S1 L2 Introduction to safeguarding children and reviewing child death

Question 1

What are the main categories of child abuse?

Answer 1

1. Physical abuse
2. Emotional abuse
3. Sexual abuse
4. Neglect

Also other ones such as

• Bullying and cyberbullying
• Child sexual exploitation
• Child trafficking
• Criminal exploitation and gangs
• Domestic abuse
• Female genital mutilation (FGM)
• Grooming
• Non recent abuse
• Online abuse

Question 2

What is abuse and neglect?

Answer 2

Forms of maltreatment of a child
Inflicting harm or by failing to act to prevent harm
By an adult or adults or another child or children

Question 3

Where can abuse and neglect happen?

Answer 3

In a family or institutional or community setting

Question 4

When assessing a child’s safeguarding and welfare what needs to be assessed?

Answer 4

• Parenting/carer capacity
• Family and environmental factors
• Child’s development needs

Question 5

What is physical abuse?

Answer 5

May involve hitting. shaking, throwing, poisoning, burning, scalding, drowning, suffocating or otherwise causing physical harm to a child
May be caused when a parent or carer fabricates the symptoms of or deliberately induces illness in a child (fabricated or induced illness)

Question 6

What is sexual abuse?

Answer 6

Involves forcing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening
Can be done by both male and female adults as well as other children

Question 7

What is included in child sexual abuse?

Answer 7

May involve physical contact, including assault by penetration or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing
Non- contact activities such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexual inappropriate ways, or grooming a child in preparation for abuse (including via the internet)

Question 8

What is sexual exploitation?

Answer 8

Form of sexual abuse
Individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under than age of 18 into sexual activity in exchange for something the victim wants or needs and/or for financial advantage or increased status of the perpetrator or facilitator

Question 9

Can someone be sexually exploited if they consent?

Answer 9

Yes it can be even if it appear consensual
It may not always involve physical contact either
Can occur through the use of technology

Question 10

What is neglect?

Answer 10

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
May occur during pregnancy as a result of maternal substance abuse

Question 11

What are some examples of neglect?

Answer 11

Once child is born failing to:

• Provide adequate food, clothing, shelter (including exclusion from home or abandonment)
• Protect a child from physical and emotional harm or danger
• Ensure adequate supervision (including the use of inadequate care givers)
• Ensure access to appropriate medical care or treatment
• Includes neglect of or unresponsiveness to, a child or young person’s basic emotional needs

Question 12

What is medical neglect?

Answer 12

Carers minimising or ignoring children’s illness or health needs - including oral needs
Failing to seek medical attention or administrating medication and treatments
- Rethink ‘Did not attend’

Question 13

Why do clinicians need to rethink about did not attend for children?

Answer 13

Should be changed to was not brought
Child cannot get there on their own
If persistent think about neglect and safeguarding

Question 14

What is emotional abuse?

Answer 14

Emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child emotional development

Question 15

How can children be emotionally abused?

Answer 15

• Conveying to children that they are worthless, or unloved, inadequate or valued only in o far as they meet the needs of another person
• Not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate
• Age or developmentally inappropriate expectations being imposed on children- interaction beyond child’s developmental capability, overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction
• Seeing or hearing the ill-treatment of another

Question 16

What are the common signs of child abuse?

Answer 16

• Unexplained changes in behaviour or personality
• Becoming withdrawn
• Seeming anxious
• Become uncharacteristically aggressive
• Lack social skills and has few friends if any
• Poor bond or relationship with parent
• Knowledge of adult issue inappropriate for their age
• Running away or going missing
• Always choosing to wear clothes which cover their body
• Visible injuries without an adequate/plausible explanation for them

Question 17

What are adverse childhood experiences?

Answer 17

Traumatic events occurring before the age of 18
Includes all types of abuse and neglect
As well as parental mental illness, substance use, divorce, incarceration and domestic violence

Question 18

What are the consequences of ACEs?

Answer 18

Significant relationship between number of ACEs a person experienced and variety of negative outcomes in adulthood, including poor physical and mental health, substance abuse and risk behaviours
More ACEs experiences = greater risk of negative outcomes

Question 19

How do ACE and safeguarding link?

Answer 19

Children often express emotion through their behaviour

ACEs can cause children to act in certain ways e.g. might be aggressive

Question 20

What are the key themes from serious case reviews?

