Safeguarding Children & Vulnerable Adults

Question 1

Safeguarding

Answer 1

Measures implemented to protect the health, well-being and human rights of individuals, which allows people to live free from abuse, harm and neglect.

Question 2

Safeguarding can also be defined as:

Answer 2

1. Protecting children from maltreatment
2. Preventing impairment of children’s health or development
3. Ensuring that children grow up in circumstances consistent with the provision of safe and effective care
4. Taking action to ensure all children have the best outcomes

Question 3

The Children Act 2004

Answer 3

Created the legal framework to establish Local Safeguarding Children Boards - the key statutory mechanism in each local authority.

Question 4

What are the core objectives of each Local Safeguarding Children Boards:

Answer 4

1)
To coordinate what is done by each person or body represented on the Board for the purposes of safeguarding and promoting the welfare of children in the area of the authority.

2)
To ensure effectiveness of what is done by each person or body for that purpose.

Question 5

The MUNRO Review:

Answer 5

This report sets out proposals for reform, enabling professionals to make the best judgments about the help to give children, young people and families.

The reform moves from a system of bureaucracy to one that values and develops professional expertise.

Question 6

Children are….

Answer 6

recognised as individuals with rights

Question 7

Multi-agency Cooperation

Answer 7

Many people/agencies accumulate small pieces of information about children e.g. playgroups, nursery, school, childminder, health visitor etc.

Question 8

Acts of commission

Answer 8

When somebody DOES something to a child which leads to harm.

Question 9

Acts of omission

Answer 9

When somebody FAILS to do something which leads to harm.

Question 10

An abused child is…

Answer 10

A boy or girl under the age of 18, who is suffering physical, sexual, emotional abuse or neglect.

Question 11

Optometrists Responsibility!

Answer 11

You are expected to recognise the signs of abuse and know what to do next if abuse or neglect are suspected.

You are NOT expected to diagnose suspicious circumstances or investigate instances where you suspect abuse or neglect are occurring.

Question 12

Physical Abuse

Answer 12

A form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocation or otherwise causing physical harm.

Question 13

Physical Abuse

Red Flag

Answer 13

Physical harm may also be caused when a parent/carer fabricates the symptoms of, or deliberately induces, illness in a child.

Question 14

Physical Abuse

What should I do?

Answer 14

1) Ask the child how the injury was caused.
2) Ask the carer how the injury was caused unless you sense this might put the child at risk.
3) Note the replies in your records.
4) Then make a referral if you suspect otherwise.

Question 15

Signs of Non-accidental Injury -

Answer 15

1. A delay by carers in seeking medical help or medical help might not have been sought at all.
2. An account of the accident may be vague or may vary.
3. There may be no explanation for the injury.
4. The child may not be allowed to tell you the story or may be hesitant.
5. There may be discrepancies between the injury and story given.
6. Carers may be hostile or may curtain discussions abruptly.
7. Interaction between child and carer may be unusual – child may be withdrawn, sad or afraid.

Question 16

Bruising Patterns -

Answer 16

Fingertip bruising:
On the upper arms or chest indicating a child has been held and/or shaken.

• Check Retina for Retinal Haemorrhages from Head Trauma, 75%

Slap marks:
Areas of petechial haemorrhages with dense parallel lines often on cheeks or buttocks.

Imprint of a weapon:
When a weapon is used, the skin is blanched in the shape of the weapon e.g. a belt, and haemorrhages appear around the edges.

Bruising to the outer ear is inherently suspicious, as it is caused by the ears being pinched or boxed.

Fresh or healed damage to the frenulum is caused by a blow to the mouth, or the feeding bottle being forced into a baby’s mouth.

Swelling or the child saying that the area of skin is painful or tender.

Question 17

Accidental Bruising

Answer 17

Most accidental bruising takes place on bony parts of the body e.g. shins, elbows.

Question 18

Burns or scalds:

Answer 18

Children whose hands or feet have been dipped in scalding water show a glove of stocking pattern.

Blistering – the skin may be soggy, pale and come away in sheets.

The skin may be branded by the hot weapon e.g. an iron.

Deliberate cigarette burns form a circular lesion around a central crater.

Question 19

Munchausen’s Syndrome by Proxy –

Answer 19

The new name is Fabricated and Induced Illness.

A factitious, mental health problem in which a caregiver makes up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability.

Because vulnerable people are the victims, MSBP is a form of child abuse or elder abuse.

Question 20

Examples of Fabricated and Induced Illness -

Answer 20

• Blood is found in the urine only when the carer is present.
• Blood in vomit only when the carer is present
• Fits only witnessed by the carer
• Hyperactivity at home

Question 21

Sexual Abuse

Answer 21

Forcing or enticing a child or young person to take part in sexual activities, not necessarily with violence, whether or not the child is aware of what is happening.

Includes non-contact activities such as involving children in looking at or producing sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways or grooming a child in preparation for abuse.

Question 22

Signs of Sexual Abuse -

Answer 22

• Physical signs of trauma
• Emotional effects such as lack of concentration, enuresis, encopresis and eating disorders.
• Self-harm, drug/alcohol abuse, prostitution or other harm.

Question 23

Enuresis:

Answer 23

Involuntary urination

Question 24

Encopresis:

Answer 24

Involuntary defecation i.e. discharge of faeces

Question 25

Emotional Abuse

Answer 25

The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development.

