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BDS3 Paediatric Dentistry > Safeguarding Children > Flashcards

Safeguarding Children Flashcards

1
Q

What is child protection?

A
  • Activity undertaken to protect specific children who are suffering, or are at risk of suffering, significant harm
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2
Q

Who are ‘children in need’?

A
  • Those who require additional support or services to achieve their full potential
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3
Q

What is safeguarding children?

A

An umbrella term for measures taken to minimise the risks of harm to children

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4
Q

What does safeguarding children include? (3)

A
  • Protecting children from maltreatment
  • Preventing impairment of children’s health or development
  • Ensuring that children are growing up in a safe and caring environment
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5
Q

What is child abuse and neglect?

A
  • Anything which those entrusted with the care of children do, or fail to do, which damages their prospects of safe and health development into adulthood
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6
Q

What are the 3 elements that must be present for it to be classed as child abuse?

A
  • Significant harm to child
  • Carer has some responsibility for that harm
  • Significant connection between carer’s responsibility for child and harm to child
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7
Q

What are the 4 major themes of ‘The Children & Young People’s Act 2014’?

A
  • Children’s rights
  • Getting it right for every child (GIRFEC)
  • Early learning and childcare
  • ‘looked after’ children
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8
Q

What are the principles of GIRFEC in the children and young people act 2014? (3)

A
  • Named person for every child as a single point of contact to provide advice and support to families and to raise and deal with concerns about child’s wellbeing (now voluntary schemes only, not mandatory)
  • Lead professional where particularly complex needs or where different agencies need to work together. (not legislated for, and will remain a matter of policy and guidance only)
  • Single child’s plan - single planning process for individual children who have wellbeing needs (legislated for)
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9
Q

The national practice model creates a shared language and approach to identifying and meeting concerns. What are the 3 things included in this?

A
  • The ‘well-being’ wheel
  • ‘my world triangle’
  • ‘resilience matrix’
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10
Q

What is CIRFEC a shared approach to? (2)

A

Shared approach to:

  • Organising and recording information about a child
  • Discussing ways of addressing concerns about wellbeing
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11
Q

What is included in the ‘my world’ triangle? (3)

A
  • How I grow and develop
  • My wider world
  • What I need from people who look after me
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12
Q

What does SHANARRI stand for?

A
  • Safe
  • Healthy
  • Achieving
  • Nurtured
  • Active
  • Respected
  • Responsible
  • Included
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13
Q

In relation to the CYPA, when can information be shared?

A
  • Information can be shared when safety is at risk, or where the benefits of sharing the information outweigh the public and individual’s interest in keeping info confidential
  • Good practice to get consent where possible and safe to do so
  • Share what you need to and keep a note of what and why you have shared the info
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14
Q

If you are unable to gain consent for information sharing in relation to the CYPA, is it still okay to share the information?

A
  • If cannot inform them that you are going to share the information but you need to do so then you still can but you need to record it
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15
Q

What is included within the children and young peoples charter? (6)

A
  • The right to respect
  • The right to information about yourself
  • The right to be protected from harm
  • The right to have a say in your life
  • The right to a good start in life
  • The right to be and feel secure
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16
Q

What does the UNCRN criticise the UK about in regards to the ‘protection’ of children? (3)

A
  • Against physical abuse and violence. Continued use of ‘reasonable chastisement’ defence to corporal punishment in the home
  • Teenagers in the penal system. Without access to health care, education or child protection
  • Lack of benefits and access to health care from asylum seeker children
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17
Q

What does the UNCRN criticise the UK about in regards to the ‘participation’ of children? (2)

A
  • Full participation for disabled children

- Access to information. Lack of recognition for the need to respect children’s rights in government documents

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18
Q

What does the UNCRN criticise the UK about in regards to the ‘provision’ of children?

A
  • Standard of living adequate for physical, mental, spiritual, moral and social development. Nearly one in three children living in poverty
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19
Q

What are ‘adult’ factors that can contribute to child abuse? (13)

A
  • Drugs
  • Alcohol
  • Poverty
  • Unemployment
  • Marital stress
  • Mental illness
  • disabled
  • Domestic violence
  • Step parents
  • Isolation
  • Abused as a child
  • Unrealistic expectations
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20
Q

What are ‘child’ factors that can contribute to child abuse? (7)

A
  • Crying
  • Soiling
  • Disability
  • Unwanted pregnancy (born at the wrong time)
  • Failed expectations
  • Wrong gender
  • Product of forced, coercive or commercial sex
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21
Q

What are ‘Community/environmental’ factors that can contribute to child abuse? (2)

A
  • Dwelling place and housing conditions

- Neighbourhood

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22
Q

What are ‘Family violence and dysfunctional family’ factors that can contribute to child abuse? (4)

A
  • Intergenerational cycle
  • Violence towards pets
  • Social isolation
  • Poverty
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23
Q

What are the big THREE concerns when thinking about parenting capacity?

A
  • Domestic Violence
  • Drug and alcohol misuse
  • Mental health problems
  • Cumulative problems increase the likelihood of a negative outcome
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24
Q

Data suggests that hoe many people experience severe maltreatment at some point in their lives?

