W08 - PAEDS: Injured Child; Acute Paediatrics; Child Protection Flashcards
Issue of trauma injury in children
blunt»_space;> penetrating. dt multiorgan effect
Fractures Children Sustain
Buckle # of distal. radius
- common
- falls and catch themselves
Clavicle fracture
Tibial # - Toddlers
Greenstick #
- Greenstick fractures are treated with closed reduction or surgery, depending on the angle of the fracture.
GrowthPlate Injuries
Salter Harris Classification
normal
type 1 = physeal #
type 2 = physeal # + metaphysis involvement
type 3 = epiphysiseal involvement
type 4 = “” “” +
Type 5 = COMPRESSION #
Injury Patterns in children
SCIWORA: nil SC radiological abn but injury present
Lap belt syndrome
RR for age groups
<1 = 30-40
2-5 = 25-30
5-12. = 20-25
Systolics andHR for age groups
<1 = 70-90mmHg / 110-160
2-5 = 80-100mmHg / 95-140
5-12 = 90-110mmHg / 80-120
Life Threatening Trauma
Resp Failure dt obstruction: FOREIGN BODY; PNEUMOTHORAX
Resp depression raised ICP, headinjury
CIRCULATORY FAILURE dt fluid loss, burns,
fluid maldistribution
Predicting weight in childrn
birth weight ~3.5 kg
< 1 year (0.5 x Age in months) + 4
1-5 year (2 x Age) + 8
6-10 years (3 x Age) + 7
Recognise signs/ markers of deterioration
Bradycardia (<60) indicates life threatening pathology (but may be seen in anorexia)
Initiate appropriate interventions
ABCDE Assessment if deterioration
- rule out cause
Wheeze no creps, 1+yo, and mgmt?
unlikely to be bronchiolitis
more likely to be viral induced wheeze
> multi dose salbutamol
Definitions of abuse and neglect
a
Legal frameworks in child protection
Children (Scotland ) Act 1995
*The Children (Scotland) Act 1995 sets out a statutory statement of parental responsibilities and rights and clarifies the law on guardianship. It requires parents and other persons who have parental responsibilities and rights to consider, as far as practical, their children’s views when making decisions which affect them.
Children and Young People (Scotland) Act 2014; GIRFEC
*Named Person was to be a point of contact for all agencies to refer to when there is concern about a child
- From birth to school attendance - Health Visitor
- School age- Head Teacher
Equal Protection from Assault (Scotland) 2019
*bring to an end the physical punishment of children by parents and others caring for or in charge of children by abolishing the common law defence of “reasonable chastisement”.
Your responsibilities, as a member of the public, a student, a health professional.
a
Factors that impact on the protection of children.
a
What to do and who can help you.
RACH: Child Protection Tea
- on-call specialist team
- general paediatric consultant
- social service involvement
referral = initial assessment to understand risk to child
- joint visit
- case conference
- immediate place of safety - child protection order
-
Alarm Bells @ Presentation
Late presentation
History changes on repeating
History inconsistent with findings
+ Bruising in NON-MOBILE infant
+ Injuries w/ nil explanation
Impetigo Vs Cigarette Burns
- similar appearance
- DISTRIBUTION OF IMPETIGO
- BURNT HAIR; HEALING of BURNS
Commonest cause of death in physical abuse in paediatrics
- abusive head trauma, <2yo
+ commonly presents with retinal haemorrhage
+ neck and cervical spine injury
Neglect - signs
Neglect is the ongoing failure to meet a child’s basic needs
LT physical and mental impact
Emotional
Abandonment
Medical
Nutritional/FTT
Educational
Physical
Failure to provide supervision
*faltering growth
Child Sexual Abuse
indicators:
- disclosure
- sexualised behaviour
- STI
- pregnancy
Fabricated or Induced Illness
Fabrication: making up the symptoms of an illness
Induction: causing a child to become unwell
- rare, 90% mother
- GP involvement
