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3. Paediatrics > Safeguarding Children > Flashcards

Safeguarding Children Flashcards

1
Q

What do we have a responsibility to raise concerns about?

A

Possible abuse or neglect of children or vulnerable adults - we must know who to contact for further advice and how to refer to appropriate authority

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2
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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3
Q

Who are children in need?

A

Thos who need additional support or services to achieve full potential

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4
Q

What measures can be taken to minimise harm to children?

A

Protecting them from maltreatment

Prevent impairment of Childs health or development

Ensure children are growing up in safe and caring environment

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5
Q

What is child abuse and neglect?

A

This is anything which those who are trusted with the care of children to or fail to do which damages the prospects of a safe and healthy development into adulthood

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6
Q

What 3 elements must be present for child abuse?

A

significant harm to chid

carer has some responsibility for that harm

significant connection between carers responsibility for child and harm to child

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7
Q

What legislation is in place to protect children in Scotland?

A

National guidance for child protection in Scotland 2014

Children and young peoples act 2014

Getting it right for every child (GIRFEC)

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8
Q

What is the child and young people act?

A

Introduced in 2014

has 13 parents - covers wide range of children policy

main themes are:

  • children rights
  • girdec
  • early leaning and childcare
  • looked after children
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9
Q

What are the 4 major themes of the children and young peoples act 2014?

A

Children rights
girfec
looked after children
early learning and childcare

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10
Q

What is GIRFEC?

A

This is where there is 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 a Childs wellbeing - its not mandatory

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11
Q

What is the national practice model for GIRFEC in cypa 2014?

A

the wellbeing wheel - shanarri

my world triangle

resilience matrix

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12
Q

What is GIRFEC a shared approach to?

A

Organising and recording info about a child, and discuss ways of addressing concerns about wellbeing

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13
Q

Describe GIRFEC?

A

Getting it right for every child is the Scottish Government’s approach to supporting children and young people. It is intended as a framework that will allow organisations who work on behalf of the country’s children and their families to provide a consistent, supportive approach for all

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14
Q

What makes up the girfec national practice model?

A

well being wheel

my world triangle

resilience matrix

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15
Q

What is the well being wheel?

A

The wellbeing wheel and indicators illustrate the basic requirements for all children and young people to grow and develop so that they can reach their full potential. The wellbeing indicators are: Safe; Healthy; Achieving; Nurtured; Active; Respected and Responsible; and Included. Collectively they are often referred to as SHANARRI.

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16
Q

What do SHANARRI ensure a child becomes?

A

Confident learner
responsible citizen
effective contributor
successful learner

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17
Q

What is the my world triangle?

A

Using the My World Triangle allows practitioners to consider systematically:

how the child or young person is growing and developing
what the child or young person needs from the people who look after him or her
the impact of the child or young person’s wider world of family, friends and community

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18
Q

What is the resilience matrix?

A

People using the Resilience matrix need to understand the basic principles of resilience and how they fit in the National Practice Model.

resiliance
adversity
protective envrionemnt
vulnerability

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19
Q

When can information about children be shared?

A

when SAFETY IS AT RISK

WHEN BENEFITS OF SHARING THE INFO OUTWEIGHT THE PUBLIC AND INDIVIDUALS INTERESTS IN KEEPING IT CONFIDENTIAL

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20
Q

If we want to share info about CYP what should we do?

A

Try get consent from child and young person if appropriate and parent too

we should only share what we have to - keep a note of what and why we shared the info

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21
Q

What are the UNs children rights?

A

Right to respect

right to info about yourself

right to be protected from harm - this is where child protecting and safeguarding comes in

right to have a say in your life

the right to a good start in life

right to be and feel secure

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22
Q

What causes child abuse - adults?

A 
Drugs
Alcohol
poverty 
mental illness
domestic violence
disabled 
step parents
absued as a child 
unrealistic expectations
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23
Q

What cause child abuse? - child?

A 
Cryig
soiling
disability 
unwanted pregnancy 
failed expectations
wrong gender 
produced of forced, coercive sex
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24
Q

What cause child abuse? - community?

A

Dwelling place and housing conditions, neighbourhood

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25
Q

What are the big three concerns in terms of parent capacity?

A

Domestic violence

drug and alcohol misuse

mental health problems

MORE THAN ONE INCREASES LIKELIHOOD OF NEG OUTCOME

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26
Q

What are the categories of child abuse?

A

Physical

Emotional

Neglect

Sexual

Non-organic failure to thrive

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27
Q

Who do we class as vulnerable children?

A

Under 5s

Irregular attenders

Medical problems and disabilities

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28
Q

Why are under 5s more vulnerable?

A

Not as school yet - nursery in Scotland at 3/4 but less opportunity to access other adults

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29
Q

Why are irregular attenders more vulnerable?

A

Repeatedly DNA

Return in pain

exposed to risk of GA

Not Brought to appt

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30
Q

Why are medical problem and disabled children more vulnerable?

