Safeguarding Flashcards
What does a child refer to?
- someone who has not reached their 18th birthday
What are the 4 categories of child abuse?
- physical abuse
- emotional abuse
- sexual abuse
- neglect
What is the meaning of alerting features?
- symptoms, signs and patterns of injury or behaviour, which may indicate child abuse
What are the RF of children requiring safeguarding?
- Previous history of child maltreatment
- Domestic violence
- Domestic/marital conflict
- Mental health disorders, learning disability, physical illness or disability in the carers
- Drug or alcohol misuse in the carers
- Housing or financial problems
- Disability or long-term chronic illness in the child
What are the general principles if you encounter alerting features?
- Listen and observe
- Seek an explanation
- Record what is said and observed, by whom, and why you are concerned
- discuss with colleagues, refer and/or seek more information
What are the key things to do whilst taking a Hx from a child with high suspicion of abuse?
- use open and non-judgemental questions
- have separate communication with the child - helps develop trust
- If using interpreters, you may need one from outside the family
What are the key things to do whilst examining the child?
- document all findings
- record signs on a body map
- obtain consent
- by the child if competent
- person with parental responsibility
- by the court
- if emergency - act in child’s best interest
Provide other examples apart from Hx and Ex where child maltreatment may come to the attention of doctors
- Communication from other agencies/departments - eg, police notifications, social services
- Disclosure by child or carer
- Behaviour towards practice staff.
- Frequent attendance or unusual patterns of attendance to healthcare services
- Change to the child’s behaviour or emotional state
- Failure to access medical care appropriately
What is neglect?
- Failure of provision to supply basic needs
- Failure to provide adequate supervision
- Failure to provide access to appropriate medical care or education
What are the signs which will prompt you to suspect physical abuse?
- Bruising in the shape of an object - fingertips, hand, ligature, stick, teeth mark or implement such as belt buckle
- bruising on a non-mobile baby
- Human/animal bites
- Lacerations, abrasions and scars
- Burns and scalds
- retinal haemorrhages or eye injuries in the absence of major accidental trauma or medical cause
- spinal injury in the absence of confirmed major accidental trauma
- Female genital mutilation (FGM)
- Intracranial injuries
What is your statutory duty as doctors if FGM is noted?
- report cases of FGM in girls under the age of 18 to the police
What are the signs of emotional abuse?
Behaviour of the child
- Recurring nightmares with similar themes
- Withdrawal of communication
- Aggressive behaviour
Behaviour of carer
- punishment for bedwetting
- Inappropriate expectations
- Using the child to fulfil an adult’s needs
What are the signs of sexual abuse?
- genital or anal symptoms
- recurrent dysuria
- foreign bodies in the vagina or anus
- Hepatitis B or anogenital warts occur in a child aged less than 13
- 13-15 is pregnant
What are the differential diagnosis for child abuse?
- Medical causes of failure to thrive.
- epilepsy.
- thrombocytopenia, leukaemia.
- Mongolian blue spot (a congenital mark)
- Medical conditions predisposing to fractures - eg, osteogenesis imperfecta, metabolic bone disease in neonates, rickets, copper deficiency, osteomyelitis, leukaemia and disseminated neuroblastoma.
- Glutaric acidaemia -rare cause of subdural haematoma.
