7 - Safeguarding

Question 1

What are the four types of child abuse?

Answer 1

• Physical
• Emotional
• Sexual
• Neglect

Question 2

What is the legal framework for child safeguarding?

Answer 2

Children Act 1989 and 2004

A child is need refers to a child that is likely to need supportive services to maintain their health and development, or is disabled.

Question 3

What are some risk factors for child abuse?

Answer 3

CHILD ABUSE

Criminal record
Health problems
Intoxicated
Learning disabilities
Disabled child

Abused as a child previously
wife Beater - domestic violence
Unwanted pregnancy
Substance use
Emotional volatility

Question 4

What is the commonest form of child abuse?

Answer 4

Neglect

Number one reason for child protection plan

Persistent failure to meet the childs basical physical or psychological needs that is likely to result in the serious impairment of the childs health or development

Question 5

Which children are at high risk of physical abuse?

Answer 5

Under 2’s

Question 6

What are some parts of a history that suggest a child has a non-accidental injury (NAI)?

Answer 6

• Mechanism of injury not compatible with injury sustained
• Child’s developmental stage inconsistent with injury presented
• Little or no explanation
• Inconsistent histories given
• Delay in presenting to healthcare
• Recurrent injuries
• The parents reaction was not appropriate to the situation

Question 7

What might you find on examination of a child that suggests a NAI?

Answer 7

• Injuries of varying ages
• Presence of burns or scalds
• Bruises on arms, legs or face consistent with gripping
• Subconjunctival haemorrhage
• Human bite marks

Question 8

What investigations should you do if you suspect a NAI?

Answer 8

Skeletal Surgery through radiology to look for:

• Rib fractures
• Skull fractures
• Metaphyseal corner fractures (occur due to a twisting/pulling motion)
• Finger fractures
• Clavicle fractures

If under 2 do CT head and senior ophthalmological review too for retinal haemorrhages

Consider clotting screen if extensive bruising

Question 9

What are some causes of bruising and fractures in children not due to NAI?

Answer 9

Do clotting, FBC and blood film, Von Willebrand Factor

Question 10

What rib fracture is more common in NAI?

Answer 10

Posterior due to squeezing

Question 11

How may neglect present?

Answer 11

• Medical
• Nutritional
• Emotional
• Physical
• Educational
• FAILURE TO SUPERVISE (multiple A and E visits)

Question 12

How may emotional abuse present?

Answer 12

Question 13

What is the definition of sexual abuse and how may it present?

Answer 13

• Allegation – a child may disclose abuse to anyone at any time
• Pregnancy
• STI
• Ano-genital injury
• Unexplained vaginal bleeding
• Unexplained rectal bleeding
• Recurrent vaginal discharge
• Soiling, bowel problems, enuresis
• Behavioural difficulties
• Unusually sexualised behaviours

Question 14

What are some of the consequences of child abuse in general?

Answer 14

The severity of these consequences is influenced by:

• The type and form of abuse
• The childs developmental stage at the time of the abuse
• Duration and frequency of abuse
• Relationship to the perpetrator (bigger effect in a relationship of trust)
• The support the child receives following disclosure

Question 15

If you have a concern there may be child maltreatment, what is your responsibility?

Answer 15

• Document everything clearly in the patients notes including any discussions at handover
• Take photos of injuries
• Inform your senior then
• Refer to safeguarding lead who will refer to social services
• Communicate with nursing staff
• Keep the child safe

Question 16

If a child discloses to you that they are being abused, how should you respond?

Answer 16

• Try not to look shocked
• Let the child know you believe them
• Tell them they are not in trouble
• Listen to what they have to say, don’t make an excuse to leave
• Don’t ask leading questions – this may affect the case if it goes to court
• Don’t make promises you cant keep
• Be honest at all times
• Inform your senior

Question 17

What are some measures that can be put into place for families with safeguarding concerns?

Answer 17

Question 18

What investigations are done for suspected NAI in under 2’s?

Answer 18

Skeletal survey
CT Head
Bloods : FBC, clotting, U&Es, LFT, Bone profile, Vitamin D
Ophthalmology assessment

Question 19

What are some examples of adverse childhood experiences?

Answer 19

4 or more ACEs then increased risk of CVD, Type 2 DM, crime

• Parent’s splitting up
• Parent with a mental health disorder
• Someone in the house in prison
• Bullying
• Losing a parent
• Poverty
• Homeless

Question 20

What are some causes of sudden unexplained infant death?

Answer 20

Question 21

What needs to be done in A and E after a sudden unexplained infant death?

Answer 21

• Document all interventions, venepuncture sites, and marks on the baby.
• Keep all clothing and the nappy
• Explain clearly to parents that despite your best efforts, the baby has died
• Explain the baby must have a post-mortem (this is a coroner’s case)
• Contact the consultant on call, the police, child protection team, and the coroner at once

Question 22

What are some risk factors for SIDS?

Answer 22

• Premature baby
• Previous baby with SIDS
• Co-sleeping
• Parental smoking

Question 23

What measures can be taken to reduce the risk of SIDS?

Answer 23

• Do not co-sleep
• Do not overheat baby’s bedroom
• Use a grow-bag so baby cannot slip under blanket
• Avoid heaters, hats, hot water bottles when sleeping
• Place baby on back

Question 24

Go and do deck 4 of GP!!!!

Question 25

What are risk factors of child abuse?

Answer 25

Question 26

What fractures are highly specific to NAI?

Answer 26

Question 27

Which fractures have low specificity for NAI?

Answer 27

Question 28

What is a section 17 and section 47?

Answer 28

**Section 17:** family in need of support **Section 47:** child protection

Question 29

What is the triangle to assess a child's welfare?

Answer 29

* Child needs * Parents * Environment

Question 30

If there is a neonatal stroke what do you need to investigate?

Answer 30

If mother is using IV cocaine

Question 31

If you suspect NAI in a child under 2 what investigations do you have to do?

Answer 31

* CT Head * Fundoscopy * Skeletal survery DO ALL 3 NOT JUST 1

Question 32

If you suspect a child is being neglected due to failure to thrive what do you need to investigate?

Answer 32

Need to rule out other causes * Coeliac's * Hypothyroid * Metabolic issues

Question 33

What is the triad of shaken baby syndrome?

Answer 33

* Retinal Haemorraghes * Subdural haematoma * Encephalopathy