A

More at risk of experiencing abuse

Serious impairment of health or development is more likely as a result of untreated dental disease

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31
Q

What is neglect?

A

Neglect is the ongoing failure to meet a child’s basic needs and the most common form of child abuse

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32
Q

What are some of a Childs needs?

A

Nutrition

warmth, clothing, shelter

hygiene and health care

stimulation and education

affection

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33
Q

What are the effects of nutrition neglect?

A

Failure to thrive

short stature than would have been

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34
Q

What are effects of warmth, clothing, shelter neglect?

A

Inappropriate clothing, cold injury, sunburn

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35
Q

What are effects of hygiene and healthcare neglect?

A

Ingrained dirt (finger nails)

head lice

dental caries

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36
Q

What are the effects of education and stimulation neglect?

A

Developmental delay

37
Q

What are effects of affection neglect?

A

Withdrawn or attention seeking behaviour

38
Q

What is the short term damage of neglect?

A

Physical health
emotional health
social development
cognitive development

39
Q

What is the long term damage of neglect?

A

adults are at higher risks of arrest, suicide attempts, major depression, diabetes and heart disease

40
Q

What is dental neglect?

A

This is the persistent failure to meet a Childs basic oral health needs resulting in serious impairment in Childs oral or general health or development

failure to ensure adequate function and freedom from pain and infection

41
Q

What factors contribute to dental caries?

A

Multifactorial

inequalities in dental health - social class, regional

inequalities in access to dental tx

42
Q

What can severe dental disease cause?

A

Toothache

disturbed sleep

difficult eating

absence from school

43
Q

How is dental neglect related to general neglect?

A

dental neglect impacts on a Childs life - their sleep, ability to eat, which in turn affects schooling, playing - can’t learn properly can’t play properly

44
Q

What does dental disease put a child at risk of?

A

Teasing due to appearance

repeated antibiotics - antibiotic resistance

repeated general anaesthetic extarctions - ga has risk

severe infection

45
Q

What is wilful neglect?

A

This is when we point out dental problems and tell parent/carer what to do and how to get it done and we set up appropriate appts that suit the pt but they fail to be Brought in or get cancelled or tx plan doesn’t get completed

ony come in when in pain or needs ga despite all preventative measures in place

46
Q

What are signs of wilful neglect?

A

Failure to attend appts, cancellations, irregular attendance

failure to complete tx plan

returning in pain several times

repeated ga for xla

47
Q

What are indicators of dental neglect?

A

obvious dental disease - to non dental trained person

impact on child - pain, problems eating and sleeping, lack of concentration

practical care offered but not returned for tx

48
Q

What are the 3 stages to manage dental neglect?

A

Preventative dental team management

preventative multi agency management

child protection referall

49
Q

What is stage one of managing dental neglect?

A

Preventative dental team management

50
Q

What is preventive dental tea, management?

A

This is when we offer support to the family and raise our concerns with the

we set targets, and must record hat we have raised concerns, targets we have set and any progress we make

we must offer appts in reasonable way they can attend - after school? can all kids come together?

51
Q

What is stage two of managing dental neglect?

A

Preventative multi agency management

52
Q

What is Preventative multi agency management?

A

This is when step 1 hast worked and pt still isn’t bringing child

so we lease with other profesh such as health visitors, school nurse, gps, social workers to see if concerns are shared

we can check if child is subject to child protection plan

we then agree a joint plan of action

53
Q

What can we send to health visitors?

A

Can download a letter to send to His of children <5 who have failed to respond to our appts
- the letter says if this fam is known to you we would welcome working together to promote their oral health

54
Q

What is stage 3 of managing dental neglect?

A

Child protection referral

55
Q

What is child protection referral?

A

This is when situation is complex or deteriorating

we follow local guidelines and referral is usually to social services by telephone followed up in writing

56
Q

What is physical abuse?

A

This is when there is over chastisement

acute/ compassionate

acute - just happens, spontaneous uncacluated reaction - often due to frustrations with child and parents feel remorse and take appropriate action and Childs needs are priority

chronic/pathological
- this is when its just accepted that this is the way things are, no remorse, help sought but not actively , child needs not a priority

57
Q

Difference between acute/compassionate and chronic pathological abuse?

A

Acute/compassionate is often in the form of shaking and is an unplanned, sponaenus reaction often due to frustration, remorse is felt and help is sought immediately, the Childs needs are a priority

chronic/pathological is a way of life, its just accepted, help may be sought but not actively and there is no remorse, children’s needs are not a priority

58
Q

What was passed in 2019 in Scotland?

A

Children (equal protection form assault) (Scotland) bill was passed removing reasonable chastisement excuse from law

59
Q

What can you not do form 7th November?

A

Physically punish a child - illegal to hit a child

60
Q

What percentage of serious head injuries occur in first year of life?

A

95%

61
Q

What percent of childhood burns are non accidental?

