8. Paediatric Child Protection and Non-Accidental Injury

Question 1

What are the Different Categories of Abuse?

Answer 1

1. Physical Abuse
2. Sexual Abuse
3. Emotional Abuse
4. Neglect
5. Fabricated and Induced Illness

Question 2

How is Child Abuse Identified?

Answer 2

1. G.P. or A&E
2. Health Visitors / Teachers / Social Workers / Public
3. Paediatricians - Role is often to Confirm Probability of Abuse

Question 3

What are the Risk Factors of Child Abuse?

Answer 3

1. Vulnerable Children - Disabilities / ill Child
2. Vulnerable Adults - Learning Difficulties / Unsupported
3. History of Unexplained Infant / Child Death
4. Parents Abused
5. Parents with Unrealistic Expectations
6. Parents with Mental Health Illness / Abusing Drugs / Abusing Alcohol

Question 4

What are the Red Flags at Presentation?

Answer 4

1. Significant Injury with no Explanation
2. History Inconsistent with Injury Pattern
3. Multiple Explanations
4. Explanation does not fit with Motor Development
5. Injuries in Non-Mobile Child
6. Delayed Presentation
7. Inappropriate Parent / Carer
8. Multiple Injuries
9. Repeated Attendances / Unusual Injuries

Question 5

What are the Main Differences between Accidental and Non-Accidental Bruises?

Answer 5

Accidental Bruises are more Common over Bony Prominences - Knee / Shins

Question 6

What are the Different Types of Thermal Injury?

Answer 6

1. Burns Caused by Dry Heat - Cigarette / Flame / Electric Burns
2. Scalds - Ho Liquid

Question 7

How is Impetigo distinguished from a Cigarette Burn?

Answer 7

1. Distribution
2. Burnt Hair
3. Healing
   Note - Both Circular and Burns often Infected

Question 8

What are the Features of Abusive Fractures?

Answer 8

1. Abusive Fractures are Frequently Occult

2. Ribs / Metaphyseal / Vertebral Fractures

Question 9

What is the Differential Diagnosis for a Fracture in a Child?

Answer 9

1. Accidental Injury
2. Normal Variant
3. Birth Injury
4. Malignancy
5. Medical Conditions associated with Fractures - Metabolic Bone Disease / Osteogenesis Imperfecta

Question 10

What is Neglect?

Answer 10

Failure to Meet Basic Physical / Psychological Needs

Question 11

What are the Forms of Neglect?

Answer 11

1. Abandonment
2. Medical Neglect
3. Nutritional Neglect
4. Educational Neglect
5. Physical Neglect
6. Failure to Provide Supervision and Guidance

Question 12

What is Emotional Abuse?

Answer 12

Psychological Maltreatment, Persistent Non-Physical Harmful Interactions. This can Manifest as:

1. Carer Preoccupied with Own Difficulties
2. Negativity Towards the Child
3. Expectations Beyond his Capabilities
4. Exposure to Traumatic Events - Domestic / Drug / Alcohol Abuse

Question 13

What are the Different Types of Sexual Abuse?

Answer 13

1. Physical Contact - Penetrative / Non-Penetrative
2. Non-Contact Activities - Exposure to Sexually Explicit Material
3. Child Sexual Exploitation

Question 14

What are the Indicators of Sexual Abuse?

Answer 14

1. Disclosure
2. Sexualised Behaviour
3. Sexually Transmitted Infection
4. Pregnancy