Systemic problems / Child Safeguarding / Healthy Child Programme / Childhood immunisations Flashcards
Describe the main types of child maltreatment
Physical abuse
Sexual abuse
Emotional abuse
Neglect
Bullying / cyberbullying
Fabricated and induced illness
Identify risk factors for child maltreatment / non-accidental injury
- Parental use of drugs and alcohol
- Domestic violence/abuse in the household
- Poor parental mental health
- Child disability or additional needs
- Excessive crying in a baby
- Carer with learning disability
- Single parent (lacks potential for parental intervention)
- Unwanted pregnancy
Additional sources of stress:
- Homelessness / poor housing
- Racism
- Unemployment / high crime rates
List some red flags from a history of a child’s injury, with regards to alerting for abuse
- Lack of explanation for injuries / condition or an inconsistent explanation
- Injuries not fitting with developmental age of child
- Delay in seeking help (with no appropriate explanation)
- Inappropriate carer/child response or odd relationship
- Previous history of unusual injury
- Already known to social services
- Repeated incidence of was not brought to appointments
Outline the procedures for raising concerns about child maltreatment
If you are concerned that a child/young person is at risk, you must:
- Inform an appropriate agency, such as your local authority children’s services, the NSPCC or the police
- You do not need to be certain that the child or young person is at risk of significant harm to take this step
When informing an agency, you should include information on:
- Child’s identity and parents/other members
- Reasons for your concern, including information on their health and relevant information regarding parents/carers
Outline the duty of care for health professionals to report concerns regarding child maltreatment
- Good medical practice places a duty on all doctors to protect and promote the health and well-being of children and young people
- All doctors must act on any concerns they have about the safety or welfare of a child or young person
State some signs/symptoms of child maltreatment on examination
- Bruises not suggestive of accidental bruising (e.g. bigger, soft tissue areas)
- Bite marks
- Subconjunctival haemorrhage
- Chronic damage to lips (punching mouth)
- Torn frenulum in mouth
- Unusual skeletal fractures e.g. femur fracture in babies nappy age
- Bruises in an immobile child
State some types of physical abuse
- Bruising
- Lacerations
- Head injury
- Fractures
- Burns
- Bites
State some features of abusive bruises
- Bruises on head (most common)
- Seen in soft tissue areas (not bony prominences)
- Can show imprints of implement
- Often larger than accidental bruises
If there has been a suspected skeletal injury in a child under 2, suggest some investigations that should be considered
- Skeletal survey
- CT head scan
- Ophthalmology assessment
- Blood tests for clotting
Briefly outline the Healthy Child Programme, who is responsible for visits and when should they occur
The programme is designed to offer every family support in making healthy choices, it includes:
- immunisations
- health information
- developmental reviews
- access to a range of community services and resources
Pregnancy - 5 years old = Health Visiting team
- Antenatal visit at 28 weeks
- New baby and mental health review at 2 weeks
- 1 year health review
- 2 year health review
Once at school = Nursing team
State some causes of inadequate nutritional intake
- Neglect
- Poor availability of food (poverty)
- Family/parental problems
- Feeding issues e.g. cleft lip/palate
- Malabsorption conditions e.g. coeliac, cystic fibrosis, IBD
- Inborn errors of metabolism
State a management plan for a malnourished child
- Consider safeguarding referral
- Involve dietician
- Medically optimise any underlying conditions e.g. IBD control
- Consider financial support for high-nutrition food
- Monitor weight gain and developments regularly
State some signs and symptoms of dehydration in babies
- Sunken fontanelle
- Sunken eyes
- Poor tears when crying
- Limited wet nappies
- Drowsy / irritable
State some signs and symptoms of dehydration in babies
- Dry mucosal membranes
- Sunken eyes
- Dark, strong-smelling wee
- Reduced urinary frequency
- Dizziness
- Tiredness
- Thirst
State some potential causes of paediatric hyperthermia
- Environmental conditions e.g. left in a hot car
- Infection e.g. brain abscess, encephalitis, meningitis
- Status Epilepticus
- Damaged hypothalamus
- Medications / illicit drugs e.g. Aspirin, stimulant drugs, serotonin drugs, anticholinergic, antipsychotics
- Thyroid storm
- Neuroleptic Malignant Syndrome
- Phaeochromocytoma
- Malignant hyperthermia
Outline how hyperthermia can be managed in paediatrics
- Remove from warm environment and remove layers
- Encourage fluid intake or IV fluids
- Evaporative cooling e.g. spray cold water while fanning
- Treat any seizures with Lorazepam
