Safeguarding Flashcards
What are the main types of child maltreatment?
- Physical abuse
- Emotional abuse
- Sexual abuse (inc. sexual exploitation)
- Neglect
- Fabricated/induced illness
- Witnessing domestic violence
- Female genital mutilation
What is physical abuse?
Causing physical harm to a child
(e.g. hitting, shaking, throwing, poisoning, burning, drowning, suffocating)
What is emotional abuse?
Persistent emotional maltreatment of a child resulting in severe and persistent adverse effects on the child’s emotional development. Includes:
- Conveying to child they are unloved/worthless/inadequate/conditionally-valued
- Developmentally inappropriate expectations & interactions
- Overprotection
- Abnormal social interaction
- Witness the ill treatment of others
- Serious bullying
- Corruption/exploitation of children
What is sexual abuse?
Forcing/enticing a young person to take part in sexual activities (inc. prostitution), whether or not the child is aware of what is happening.
Includes:
- Physical contact
- Non-physical contact (e.g. encouraging sexually inappropriate behaviour)
What is neglect?
Persistent failure to meet a child’s basic physical/psychological needs, likely resulting in serious impairment of the child’s health/development.
Includes parent/carer failing to provide:
- Adequate food & clothing
- Shelter
- Protection from physical and emotional harm/danger
- Adequate supervision
- Access to appropriate medical care / treatment
- Emotional support/responsiveness
What is fabricated/induced illness?
A group of harmful behaviours by parent/carer.
May consist of:
- Verbal fabrication (telling false story of child illness to get healthcare)
- Induction of illness (via suffocation, poisoning, overdosing on meds, etc.)
When do you suspect fabricated/induced illness?
When a child has frequent unexplained illness & multiple hospital admissions with symptoms that only occur in caregiver’s presence and are not substantiated by clinical findings.
What is female genital mutilation?
All procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons
What are the different types of FGM?
What are the risk factors for child maltreatment?
- Inability to meet parent’s expectations
- Child born as a result of forced, coercive, or commercial sex
- Parental mental health problems
- Parental indifference/intolerance/anxiousness
- Parental alcohol/drug abuse
- Step-parents
- Domestic violence
- Multiple/closely spaced births
- Social isolation/lack of social support
- Young parental age
- Poverty & poor housing
How may child abuse present?
- Physical symptoms/signs
- Psychological symptoms/signs
- Concerning interaction observed between child & parent/carer
- Child may tell someone about the abuse
- Abuse may be observed
What do you need to consider in the presentation of a physical injury?
- Child’s age and developmental stage
- History given by the child
- Plausibility of the explanation of the injury
- Any background of previous injury/concerns
- Delay in reporting the injury
- Inconsistent histories from caregivers
- Innapropriate reaction from caregivers (e.g. vague, evasive, unconcerned, excessively distressed/aggressive)
When is a fracture more likely to be inflicted?
- When seen in a non-mobile child (without fragile bones)
- Rib fracture
- Multiple fractures (Increased likelihood if # are different ages)
When is bruising most likely to be inflicted?
- Shape of a hand
- On the neck (strangulation)
- On the wrists/ankles (ligature marks)
- On the buttocks (esp if < 2 yo or no reasonable explanation)
When are burns most likely inflicted?
- Immobile child
- In the shape of an implement (e.g. cigarette, iron)
- ‘Glove or stocking’ burn consistent with forced immersion
When are bites most likely inflicted?
Bruising in the shape of a bite thought unlikely to be by young child.
What features of the child’s appearance/behaviour should make you consider the possibility of neglect?
- Consistenly missing important medical appointments
- Lacks needed medical/dental care/immunisations
- Seems ravenously hungry
- Is dirty
- Is wearing inadequate clothing in cold weather
- Is abusing alcohol/drugs
- Says there is no-one at home to provide care
What features of the caregiver’s appearance/behaviour would make you consider neglect?
- Appears indifferent to the child
- Seems apathetic/depressed
- Irrational / bizaare behaviour
- Drug/alcohol abuse
What parental perceptions of the child can indicate emotional abuse?
Caregiver percieves child as:
- ‘Wrong’ gender
- Unduly ‘difficult’
- Born during parental separation/violence
What behaviour may hint towards emotional abuse of a baby?
Observable behaviour of the child:
- Apathetic
- Delayed development
- Non-demanding
Mother may describe child as:
- Spoiled
- Attention-seeking
- In control
- Not loving her
What behaviour may hint towards emotional abuse of a toddler?
- Violent
- Apathetic
- Fearful
What behaviour may hint towards emotional abuse of a school child?
- Wetting/soiling
- Relationship difficulties
- Nonattendance
- Antisocial behaviour
What behaviour may hint at emotional abuse of adolescents?
- Self-harm
- Depression
- Oppositional/aggressive behaviour
- Delinquent behaviour
How may sexual abuse be recognised?
Child / young person may:
- Tell someone about the abuse
- Be identified in pornographic material
- Be pregnant
- Have an STI with no clear explanation
What physical symptoms may coincide with sexual abuse?
- Vaginal bleeding, itching, discharge
- Rectal bleeding
What behavioural symptoms may coincide with sexual abuse?
- Any of the symptoms for emotional abuse
- Unexpected awareness / acting out of sexualised behaviour beyond age
- Soiling / secondary enuresis (bed-wetting)
- Self-harm
- Aggressive or sexualised behaviours
- Regression
- Poor school performance
What investigation is indicated in all children with suspected physical abuse under 30 months of age?
Full radiographic skeletal survey with oblique views of the ribs
What alternative causes shoulde be considered and excluded in a child presenting with bruising?
- Coagulation disorders
- Slate gray naevi (Mongolian blue spot)
What alternative causes shoulde be considered and excluded in a child presenting with fractures?
- Osteogenesis imperfecta (Brittle bone disease, usually type 1)
- Ask about family history bc autosomal dominant disorder
- Examine for blue sclerae
- Wormian bones in skull on skeletal survey (extra bones in skull sutures)
What alternative causes shoulde be considered and excluded in a child presenting with scalds / burns?
- Bullous impetigo
- Scalded skin syndrome
What investigations are required in ALL children with suspected brain injury?
- Immediate CT head scan followed by MRI head scan
- Skeletal survey (to exclude fractures)
- Expert opthalmological examination (to identify retinal haemorrhages)
- Coagulation screen
How do you go about assessing a child for potential abuse?
- Talk to the child seperately from parents with a chaperone, taking a detailed history and full examination
- Any injuries or medical findings hsould be carefully noted, measured, recorded and drawn on a body map and photographed (with consent)
- Plot height, weight and head circumference on centile charts
- Note interaction between child & parent
- Make sure all notes are meticulous, dated/timed and signed on each page.
If abuse is suspected/confirmed and a decision is made to immediately protect any children from further harm, how is this done?
- Admit to hospital (allowing for investigations and MDT assessment)
- May require legal enforcement if parents not compliant
- Placement with foster care (if medical treatment not necessary)
- Alert police / social services to any concerns surrounding other children at home.
Who has a role in child protection?
- Social workers
- Health visitors
- Police
- GP / Paediatrician
- Teachers
- Lawyers
What is decided in child protection conferences?
- Whether child should be provided with child protection plan & under what category
- Whether there should be an application to the Court to protect the child
- What follow-up is needed
