Safeguarding Children Flashcards
What do we have a responsibility to raise concerns about?
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
What is child protection?
Activity undertaken to protect specific children who are suffering or are at risk of suffering significant harm
Who are children in need?
Thos who need additional support or services to achieve full potential
What measures can be taken to minimise harm to children?
Protecting them from maltreatment
Prevent impairment of Childs health or development
Ensure children are growing up in safe and caring environment
What is child abuse and neglect?
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
What 3 elements must be present for child abuse?
significant harm to chid
carer has some responsibility for that harm
significant connection between carers responsibility for child and harm to child
What legislation is in place to protect children in Scotland?
National guidance for child protection in Scotland 2014
Children and young peoples act 2014
Getting it right for every child (GIRFEC)
What is the child and young people act?
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
What are the 4 major themes of the children and young peoples act 2014?
Children rights
girfec
looked after children
early learning and childcare
What is GIRFEC?
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
What is the national practice model for GIRFEC in cypa 2014?
the wellbeing wheel - shanarri
my world triangle
resilience matrix
What is GIRFEC a shared approach to?
Organising and recording info about a child, and discuss ways of addressing concerns about wellbeing
Describe GIRFEC?
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
What makes up the girfec national practice model?
well being wheel
my world triangle
resilience matrix
What is the well being wheel?
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.
What do SHANARRI ensure a child becomes?
Confident learner
responsible citizen
effective contributor
successful learner
What is the my world triangle?
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
What is the resilience matrix?
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
When can information about children be shared?
when SAFETY IS AT RISK
WHEN BENEFITS OF SHARING THE INFO OUTWEIGHT THE PUBLIC AND INDIVIDUALS INTERESTS IN KEEPING IT CONFIDENTIAL
If we want to share info about CYP what should we do?
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
What are the UNs children rights?
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
What causes child abuse - adults?
Drugs Alcohol poverty mental illness domestic violence disabled step parents absued as a child unrealistic expectations
What cause child abuse? - child?
Cryig soiling disability unwanted pregnancy failed expectations wrong gender produced of forced, coercive sex
What cause child abuse? - community?
Dwelling place and housing conditions, neighbourhood
What are the big three concerns in terms of parent capacity?
Domestic violence
drug and alcohol misuse
mental health problems
MORE THAN ONE INCREASES LIKELIHOOD OF NEG OUTCOME
What are the categories of child abuse?
Physical
Emotional
Neglect
Sexual
Non-organic failure to thrive
Who do we class as vulnerable children?
Under 5s
Irregular attenders
Medical problems and disabilities
Why are under 5s more vulnerable?
Not as school yet - nursery in Scotland at 3/4 but less opportunity to access other adults
Why are irregular attenders more vulnerable?
Repeatedly DNA
Return in pain
exposed to risk of GA
Not Brought to appt
Why are medical problem and disabled children more vulnerable?
More at risk of experiencing abuse
Serious impairment of health or development is more likely as a result of untreated dental disease
What is neglect?
Neglect is the ongoing failure to meet a child’s basic needs and the most common form of child abuse
What are some of a Childs needs?
Nutrition
warmth, clothing, shelter
hygiene and health care
stimulation and education
affection
What are the effects of nutrition neglect?
Failure to thrive
short stature than would have been
What are effects of warmth, clothing, shelter neglect?
Inappropriate clothing, cold injury, sunburn
What are effects of hygiene and healthcare neglect?
Ingrained dirt (finger nails)
head lice
dental caries
What are the effects of education and stimulation neglect?
Developmental delay
What are effects of affection neglect?
Withdrawn or attention seeking behaviour
What is the short term damage of neglect?
Physical health
emotional health
social development
cognitive development
What is the long term damage of neglect?
adults are at higher risks of arrest, suicide attempts, major depression, diabetes and heart disease
What is dental neglect?
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
What factors contribute to dental caries?
Multifactorial
inequalities in dental health - social class, regional
inequalities in access to dental tx
What can severe dental disease cause?
Toothache
disturbed sleep
difficult eating
absence from school
How is dental neglect related to general neglect?
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
What does dental disease put a child at risk of?
Teasing due to appearance
repeated antibiotics - antibiotic resistance
repeated general anaesthetic extarctions - ga has risk
severe infection
What is wilful neglect?
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
What are signs of wilful neglect?
Failure to attend appts, cancellations, irregular attendance
failure to complete tx plan
returning in pain several times
repeated ga for xla
What are indicators of dental neglect?
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
What are the 3 stages to manage dental neglect?
Preventative dental team management
preventative multi agency management
child protection referall
What is stage one of managing dental neglect?
Preventative dental team management
What is preventive dental tea, management?
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?
What is stage two of managing dental neglect?
Preventative multi agency management
What is Preventative multi agency management?
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
What can we send to health visitors?
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
What is stage 3 of managing dental neglect?
Child protection referral
What is child protection referral?
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
What is physical abuse?
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
Difference between acute/compassionate and chronic pathological abuse?
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
What was passed in 2019 in Scotland?
Children (equal protection form assault) (Scotland) bill was passed removing reasonable chastisement excuse from law
What can you not do form 7th November?
Physically punish a child - illegal to hit a child
What percentage of serious head injuries occur in first year of life?
95%
What percent of childhood burns are non accidental?
10-12%
Why is it unusual for bad burns to happen on hands?
Reflex - will pull away from hot object - think about non accidental
Approx how much of injuries in abuse cases are on head and neck area and why?
60%
easy to get to
where child makes noise from
Where are accidentally injuries likely to occur?
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
What is important to remember in accidental injuries?
accidental injuries In bony prominence areas
match the history
match with development of child
What is important to remember about non accidental injuries?
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
What injuries are common in non accidentally injuries?
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
What are some oro-facial signs of physical abuse?
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
What are some major clinical features of abuse?
Skin lesions - bruises, burns, bites, lacs
bone lesions - fractures
intracranial lesions form shaking
visceral lesions - from blunt trauma
What is important about brusing?
everyone heals different but on each individual they should heal similarly
What is tattoo bruising?
this is when bruise matches the thing that has caused it
What must we look at on the ears?
All 3 sides, look for pinches and bruises - will bruise easily as skin –> cartilage
What abuse signs can we see intramurally?
Contusions
bruises
abrasions and lacs
burns
tooth trauma
frenal injuries
when might we be suspicious about frenal injuries?
iN NON MOBILE CHILD
what can impetigo also look like?
Cig burns
What can birthmarks look like?
Bruises - good that we know child and will know what’s a birthmark or not
What raises out suspicions of Childs and parents?
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
What is our final abuse check list questions?
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?
If parent says child got dental trauma from falling into wall due to alcohol at 13/14 would this raise concerns?
yes, referral needed
Wha are the final checklist observations in physical abuse?
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?
Why is it important we refer if we have suspicions?
we could prevent death of a child and can be first link in chain to offer support to a family in crisis
What is expected of us in terms of suspected abuse? (4)
OBSERVE
RECORD
COMMUNICATE
REFER FOR ASSESSMENT
What are we not expect to do as a dentist?
Diagnose abuse - this is made as part of a multi disciplinary team decision - we just observe record communicate and refer
How can we help children at risk?
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
How do we refer?
Initially by phone
followed up in writing
What form do we use for referrals?
Notification of concern form/ shared referral form
What does the notification of concern form have?
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
What happens if we make a referral?
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?
If no further cp action is required what may happen in Scotland and England?
England - may get additional support
scotland - join investigation
