Child safe guarding and child death reviews Flashcards
(37 cards)
1
Q
Define child abuse
A
- Maltreatment of a child (<18)
- Infliction of harm
- Failure to prevent harm
2
Q
What is significant harm?
A
- Ill treatment or impairment of health or development
- Legal justification for LA intervention into family life
3
Q
What are the categories of child abuse?
A
- Neglect
- Physical (includes Fabricated or Induced Illness/perplexing presentations and FGM)
- Sexual
- Emotional
4
Q
Define neglect
A
- Persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in serious impairment of the child’s health or development
- May occur during pregnancy as a result of maternal substance abuse
5
Q
What might neglect involve once a child is born?
A
Carer/parent fails 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 (includes inadequate care-givers)
- Ensure access to appropriate medical care or treatment
- Neglect of/unresponsiveness to a child’s basic emotional needs
6
Q
How are doctors supposed to document children missing appointments?
A
- Was Not Brought instead of Did Not Attend
- Prevents blame being placed on child
7
Q
What are some red flags for neglect that may be noted during taking a child’s history?
A
- Recurrent non attendance at appointments/non-adherence to medication
- Missed routine screening/immunisations
- Faltering growth
- Delay in development
- Recurrent infestations/infections/injuries
- Poor school attendance
- History of injury where explanation suggests inappropriate supervision
8
Q
What may be seen on examining a neglected child?
A
- Poor nutritional status/poor growth
- Dental decay
- Signs of recurrent/chronic infection or infestation
- Dirty/unkempt/smelly
9
Q
What may physical abuse of a child involve?
A
- Hitting, shaking, throwing, poisoning, burning, scalding, drowning, suffocating etc.
- May also be caused when a parent/carer fabricates symptoms of/deliberately induces illness in a child
10
Q
What are some red flags for physical abuse that may be noted during taking a child’s history?
A
- Lack of/inadequate explanation for injury
- Delay in seeking medical attention/inappropriate response
- Inconsistent accounts
- Presence of multiple risk factors/child or family known to Social Care
- Direct disclosure
11
Q
What may be seen on examining a child suffering from physical abuse?
A
- Unexplained bruising in a vulnerable child
- Unexplained fractures/burns/scalds/head injury
- Patterns: implement/sparing/bites/handprints
- Injury not consistent with history/developmental age
- The younger the child is, the more vulnerable they are
12
Q
What needs to be done if physical abuse to a child is suspected?
A
- Bloods
- Vitamin D, calcium bone profile
- Skeletal survey
- Ophthalmology assessment
- CT head
13
Q
Define sexual abuse
A
- Forcing or enticing a child or young person to take part in sexual activities, not necessarily involving high levels of violence, whether or not the child is aware of what is happening
14
Q
What may sexual abuse involve?
A
- Physical contact (including assault by penetration or non-penetrative acts)
- May be non-contact activities e.g. children looking at/producing sexual images, grooming
- Can take place online and technology used to facilitate offline abuse
- Perpetrators not solely adult males
15
Q
Outline what child sexual exploitation involves
A
- An individual or group takes advantage of power imbalance to coerce, manipulate a child <18 years into sexual activity
- In exchange for something the victim wants/needs
- Or for financial advantage/increased status of perpetrator
- Victim may have been exploited even if sexual activity appears consensual
- Does not always involve physical contact - can occur through use of technology
16
Q
What are some red flags for sexual abuse that may be noted during taking a child’s history?
A
- Disclosure
- Pregnancy/signs of sexual activity in a child under 13 years
- STIs
- Anogenital injury/unexplained bleeding
- Recurrent vaginal discharge
- Soiling/wetting - differential diagnosis
- Behavioural change
17
Q
What should be done in response to identifying that a child may have been sexually abused?
A
- Immediate health needs are paramount
- Referral to social care
- Forensic assessment undertaken at specialist Sexual Assault Referral Centre by staff with appropriate skills and expertise
18
Q
Give examples of emotional abuse
A
- Rejecting
- Isolating
- Terrorising
- Ignoring
- Corrupting
- Cyberbullying
19
Q
Define emotional abuse
A
- Persistent emotional maltreatment of a child causing severe and persistent adverse effects on the child’s emotional development
20
Q
What may emotional abuse involve?
