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Year 5 - Paediatrics > Safeguarding - non-accidental injury and neglect > Flashcards

Safeguarding - non-accidental injury and neglect Flashcards

1
Q

What is the most common type of intentional burn injury?

A

Scalding by immersion in hot water

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2
Q

What factors make you suspect intentional over non-intentional burns?

A

Distribution of intentional injury:

  • Lower limbs especially feet
  • Bilateral
  • Buttock/perineal
  • Posterior burn significantly associated with abuse

Patterns of intentional injury:

  • Symmetrical
  • Clear upper limits
  • Skin fold sparing
  • Circumferential
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3
Q

Apart from hot water/drinks what else can be the cause of burns in children?

A
  • Domestic irons e.g. palm of the hand
  • Hairdryers
  • Cigarettes or lighters e.g. hands, trunk; would match the shape of top of lighter or roundness of a cigarette
  • Grease/oil
  • Frostbite to feet
  • Light bulb
  • Curling tongs
  • Glowing knife
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4
Q

What are some intentional burn mimickers?

A
  • Dermatitis
  • Caustic burn (detergent)
  • Pressure/friction injuries
  • Walking on hot surfaces
  • Insect bites
  • Photodermatitis - sun exposure following chemical contact like perfume
  • Infections e.g. SSSS, bullous impetigo, toxic shock, tinea capitis
  • Eczema
  • Congenital insensitivity to pain
  • Haemangiomas
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5
Q

Name 3 intentional burns without malicious intent.

A

Common in South Asian and Somalian populations

  • Traditional remedies for illness
  • Hot boiled egg to the skin/face for bruising
  • Moxibustion - moxa hern, burning yarn or cigatette in Chinese medicine
  • Cupping
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6
Q

What age group is accidental bruising uncommon in?

A

Pre-mobile infants i.e. not crawling or no independent mobility

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7
Q

What sites is accidental bruising most common in?

A
  • Shins and knees
  • Back of head
  • Front of face (T of forehead, nose, upper lip and chin)
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8
Q

Which parts of the face is it uncommon to have accidental bruising?

A

Cheeks and around eyes

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9
Q

Which parts of the body are common sites for non-accidental bruising?

A
  • Cheeks
  • Ears
  • Neck
  • Genitalia
  • Buttocks
  • Head
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10
Q

What are some characteristics of bruising suggestive of physical child abuse?

A
  • in children who are not mobile
  • away from bony prominences
  • face, abdomen, arms, buttocks, ears, neck and hands affected
  • clusters of bruises
  • uniform shape of bruises
  • imprint of implement or lgature
  • petechiate in the absence of bleeding disorders
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11
Q

What type of imaging can be used to see old bruises?

A

Ultraviolet photography may show two to ten month old injuries

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12
Q

What can be an iatrogenic cause of retinal haemorrhages in an emergency in a child?

A

Cardiopulmonary resuscitation although there is only weak evidence to support this

May also be as a consequence of delivery in the infant is less than 42 days old (esp in vacuum delivery or with forceps)

https://www.rcpch.ac.uk/resources/child-protection-evidence-retinal-findings

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13
Q

What is a common cause of retinal haemorrhage in non-accidental injury?

A

Shaking a baby

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14
Q

Who is usually the point of call if you have a safeguarding issue?

A

Safeguarding team or a social worker team who receive, triage and action new referrals within 24 hours

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15
Q

What are the 4 potential outcomes after you contact the safeguarding team?

A
  1. No further action required
  2. Case suitable for early help
  3. Assessment of family done and child becomes a Child in Need (CIN) under Section 17 of the Children Act 1989
  4. Child has sustained or is at risk of significant hard and child protection proceedings must be started under Section 47 of the Children Act 1989
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16
Q

What does Section 47 of the Children Act 1989 say?

A

Section 47 of Children Act 1989 – Requires the local authority to co-ordinate an investigation where a child has been subject to or is at risk of significant harm. The aim of this multi-agency enquiry is to decide whether any action is required to safeguard and promote the welfare of the child. Usually the police CAIT (“Child Abuse Investigation Team”) is involved.

17
Q

What does the Section 17 of the Children Act 1989 say?

A

An assessment of the family is carried out leading to the child becoming a Child In Need (CIN)

18
Q

What should a referral about a safeguarding concern include?

A

Why, what, where, when and who? The referral needs to be factual, but should include an opinion about why you are concerned, or the perceived risk to the child.

  1. Name, date of birth and address of the child, parents , siblings and any other household members
  2. Addresses of all places the child spends time
  3. School/ Nursery/ GP name and address
  4. Concerns that have lead you to refer the child on this occasion
  5. Have there been any previous concerns that you know about? Previously known to Social Care? Name and number of social worker/ family support worker?
  6. Where the child is now and how can they contact you
  7. Any other children in the household who may at present be at risk
19
Q

What two pathways are available to remove children from a harmful environment?

