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Children's Health > Safeguarding > Flashcards

Safeguarding Flashcards

1
Q

What is shaken baby syndrome?

A

A form of severe child abuse where an adult shakes a baby out of anger or frustration, usually because of crying.

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2
Q

What can happen to the baby if it has been shaken - list 4 complications out of 8?

A
  1. Subdural haematoma
  2. Subarachnoid haemorrhage
  3. Direct trauma to the brain - comes into contact with the skull and damages
  4. Breakage of axons in the deeper cortex
  5. Hypoxic brain injury
  6. Retinal haemorrhage
  7. Skull fracture
  8. Body bone fractures
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3
Q

What is the most common age of a shaken-baby?

A

3-8 months old (can range up to 4 years but more commonly under 2 years)

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4
Q

List 6 signs of a shaken baby, these can occur immediately or 4-6 hours after the incident.

A
  1. Altered consciousness
  2. Drowsy and irritable
  3. Coma
  4. Convulsions or seizures
  5. Dilated pupils, unresponsive to light
  6. Decreased appetite
  7. Vomiting
  8. Posture; head back, back arched
  9. Breathing irregularities
  10. Low and shallow breathing
  11. Cardiac arrest
  12. Death
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5
Q

List 6 physical signs we might find on examination of a shaken baby

A
  1. Retinal haemorrhages
  2. Closed head injury bleeding
  3. Lacerations
  4. Contusions (brusing)
  5. Concussions
  6. Bruising to the face, scalp, arms, abdomen or back
  7. Soft tissue swellings
  8. Abdominal inuries
  9. Chest injury
  10. Hypotensive
  11. Tense fontanelle
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6
Q

What can the long term medical problems be for a shaken baby?

A
  1. Cerebral palsy
  2. Paralysis
  3. Vision loss/blindness
  4. Mental retardation
  5. Epilepsy
  6. Seizures
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7
Q

Which other services when a baby presents with NAI or signs of abuse?

A
  • Social Services

- Police (in some scenarios)

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8
Q

What further investigations would we carry out when a baby presents with NAI, subdural bleeding?

A
  • Skeletal survey; Look for fractures
  • Ophthalmology review; retinal haemorrhages
  • Metabolic testing; exclude glutaric aciduria
  • Blood coagulation
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9
Q

What are the 5 types of child maltreatment?

A
  1. Physical
  2. Emotional
  3. Neglect
  4. Sexual
  5. Factitious or Induced injury
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10
Q

What a child risk factors that might increase their chance of being abused?

A
  • Younger child
  • Increased needs e.g. disabled
  • Low BW
  • Multiple births (twins, triplets etc)
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11
Q

What parental risk factors might increase the chance of them being abusive to their child?

A
  • Younger parental age
  • Mental illness
  • Drug/alcohol abuse
  • Domestic violence
  • Lower socio-economic group
  • Parents were abused
  • Criminal history
  • Chaotic family
  • Vulnerable/lonely parent
  • Known animal abusers
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12
Q

What is a body map and what is it used for?

A

A drawing of a body used to document visible findings on examination

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13
Q

What are the reassuring features in an accidental injury history?

A
  • Mechanism consistent with injury
  • Consistent stories
  • Story corroborated by other sources
  • No delay in seeking medical attention
  • Appropriate concern from parent
  • One-off injury
  • Injury consistent with child age/development/mobility
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14
Q

What are the worrying features in a history of an NAI?

A
  • No mechanism for injury or mechanism is inconsistent with injury
  • Delay in seeking medical attention
  • Inconsistent histories from multiple sources
  • Inappropriate parent reaction (vague, unconcerned, aggressive, excessively distressed)
  • Recurrent
  • Injuries inconsistent with age/development/mobility
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15
Q

What fractures are common in paediatric patients with accidental injury?

A
  • Linear skull fractures
  • Long bone fractures in >5 years old
  • Fracture types differ in their ratio of accidental vs. NAI
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16
Q

What are the common fracture features we see in paediatric patients with NAI?

A
  • Metaphyseal fractures
  • Posterior rib fractures
  • Fractures differing in age
  • Complex skull fractures
  • Long bone shaft fractures in non-mobile children
17
Q

Where to toddlers commonly get accidental bruising?

A

Forehead and shins

18
Q

Bruises in which locations would make you concerned about NAI in a child?

A

Face, back and buttocks

19
Q

When would you be particularly concerned about a bruise in a paediatric patient?

A

If the bruise is shaped like an object or body part e.g. hand, belt, finger marks

20
Q

What types of burns would make you concerned about an NAI in a child?

A
  • Uniformly shaped burns e.g. cigarette

- Glove-stocking distribution

21
Q

What is the ‘Toxic Trio’?

A
  1. Domestic Violence in the home
  2. Alcohol or drug abuse
  3. Mental illness of a parent/guardian
22
Q

List 5 out of 13 possible differentials for an NAI suspected bruising

A
  1. Accidental injury
  2. Immune thrombocytopenia (ITP)
  3. Meningococcal septicaemia
  4. Henoch Schonlein Purpura
  5. Mongolian blue spot
  6. Leukaemia
  7. Haemophilia A
  8. Christmas disease (haemophilia B)
  9. Von Willebrands disease (vWD)
  10. Children with hypermobility syndromes e.g. Ehlers Danlos
  11. Vasculitis
  12. Concurrent viral illness may cause increased bruising
  13. Petechiae
23
Q

List 4 out of 7 differentials to NAI with fractures

A
  1. Accidental injury
  2. Osteogenesis imperfecta (brittle bone)
  3. Copper deficiency
  4. Vitamin D deficiency
  5. Vitamin C deficiency
  6. Ehler Danlos
  7. JOBs syndrome
24
Q

How can gross neglect manifest clinically in a child?

A
  1. Failure to Thrive
  2. Inadequate hygiene
  3. Poor development of emotional attachment to child’s caregiver
  4. Delay in development (Speech and language)
  5. Poor attendance to school and health services
  6. Failure to supervise e.g. toddler hit by car when not being watched
  7. Unsupervised young children at home

Children's Health (14 decks)

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