Paediatric Child Protection and Non-Accidental Injury

Question 1

What is the “triad of abuse risk factors”?

Answer 1

Drug abuse

Domestic Violence

Parental Mental Health

Question 2

Categories of abuse?

Answer 2

• žPhysical Abuse
• žSexual Abuse
• žEmotional Abuse
• žFabricated and Induced Illness - (carer will exaggerate or make up symptoms, or give poison (such as insulin))
• žNeglect

Question 3

WHat are some alarm bells for physical abuse?

Answer 3

• Late presentation
• History changes on repeating (parents story inconsistent)
• History inconsistent with the findings.

Question 4

In terms of “history of inconsistent with findings” what must be known?

Answer 4

Know what is normal and abnormal

• growth
• development
• common presentations, injuries and illnesses

Question 5

Bruising at what age is abnormal and why?

Answer 5

Very young children, who don’t have the ability to bruise themselves.

Question 6

Which pattern of bruising is consistent with abuse?

Answer 6

Linear patterns of bruising. such as from a hand or a belt.

Question 7

What investigations would be done in a child under 1 with bruising?

Answer 7

Skeletal survey (full body x-ray)

CT head

Ophthalmology

Question 8

What are the types of thermal injrues?

Answer 8

Burns

• Dry heat

Scalds

• Hot liquid

Question 9

What is sparing in thermal injuries?

Answer 9

.

Question 10

What fractures in a child are suspicious?

Answer 10

Rib fractures - you never get rib fractures in a child (unless car accident etc.)

Spiral fracture - coming from a twisting injury

Fractures in children that are not able to move

Femoral and hip fractures too.

Question 11

What types of child neglect are the medics responsibilty?

Answer 11

Medical neglect

Nutritional neglect

Question 12

What are the indicators of sexual abuse?

Answer 12

žDisclosure​ - must always believe a child.

žSexualised Behaviour​

žSTIž

žPregnancy

Question 13

Generally, outline Child Sexual Abuse/Forensic Examination?

Answer 13

• žJoint Paediatrician/Forensic Medical Examiner
• žDo not repeat interview
• žVideo Colposcope
• žGeneral Physical Examination
• žDevelopmental Assessment

Question 14

Generally outline fabricated or induced ilness?

Answer 14

• žRare form child abuse
• žSpectrum
• ž90% mother
• žLikely underestimated in prevalence studies
• žMotivation unclear
• žMulti-agency issue
• žGP must be involved if FII suspected