Child Protection and NAI

Question 1

What legislation is there surrounding child protection?

Answer 1

• Untied nation rights of the child
• Children (Scotland) Act 1995
• Children and Young people (Scotland) Act 2014
• Named person

Question 2

In what way may the public be aware of cases of child abuse?

Answer 2

• See and hear aspects of child care that cause concern
• Social media
• Volunteering

Question 3

In what way are we obligated through our professional duty to protect children?

Answer 3

• GMC
• Contract
• Public role to protect and prevent from

Question 4

Who’s responsibility is it to safeguard children?

Answer 4

Everyone’s responsibility

Question 5

What duty to all children have?

Answer 5

All doctors have a duty to act upon any concerns they have about the safety or welfare of a child or young person

Question 6

What happens after a referral has been made to police or social work?

Answer 6

After a referral is made the response depends on the level of risk or harm identified. An initial assessment will be made to gather information and understand the risks to the child

Question 7

What could be included in an initial assessment of a child referred to the police or social work?

Answer 7

• Joint Visit health , social work, police
• Child Protection Case Conference
• Immediate place of safety- Child Protection Order
• Children’s Panel may need compulsory measures of supervision
• Looked after Child -Accommodated or at home

Question 8

Who must ALWAYs be informed if a child is at risk?

Answer 8

Social services

Question 9

What are the categories of abuse?

Answer 9

• Physical abuse
• Sexual abuse
• Emotional abuse
• Fabricated and induced illness
• Neglect

Question 10

What are the alarm bells for the presentation of physical abuse?

Answer 10

• Late presentation
• History changes on repeating
• History inconsistent with findings

Question 11

How do you identify a history that is inconsistent with findings?

Answer 11

Know what is normal and what is not

• Growth
• Development
• Common presentations of common problems, injuries and illnesses
• Common presentation of NAI

Question 12

What types of thermal injury can children sustain?

Answer 12

• Burns by dry heat

- Scalds by hot liquid

Question 13

What patterns of burns/scalds suggest NAI?

Answer 13

Burns with spared areas

Question 14

How can you distinguish cigarette burns from impetigo?

Answer 14

• Both circular
• Burns often infected
• Look for distribution
• Look for burnt hair
• Healing
• Patches of impetigo tend to vary in size

Question 15

What distinguishes accidental from NA fractures?

Answer 15

• Mechanism (spiral suggests NAI)
• Age
• Developmental status

Question 16

What is the commonest cause of death in physical abuse?

Answer 16

Abusive head trauma

Question 17

What are the features of abusive head trauma?

Answer 17

• Predominantly < 2 years of age.
• Mortality upto 30%
• Half have residual disability
• Presentation variable
• Retinal haemorrhages seen in 80%
• Neck and cervical spine injury

Question 18

What are the categories of neglect?

Answer 18

• Emotional
• Abandonment
• Medical
• Nutritional/FTT
• Educational
• Physical
• Failure to provide supervision

Question 19

What are the indicators for sexual abuse?

Answer 19

• Disclosure
• Sexualised behaviour
• STI
• Pregnancy

Question 20

What is involved in a CSA/forensic examination?

Answer 20

• Joint Paediatrician/Forensic Medical Examiner
• Do not repeat interview
• Video Colposcope
• General Physical Examination
• Developmental Assessment

Question 21

What are the features of FII?

Answer 21

-Rare form child abuse
Spectrum
90% mother
-Likely underestimated in prevalence studies
-Motivation unclear
-Multi-agency issue

Question 22

Who needs t be involved in FII is suspected?

Answer 22

GP

Question 23

What do we do as a doctor with a child we suspect is being abused?

Answer 23

• Take a history
• Examine the child
• Clinical investigations, if needed
• Reach a preliminary opinion
• Consult with other agencies
• Give a revised opinion, if needed

Question 24

What 3 investigations should be carried out?

Answer 24

• Skeletal survey
• CT head
• Ophthalmology