A
  • 1 in 5
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25
Q

What are the different categories for child abuse? (5)

A
  • Physical
  • Emotional
  • Neglect
  • Sexual
  • (non-organic failure to thrive - not really used as a category anymore)
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26
Q

Who are classed as the most vulnerable children? (3)

A
  • Under 5’s
  • Irregular attenders (repeatedly DNA, returns in pain, exposed to risk of GA)
  • Medical problems and disabilities (more at risk of experiencing abuse of all kinds, serious impairment of health or development is more likely as a result of untreated dental disease - ‘looked after’ children)
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27
Q

How many death in the UK per week are due to child abuse?

A

1-2 deaths per week

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28
Q

In Scotland, each year, how many children are killed by a parent or parent substitute?

A

About 10 children per year

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29
Q

What are the effects of child neglect in relation to ‘nutrition’?

A
  • Failure to thrive/ short stature
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30
Q

What are the effects of child neglect in relation to ‘warmth, clothing and shelter’?

A

Inappropriate clothing:

  • Cold injury
  • Sunburn
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31
Q

What are the effects of child neglect in relation to ‘Hygiene and health care’?

A
  • Ingrained dirt (finger nails), head lice, dental caries
32
Q

What are the effects of child neglect in relation to ‘Stimulation and education’?

A

Developmental delay

33
Q

What are the effects of child neglect in relation to ‘affection’?

A

Withdrawn or attention seeking behaviour

34
Q

Why is it possible that ‘neglect of neglect’ may occur?

A

Because neglect is less incident focused or because there is less shared understanding of what is meant by neglect and how it should be responded to

  • Neglect is common TODAY
  • Neglect damages children
  • Neglect can kill
35
Q

What are 2 typical examples of scenarios that could kill a child?

A
  • Child under 1yr deprived of food and drink

- Older independently mobile child inadequately supervised

36
Q

What are possible short term damages of child abuse? (4)

A
  • Physical health
  • Emotional health
  • Social health
  • Cognitive development
37
Q

What are possible long term damages of child abuse? (5)

A

Adults neglected as children have a higher incidence of:

  • Arrest
  • Suicide attempts
  • Major depression
  • Diabetes
  • Heart Disease
38
Q

What is the definition of dental neglect?

A
  • The persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development
39
Q

What are examples of things that severe dental disease can cause in relation to children? (4)

A
  • Toothache
  • Disturbed sleep
  • Difficulty eating/change in food preferences
  • Absence from school
40
Q

What can dental disease put children at risk of? (4)

A
  • Teasing due to poor dental appearance
  • Repeated antibiotics
  • Repeated GA extractions
  • Severe infection
41
Q

What is classed as wilful dental neglect? (4)

A

After dental problems have been pointed out:

  • Irregular attendance, repeated failed appointments, repeated late cancellations
  • Failure to complete treatment
  • Returning in pain at repeated intervals
  • Repeated GA for dental extractions (despite all of the preventative measures you have put in place)
42
Q

What are indicators of dental neglect? (3)

A
  • Obvious dental disease (to someone not professionally trained in that area)
  • Impact on the child (so pain, problems with eating, not sleeping, not able to concentrate etc)
  • Practical care has been offered, yet the child has not returned for treatment
43
Q

How can we manage dental neglect? (5)

A

3 stages:

  • Preventive dental team management
  • Preventive multi-agency management
  • Child protection referral
  • Patient/carer offered treatment and sent reminder
  • Standard letter to health visitor or practice nurse i.e. multiagency response
44
Q

What is included in stage one of dental neglect management: preventive dental team management? (5)

A
  • Raise concerns with patient
  • Offer support
  • Set targets
  • Keep records and monitor progress
  • Important to document it all
45
Q

What is included in stage two of dental neglect management: preventive multi-agency management? (5)

A
  • Liase with other professionals (e.g. health visitor, school nurse, general medical practitioner, social worker) to see if concerns are shared
  • A child may be the subject of a CAF (common assessment framework) at this level
  • Check if child is subject to a child protection plan (which replaced the child protection register)
  • Agree to joint plan of action, review at agreed intervals
  • Letter to HV of children <5 who fail appointments and have failed to respond to letter from dental practice
46
Q

What is included in stage three of dental neglect management: child protection referral? (3)

A
  • In complex or deteriorating situations
  • Follow local guidelines
  • Referral is to social services (usually by telephone followed up in written)
47
Q

In the assessment framework what is included in the ‘child’s development needs’ section? (7)

A
  • Health
  • Education
  • Emotional & behavioural development
  • Identity
  • Family & social relationships
  • Social presentation
  • Selfcare skills
48
Q

In the assessment framework what is included in the ‘family and environmental factors’? (6)

A
  • Family history and functioning
  • Wider family
  • Housing
  • Employment
  • Family’s social integration
  • Community Resources
49
Q

In the assessment framework what is included in the ‘parenting capacity’ section? (6)

A
  • Basic care
  • Ensuring safety
  • Emotional warmth
  • Stimulation
  • Guidance & boundaries
  • Stability
50
Q

Give examples of physical abuse towards children? (3)

A
  • Over chastisement (cultural)
  • Acute/spontaneous (shaking)
  • Chronic/pathological (way of life)
51
Q

What kind of physical abuse is acute/compassionate? (3)

A
  • Spontaneous uncalculated reaction
  • Remorse, take appropriate action
  • Child’s needs are a priority
52
Q

What kind of physical abuse is chronic/pathological? (3)

A
  • Help sought but not actively
  • No remorse
  • Child’s needs are not a priority
53
Q

What % of head injuries in the first year of life are non-accidental and a result of physical abuse?