A

Police powers of protection/police protection order (PPO) - not a court order but police can temporarily house a child in ‘a place of safety’ for up to 72 hours but parent retains parental responsibility

Emergency protection order (EPO) - issued by court and authorises the local authority (applicant) to remobe child from home or prevent removal from hospital. Can last up to 8 days but parent retains parental responsibility

20
Q

What is the significance of EPO/PPO in the medical setting?

A

Parents retain parental responsibility so you must gain their consent before performing the child protection medical or investigations/interventions

21
Q

What does a child protection medical assessment involve?

A

History and examination by a paediatrician. Used to pick up injuries and unmet health needs.

1. Medical proforma- most trusts will have their own version. It can act as a prompt to remind you of what questions to ask. Remember to use the child’s own words as much as possible. Consent must be gained, and ideally written consent is best.

2. Growth chart- good practice to document the height and weight especially if there are child protection concerns.

3. Medical Photography- generally, this requires written consent and needs to be done via the hospital’s medical illustration department. This isn’t always available out of hours- in some hospitals A&E may have a camera that can be used for this purpose

4. Body mapping

22
Q

Who decides whether a child protection plan is needed?

A

Children’s social care team at a case conference (AKA initial child protection conference ICPC) within 15 working dats of the case.

23
Q

What does a child protection plan include?

A

This is a document by local authority and should specify how to:

  1. Ensure the child is safe and protected from further harm
  2. Promote the child’s health, welfare and development
  3. Support the family to protect and promote the child’s welfare, provided this is in the child’s best interests.
24
Q

What is section 31?

A

Care order - issued by court to remove the child from their home and share parental responsibility between the parents and the local authority. Lasts until the child is 18, adoption, or until the court deems it unnecessary.

25
Q

Why are delayed presentations a cause for concern?

A

If significant, the child would have made it clear earlier that they were in pain.

26
Q

https://dontforgetthebubbles.com/safeguarding-module/

A
27
Q

What are the adverse effects of child abuse or neglect on the child?

A
  • effects on growth and physical development
  • impaired language development and behaviour by age 4
  • impaired ability to socialise, play and learn
  • increased likelihood of being involved in antisocial behaviour
  • increased likelihood of suicidal thoughts and attempts during adolescence
28
Q

What are important questions to ask in the context of physical abuse?

A
  1. What are the injuries and how did they present?
  2. When did they happen? What was the child doing at the time?
  3. Can you give an explanation for the injuries? Can anyone else?
  4. Address any discrepancy evident in the account
  5. What action was taken after the injury was discovered?
  6. Check for any previous injuries
  7. Decide if the explanation is consistent or not with the developmental level of the child.
29
Q

What can some of the more subtle signs be that can alert you to child protection issues?

A
  1. Child looking unkempt- soiled clothes, pram, dirty fingernails
  2. Large full wet nappy +/- nappy rash
  3. Child who is mobile who has been brought out without shoes
  4. Child not dressed appropriately e.g. in cold weather no coat
  5. Poor dental hygiene or dental caries
30
Q

How often should a child protection plan be reviewed?

A
  • At regular intervals – first at 3 months then at 6 monthly intervals.
  • If all the points of the CP Plan have been achieved, and the child is no longer considered to be at risk of harm, the CP plan can be discontinued.
  • If not, or if the child has been on a CPP for 2 years, a legal planning meeting is held to decide if the child should be taken into care, and become ‘Looked After’.
31
Q

A mum has come in with 3 children who are all not in school on a weekday. You want to inform their social worker of this but it is now midnight. What should you do?

A

There may be protocols for this which vary

  1. Documenting in notes may be enough with a fallback mechanism for someone to contact the social worker within hours
  2. Contacting the Local Children’s Protection Services out of hours
32
Q

What investigations should be done when concerned about child protection? (RCPCH)

A

Bloods:

  • Full blood count
  • Coagulation studies (basic and extended)
  • Liver function tests
  • Amylase
  • Bone chemistry and vitamin D/parathyroid hormone
  • Urine and blood toxicology (if appropriate depending on history)

Imaging:

  • Skeletal survey with follow up films
  • Bone scan (done in certain situations)
  • Computed tomography (CT) head scan
  • Magnetic resonance imaging (MRI) brain and spinal cord
  • Ophthalmology examination
33
Q

How do you deal with confrontational parents when addressing safeguarding concerns?

A
  1. Do not be judgemental
  2. Speak in a neutral tone, calmly and kindly
  3. Use open body language
  4. Explain that the child is the most important thing for you, your role is to find out what has happened and so you are obliged to refer to the Local Children’s Protection Services
  5. It is important to have another health professional with you. Many, on the other hand, will surprise you if you explain the situation well, by behaving very reasonably
  6. Call security if you feel the situation may escalate

Year 5 - Paediatrics (91 decks)

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