Child Protection Flashcards
Response expectation
-To identify and consider the child’s wellbeing, and to share appropriate information with others collaboratively with the child, their family and other services.
-Services and agencies that may previously have seen their role as being to „pass on‟ concerns are now expected to take a proactive approach to identifying and responding to potential risks, irrespective of whether the child in question is their “client‟, “patient‟ or service user‟
WHO definition neglect
The failure of a parent to provide for the development of the child – where the parentis in a position to do so – in one or more of the following areas: health, education, emotional development, nutrition, shelter and safe living conditions. Neglect is distinguished from circumstances of poverty in that neglect can occur only in cases where reasonable resources are available to the family or caregiver
Prevalence of neglect
-1 in 10 children have experienced neglect
-Over 24,300 children were identified as needing protection from neglect 2016 (UK child protection)
-Neglect is a factor in 60% of serious case reviews
-Child neglect is the most common form of child abuse, but it isn’t always easy to identify
Why does neglect matter?
-Neglect is damaging to children in the short and long term. Neglect is associated with some of the poorest outcomes. It affects children in the early years, but teenage neglect, often overlooked, is also damaging.
-The experience of neglect affects physical, cognitive and emotional development; relationships, behaviour and opportunities
Examples of neglect
-Being left alone in the house or in the streets for long periods of time
-Lack of parental support for school attendance
-Being ignored when distressed, or even when excited or happy
-Lack of proper healthcare when required
-Having no opportunity to have fun with their parents or with other children.
-Inadequately fed and clothed
Features where you should consider neglect
-Severe and persistent infestations (e.g. -Scabies or head lice)
-Parents who do not administer essential prescribed treatment
-Parents who persistently fail to obtain treatment for tooth decay
-Parents who repeatedly fail to attend essential follow-up appointments
-Parents who persistently fail to engage with child health promotion
-Failure to dress the child in suitable clothing
-Animal bite on an inadequately supervised child
Suspect if:
-Failure to seek medical advice which compromises the child’s health
-Child who is persistently smelly and dirty
-Repeat observations that:
=Poor standards of hygiene that affects the child’s health
=Inadequate provision of food
=Living environment that is unsafe for the child’s development stage
Features where you should consider sexual abuse
-Persistent dysuria or anogenital discomfort without a medical explanation
-Gaping anus in a child during examination without a medical explanation
-Pregnancy in a young women aged 13-15 years
-Hepatitis B or anogenital warts in a child 13-15 years
Suspect if:
-Persistent or recurrent genital or anal symptoms associated with a behavioural or emotional change
-Anal fissure when constipation and Crohn’s disease have been excluded as the cause
-STI in a child younger than 12 years (where there is no evidence of vertical or blood transmission
-Sexualised behaviour in a prepubertal child
Features where you should consider physical abuse
-Any serious or unusual injury with an absent or unsuitable explanation
-Cold injuries in a child with no medical explanation
-Hypothermia in a child without a suitable explanation
-Oral injury in a child with an absent or suitable explanation
Suspect if:
-Bruising, lacerations or burns in a child who is not independently mobile or where there is an absent or unsuitable explanation
-Human bite mark not by a young child
-One or more fractures if there is an unsuitable explanation, including:
=fractures of different ages
=X-ray evidence of occult fractures
-Retinal haemorrhages with no adequate explanation
Complications of neglect
-Neglect can cause profound negative and long-term effects on brain and other physical development, behaviour, educational achievement and emotional wellbeing
-For some children neglect is so profound that they starve to death, or die because of accidents associated with lack of supervision
-The simple and stark reality for children whose needs are not being met is that life is pretty miserable
Evidence of neglect
-In interactions with mother, children demonstrate passive and withdrawn behaviour
-Unintentional caustic burns (initially mistaken for abusive burns): laundry detergent split onto clothes
What can I do as a medical doctor?
-Assess the child clinically- clinical skills
-Record attendance rates and reasons for non-attendance, immunisation status and compliance with treatment- history taking and recording
-Record how the child interacts with their parents, other significant people present and adults that the child is less familiar with; for example yourself- observation
-Paediatricians (doctors) should contribute to multiagency frameworks of assessment- work together
What is the evidence around bruising in non mobile babies?
-The medical evidence around inadequately or un-explained bruising in non-mobile babies is clear. Although the baby cannot tell us what has happened, we know that bruising is strongly related to mobility; bruising in a baby with no independent mobility is very uncommon
-We risk missing more serious later abuse if we fail to act on bruising in non mobile babies, which can be a sentinel sign of abuse, with possible fatal consequences
-The pattern of bruising can indicate an increased likelihood of abuse. Abusive bruises are more common on the ear, face, neck, torso and buttocks. Of note only 5% of accidental bruising is found on the cheeks
Background history of neglect
-Maternal LAC- cared by grandparents
-Maternal MH concerns
-Erratic behaviour
-Verbal domestic abuse
-Overdose in early pregnancy
-2nd child
-PBCPCC- not registered- engaging with supports
-Interagency Referral Discussion
-Child visiting policy
-Police investigation- mobile phone evidence
-CMA of older 2y old sibling- concerns reemotional attachment
-Parental acrimony
Overview of abusive head trauma
-Head injury is the most common cause of death in physical child abuse.
-95% of severe head injury is inflicted within the first year of life.
-AHT is commonly seen in babies < 6 months.
-Mortality is 30%.
-Half of survivors have residual disability.
-Sudden collapse, intracranial bleed, brain injury, retinal haemorrhages, fractured ribs
Evidence of abusive head trauma
-Abusive head trauma (AHT) is associated with a high morbidity and mortality in children. AHT includes a variety of features such as extra-axial haemorrhages with or without cerebral oedema, hypoxic ischaemic injury or cerebral contusion
-In a child with intracranial injury and rib fracture the meta-analysis showed that the positive predictive value for AHT is73% (95% confidence interval (CI) 50%-88%) and odds ratio of 3 (95%CI 0.7 – 12.8)