Answer 20

• Need to be aware of confirmatory bias and for practitioners to reflect on their own biases and ensure these do not cloud their work with children and families
• Value of using chronologies, including medical and medication reviews to support referrals to Children’s social care and provide clarity to all involved of the extent, pattern and severity of concern
• Where information comes to the attention of the practitioner which suggest a primary age child has self harmed serious consideration must be given to weather there are underlying factors, including abuse
• Recognising males that pose a risk
• Balancing the needs of parents and children- needs of children always priority

Question 21

How do you handle a disclosure?

Answer 21

• Listen!!- rather than ask questions
• Do not stop a young person who is freely recalling significant events
• Remain calm- do not give the young person the impression that what they have said is shocking or upsetting
• Do not promise to not tell anyone or that everything will be okay → Thank you for sharing this information, in order to keep you safe I will need to pass that information on…
• Make a report as soon as possible quoting the young person where possible (use the exact language that the young person used) - record timing, setting, people present…
• Record all subsequent events up to the time of the decision as to whether to start a formal child protection investigation
• Reassure the child or young person that it was the right thing to do in telling you

Question 22

What steps do you take if you are worried or concerned about the welfare of a patient?

Answer 22

1. Where appropriate seek an explanation for your concerns usually from a parent, carer or child
2. Record events accurately, date and sign, check background information within your organisation
3. Inform and discuss with your line manager or supervisor
4. Agree what action to take e.g. just keep a record, refer to other agency, fill in MARF form, refer to social care…
5. If a referral to social care ensure information is passed on immediately by phone
6. Within 24hours, follow up with a written record of referral information
7. Provide further background information to social care when requested

Question 23

Why are child deaths reviewed?

Answer 23

• Establish where possible the cause or causes of death
• Identify any potential contributory and modifiable factors
• Provide ongoing support to the family
• Learn lesson in order to reduce the risk of future child deaths

Question 24

What is the process that is followed when a child dies?

Answer 24

Child dies→ Immediate decision making and notifications e.g. can death certificate be issued coroners notified, GP, schools etc.. → investigation and information gathering → child death review meeting → independent review by CDR partners at child death overview panel or equivalent → national child mortality database → local and nation learning shared

Question 25

What is a joint agency response?

Answer 25

Involvement of multiple different agencies - health care, police, social care
Why ?
1- Death is or could be due to external causes
2- Sudden and no immediately apparent cause (inc SUDI/C) e.g. cot death
3- Occurs in custody/ detained under mental health act
4- Initial circumstances raise suspicions death may not have been natural
5- Unattended stillbirth- born before reaching hospital on arrival dead- could have been harmed following birth causing death
6- Sudden collapse with very poor prognosis- before death, visit scene of collapse establish cause

Question 26

What is the national picture around child death?

Answer 26

6000 death in UK
2/3 before 1st year of life
Above 1yr - injuries most frequent cause- many preventable
Association between deprivation and mortality rate across lifespan
Infant and child mortality falling, but lagging behind other comparable companies

Question 27

What is the relationship between deprivation and child death?

Answer 27

Most deprived areas have the highest death child death rate

Question 28

What are the risk factors for child abuse?

Answer 28

Parent/carer
- Alcohol, substance misuse, mental health- toxic trio
- Biological relationship- if not related might be abusive
- History of adult being abused in the past
- ACEs in childhood
Child
- Additional needs/ learning difficulties
Stressors
- Unemployment
- Divorce
- Lockdown- uncertainty
- Debt
- Death of family relative
- Deprived conditions
- Unstable housing arrangements

Question 29

What are the signs of physical abuse?

Answer 29

Repeated or patterned injuries

• Bruising → particularly indicative of abuse if observed in infants and immobile children
• Broken or fractured bones, or evidence of old fractures
• Burns or scalds, particularly to the feet or bottom
• Lacerations to the body or mouth
• Bite marks
• Scarring
• The effects of poisoning e.g. vomiting, drowsiness, seizures
• Breathing problems from drowning, suffocation or poisoning
• Head injuries in babies and toddlers may be signalled by the following symptoms: swelling, bruising, fractures, being extremely sleepy, breathing problems, vomiting, seizures, being irritable, or not feeding properly
• Seeming frightened of parents, reluctant to return home after school
• Displays frozen watchfulness
• Constantly asking in words/actions what will happen next
• Shrinks away at the approach of adults