A

10-12%

62
Q

Why is it unusual for bad burns to happen on hands?

A

Reflex - will pull away from hot object - think about non accidental

63
Q

Approx how much of injuries in abuse cases are on head and neck area and why?

A

60%

easy to get to
where child makes noise from

64
Q

Where are accidentally injuries likely to occur?

A

Bony prominences - areas that stick out such as palm of hands, knee, shins

forehead, nose, chin

elbows

head injuries tend to involve parietal, occiput or forehead

65
Q

What is important to remember in accidental injuries?

A

accidental injuries In bony prominence areas

match the history

match with development of child

66
Q

What is important to remember about non accidental injuries?

A

Injuries to both sides of body

injuries to soft tissues

injuries with particular patterns

any injury that does fit explanation

delays in presentation without reasonable explanation

untreated injuries

67
Q

What injuries are common in non accidentally injuries?

A

black eyes - bilateral

soft tissues of cheeks

intra oral injuries

ears - pinch marks, bruises

triangle of safety - ears, side of face and neck

inner aspects of arms

back and side of trunks

chest and abdo

inner aspect of thighs

soles of feet

68
Q

What are some oro-facial signs of physical abuse?

A

Bursing of face - punches, slapping, nips

brusing - pinch, pull

abrasions and lacerations

burns and bites

neck - choke or cord marks

eye injuries

hair pulling

fractures of nose mandible or zygoma

69
Q

What are some major clinical features of abuse?

A

Skin lesions - bruises, burns, bites, lacs

bone lesions - fractures

intracranial lesions form shaking

visceral lesions - from blunt trauma

70
Q

What is important about brusing?

A

everyone heals different but on each individual they should heal similarly

71
Q

What is tattoo bruising?

A

this is when bruise matches the thing that has caused it

72
Q

What must we look at on the ears?

A

All 3 sides, look for pinches and bruises - will bruise easily as skin –> cartilage

73
Q

What abuse signs can we see intramurally?

A

Contusions

bruises
abrasions and lacs

burns

tooth trauma

frenal injuries

74
Q

when might we be suspicious about frenal injuries?

A

iN NON MOBILE CHILD

75
Q

what can impetigo also look like?

A

Cig burns

76
Q

What can birthmarks look like?

A

Bruises - good that we know child and will know what’s a birthmark or not

77
Q

What raises out suspicions of Childs and parents?

A

Delay in getting help

vague story, lacks details, different story form person to person

story doesn’t match injury

parents mood is abnormal - they are preoccupied when all attention should be on child

parents behaviour raises concerns

Childs appearance and interaction with parents is abnormal

child may say something that contradicts parents

history of preventative injury

history of violence in family

78
Q

What is our final abuse check list questions?

A

Could these have been caused accidentally and if so how?

does the explanation for injury fit age and clinical findings?

if age is consistent with injury is this within normally acceptable limits of behaviour?

if delay in seeking help, why?

79
Q

If parent says child got dental trauma from falling into wall due to alcohol at 13/14 would this raise concerns?

A

yes, referral needed

80
Q

Wha are the final checklist observations in physical abuse?

A

How is the child acting

how is child and parents relationship?

how does child react to other people?

how does child react to dental or med exam?

have any comments been made by child or parent that raise concerns to us?

81
Q

Why is it important we refer if we have suspicions?

A

we could prevent death of a child and can be first link in chain to offer support to a family in crisis

82
Q

What is expected of us in terms of suspected abuse? (4)

A

OBSERVE

RECORD

COMMUNICATE

REFER FOR ASSESSMENT

83
Q

What are we not expect to do as a dentist?

A

Diagnose abuse - this is made as part of a multi disciplinary team decision - we just observe record communicate and refer

84
Q

How can we help children at risk?

A

Share concerns with a named person

contact local paeds dept to ask for advice and where to go

ask experienced colleague for help

ask child protection advisor for help

contact social work

contact child services department

we cn phone and ask for advice

85
Q

How do we refer?

A

Initially by phone

followed up in writing

86
Q

What form do we use for referrals?

A

Notification of concern form/ shared referral form

87
Q

What does the notification of concern form have?

A

It has our details

designated contact person different to us details - this is incase we are out of office then a dental nurse or practice manager can be contacted

whoever we referred to on the phone - name of them, there role

subject of referral - is parent aware? if not why? will it put someone in danger by informing parent of this referral? or can we not get a hold of them?

name of child referred and their detals

family details - who’s in the house

siblings

summary of concerns

reason for referral

agreed actions

agency involvement

88
Q

What happens if we make a referral?

A

If a child is in immediate danger there is a child protection order, exclusion order, child assessment order and the child may be removed by police

if not immediate danger then investigation begins and an assessment is made and discussion is had - is child at risk of significant harm?

89
Q

If no further cp action is required what may happen in Scotland and England?

A

England - may get additional support

scotland - join investigation

3. Paediatrics (10 decks)

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