Question 26

Emotional Abuse consists of:

Answer 26

• It may involve conveying to a child that they are worthless or unloved, inadequate or valued insofar.
• It may include not giving the child opportunities to express their views – silencing or making fun of them.
• Imposing age or developmentally inappropriate expectations on children.
• Bullying
• Frequently causing a child to feel frightened or in danger.
• Over-protection, limiting exploration and learning, preventing normal social interaction
• Exposing a child to ill-treatment of another person.
• Continual Self-deprecation

Question 27

Effects of Emotional Abuse on Infants:

Answer 27

Withdrawn and developmentally delayed.

Self-stimulation is often seen e.g. head banging and rocking and a lack of responsiveness.

Question 28

Effects of Emotional Abuse on Pre-school Children:

Answer 28

A delay in learning to talk, reduced concentration and hyperactivity, aggressiveness towards other children.
Children may seek physical contact with strangers.

Question 29

Effects of Emotional Abuse on School Children:

Answer 29

Difficulty in learning, poor concentration and hyperactivity, aggression, disruptive in classes.

Unusal patterns of defecation or urination. Low self-esteem and self-harm.

Question 30

Neglect

Answer 30

The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development.

Question 31

Neglect consists of:

Answer 31

• Failure to provide adequate food, clothing or shelter, also exclusion from home or abandonment.
• Failure to protect a child from physical or emotional harm or danger.
• Failure to ensure adequate supervision.
• Failure to access appropriate medical care or treatment.
• Unresponsiveness to a child’s emotional needs.

Question 32

Neglect may occur during Pregnancy

Answer 32

Thru: substance misuse, malnutrition and not acknowledging the pregnancy.

Question 33

Signs of Neglect -

Answer 33

1) Coming to school hungry
2) Inappropriate clothing for the weather
3) Poor hygiene – nappy rash
4) Perpetual tiredness
5) Failure to thrive

Question 34

An example of inappropriate feeding is…

Answer 34

Prop-feeding

Question 35

Inappropriate interaction between a carer and a child may be a sign of neglect:

Answer 35

• No spontaneity
• Rehearsed interactions
• Silence when carer is present
• No eye contact from the child
• Does the child think before answering?
• Is the child ignored?
• Is the child shouted at?
• Is the child handled roughly by the carer?

Question 36

What should I do as a Health-Care Professional?

Answer 36

1) Observe:

Note factual signs and symptoms and note them in the records without alarming the patient or alerting the possible abuser.

If appropriate, listen sympathetically to the patient but DO NOT agree to not tell anyone what they have told you.

2) Discuss:

Do not delay!

Alert and discuss your concerns with your line manager according to your practice policy. Decide with your manager whether it is appropriate to inform a carer e.g. estranged parent.

Remember, particularly in the case of a child, you may be the only person to have noticed anything unusual or whom they have confided in.

You therefore have a professional duty to act as their advocate.

Relevant personal information can be shared lawfully if it is to keep a child or individual at risk safe from neglect or physical, emotional or mental harm, or if it is protecting their physical, mental, or emotional well-being.

3) Act:

If appropriate, inform your LSCB and supply them with your written records. Decide with them whether a referral is appropriate.

4) Confirm:

Confirm telephone notifications in writing by email or letter within 48 hours.

Referrals often confirm within one working day.

If you have not heard back within three working days, contact again.

Keep contacting (including considering using another route) until you receive confirmation of receipt or other substantive communication or advice.

5)
Ensure that all observations, advice sought, advice received and actions taken are recorded and stored confidentially and separately from the patient’s optical record.

In the unlikely event that you come across an individual in optical practice who is at immediate risk of harm, contact the police.

Question 37

Glove of stocking pattern definition

Answer 37

Are seen when feet or hands are held in the water. The line of demarcation is possible evidence that the injury was not accidental.

Question 38

Frenulum

Answer 38

A small fold or ridge of tissue which supports lips and gums.

Question 39

Petechial Haemorrhage -

Answer 39

A small, red or purple spot on the skin or conjunctiva, caused by a minor bleed from broken capillary blood vessels.

Question 40

Blunt Force Trauma

Answer 40

Caused by a blunt object striking some part of the body.

The typical signs of blunt force trauma include lacerated major blood vessels or aorta, lacerated or crushed organs, hematoma, crushed or severed spinal cord or fractures of the skull.

Question 41

The Data Protection Act 2018

Answer 41

Specifically includes ‘safeguarding of children and individuals at risk’ as a condition that allows practitioners to share information without consent.

Information can be shared legally without consent, if a practitioner is unable to, or cannot be reasonably expected to, gain consent from the individual, or if seeking consent could place a child or adult at risk.

Question 42

When reporting information, reports should be restricted to..

Answer 42

1) The nature of the injury, suspicious behaviour or concern.
2) Facts which support the concerns.

Question 43

Along with the Referral Form copy,

Answer 43

You and the person with whom you are sharing the information must agree what the patient/relatives/legal guardians/carers/person will be told, by whom and when, and you should keep a note of what has been agreed together.

Question 44

Female Genital Multilation

Answer 44

All healthcare professionals in England and Wales have a legal obligation to report any case of FGM in girls under the age of 18 to the police by telephoning 101 or 999 if there is an immediate risk.

If there is no immediate risk, you can also contact the National Society for the Prevention of Cruelty to Children on 0800 028 3550.

Question 45

Registered optical professionals

Answer 45

Have a professional duty to make the care of the patient their first and continuing concern. By definition this includes safeguarding them from abuse.