexual abuse:
Disclosure STDs Sexualised behaviour Pregnancy Soiling
Fabricated or Induced Illness (FII)
Often on background of existing disease
Bizarre illness events
Strange new symptoms
Parental reportage out of keeping with physical findings
Symptoms only witnessed by one
Unneeded operations (tonsils removed at parents requests)
What is neglect?
Persistent failure to meet a child’s basic physical or psychological needs
Three concerning areas to find bruises on children?
Torso
Ears
Neck