A
- Conveying worthlessness/unloved/inadequate
- Deliberately silencing or making fun of a child’s voice
- Imposing age/developmentally inappropriate expectations on children
- Over protection and limiting exploring or learning
- Preventing participation in normal and social interaction
- Serious bullying/exploitation/corruption
- Some level involved in all types of abuse but may occur alone
21
Q
What are some red flags for emotional abuse that may be noted during taking a child’s history (baby)?
A
- Infants: feeding difficulties, crying, poor sleep patterns, delayed development. Parents describe baby in negative terms
22
Q
What are some red flags for emotional abuse that may be noted during taking a child’s history (toddler)?
A
- Toddler/preschool: behavioural spectrum from overactive to apathetic, noisy to quiet, developmental delay
23
Q
What are some red flags for emotional abuse that may be noted during taking a child’s history (school aged)?
A
- School aged: wetting and soiling, relationship difficulties, poor school performance, non-attendance, anti-social behaviour
24
Q
What are some red flags for emotional abuse that may be noted during taking a child’s history (adolescent)?
A
- Adolescents: self-harm, substance misuse, eating disorders, oppositional, aggressive, delinquent behaviours
25
What may be seen on examining a child who is being emotionally abused?
- Growth (underweight)
- Emotional signs (non-specific)
- Behavioural (wide range)
- Development (failure to achieve milestones, academic failure)
26
What else do we need to safeguard children against?
- Online abuse and grooming
- Child criminal exploitation/county lines
- Trafficking
- Radicalisation
- Modern slavery
- FGM/cutting
- Forced marriage
- Honour based violence
- Discriminatory abuse
27
What is the triad of vulnerability for child abuse?
- Domestic abuse
- Mental illness of parent or carer
- Parental drug and/alcohol misuse
28
What else makes children vulnerable to abuse?
- Under 2 years
- Pre-verbal babies and children
- Those with additional needs/disability
- Vulnerable/ marginalised young people
29
Give examples of Adverse Childhood Experiences
- Physical abuse and neglect
- Sexual abuse
- Emotional abuse and neglect
- Domestic violence
- Mental ill-health
- Incarceration
- Substance misuse
- Parental separation
30
What are the consequences of ACEs?
- Disrupted neurodevelopment and allostatic load
- Social, emotional and cognitive impairment
- Adoptions of high risk behaviours and crime
- Disease, disability, social problems, low productivity
- Early death
31
What happens after you raise concerns about a child?
- Referral to local authority (Social care/ MASH)
- Reasonable cause to suspect that child is suffering or is likely to suffer significant harm
- Duty to make enquiries under Section 46 of the Children Act 1989
32
What interventions/support are carried out when child abuse is suspected?
- Universal services
- Early help
- Children in Need - consent required
- Child protection - consent not required
33
What needs to happen in order to effectively safeguard children?
- Interagency communication and information-sharing
- See bigger picture and have a family focus
- Listen to and see child
- Be aware of disguised compliance, voice of child, overreliance on parental accounts
- Following up missed appointments and linking incidents
- Recognising abuse
- Process for escalation/challenge
34
What should you do if a child discloses abuse or you are concerned for their welfare?
- Don't ask leading questions
- Document verbatim what was said
- Don't promise confidentiality
- Talk immediately to one of the professionals you are working with - they will escalate appropriately
35
Why review child deaths?
- To establish, where possible, a cause or causes of child death
- To identify any potential contributory and modifiable factors
- To provide ongoing support to family
- To learn lessons in order to reduce risk of future child deaths
36
What happens once a child dies?
- Immediate decision making
- Investigation and information gathering
- Child death review meeting
- Independent review
- National child mortality database
37
Who is involved in the child death review process?
- CDR team: designated Dr, nurses, manager, admin
- Immediate response: health, social care, police
- Review process: all agencies involved in care of child in life or investigating death