A
  • 95%
54
Q

What % of 5 year olds attending A&E due to a body injury are caused by physical abuse?

A

10%

55
Q

What % of childhood burns are non-accidental?

A

10%-12%

56
Q

What % of injuries in abuse cases are on the head and neck?

A

60%

  • (because it is there and easy to get to)
  • (It is often where the child is making noise from)
57
Q

Look at slide for where accidental and non accidental injuries tend to be

A

:)

58
Q

What are extra-oral signs of physical abuse? (8)

A
  • Bruising of face (punch, slap, pinch)
  • Bruising of ears (pinch, pull)
  • Abrasions and lacerations
  • Burns and bites
  • Neck (choke or cord marks)
  • Eye injuries
  • Hair pulling
  • Fractures (nose>mandible>zygoma)
59
Q

What are major clinical features of physical abuse? (4)

A

Skin lesions
- Bruises, burns, bites, lacerations

Bone lesions
- Fractures

Intracranial lesions
- From shaking

Visceral lesions
- (intra-abdominal) - blunt trauma

60
Q

What are intra-oral signs of physical abuse? (6)

A
  • Contusions
  • Bruises
  • Abrasions and lacerations
  • Burns
  • Tooth trauma
  • Frenal injuries
61
Q

What % of abuse cases have some sort of intra-oral injury?

A

About 33%

62
Q

What is a medical equivalent that can be mistaken for cigarette burns?

A

Impetigo

63
Q

What is a medical equivalent that can be mistaken for bruises?

A

Birthmarks

64
Q

What is a medical equivalent that can be mistaken for trauma?

A

Facial infection

65
Q

What is a medical equivalent that can be mistaken for a child that bruises easily?

A
  • Coagulation problems
66
Q

What factors are included in the index of suspicion in relation to child abuse? (9)

A
  • Delay in seeking help
  • Story vague, lacking in detail, vary with each telling and person to person
  • Account not compatible with injury
  • Parents mood abnormal - preoccupied
  • Parents behaviour gives cause for concern
  • Child’s appearance and interaction with parents is abnormal
  • Child may say something contradictory
  • History of previous injury
  • History of violence within the family
67
Q

What are the final checklist questions you need to ask yourself when considering if physical abuse is occurring? (4)

A
  • Could the injury have been caused accidentally and if so how?
  • Does the explanation for the injury fit the age and the clinical findings?
  • If the explanation is inconsistent with the injury, is this itself within normal acceptable limits of behaviour?
  • If there has been a delay in seeking advice, are there good reasons for this?
68
Q

What is the final checklist of observations you need to make when considering if physical abuse is occurring? (5)

A
  • The general demeanour of the child
  • The nature of the relationship between guardian and child
  • The child’s reactions to other people
  • The reaction of the child to any medical or dental examination
  • Any comments by the child and or guardian that give concern about the child’s upbringing or lifestyle
69
Q

For neglect and physical injury the dental team could…? (2)

A
  • Contribute a vital piece of the jigsaw to prevent the death of a child
  • Be the first link in the chain to offer support to a family in crisis
70
Q

What is expected of the dental team in physical abuse cases? (5)

A
  • Observe
  • Record
  • Communicate
  • Refer for assessment

NOT expected to diagnose

71
Q

As a dentist we need to know where to go for help and advice on dental abuse cases. Give examples of these? (7)

A
  • Experienced colleague
  • Named safeguarding nurse
  • Child protection adviser
  • Named doctor for safeguarding
  • Social work/social services (e.g. social care direct)
  • Children’s services department (e.g. First Contact)
  • NSPCC Helpline 08088005000
72
Q

When doing a referral for physical abuse, how should this be done? (3)

A
  • By telephone initially, follow up in writing
  • Stick to the facts
  • Statement of concerns
73
Q

Look at slides on notification of concern forms.

A

:)

74
Q

After a referral if a child is in immediate danger, what should you do? (4)

A
  • Child protection order
  • Exclusion order
  • Child assessment order
  • Removal by police or authority of a JP

(one of these 4 things will happen)

75
Q

What happens after you refer a patient for physical abuse?

A
  • Investigation
  • Initial assessment
  • Discussion
  • (begin to decide of child is at risk of significant harm)

Then:

  • No further CP action, may get additional support
  • Joint investigation

BDS3 Paediatric Dentistry (9 decks)

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