Safeguarding

Question 1

categories of abuse (5)

Answer 1

• physical
• emotional
• sexual
• neglect
• inducing injury

Question 2

signs of abuse

Answer 2

• behavioural changes
• clothes ill fitting/dirty
• poor hygiene
• not wanting to change clothes in public
• frequent unexplained injuries
• lack concentration @ school
• reaching developmental milestones late
• use of sexual language
• sexual health problems

Question 3

what is SENCO

Answer 3

Special Educational Needs Coordinator

• support and identify children with special educational needs

Question 4

differentials for a 5 month old presenting with a full fontanelle, irritability, refusing feeds, vomiting, tachycardic, cool peripheries

Answer 4

• meningitis
• sepsis
• viral encephalitis
• shaken baby syndrome
• metabolic syndrome: disruption of urea cycle

Question 5

management of a 5 month old presenting with irritability, no fever, full fontanelle, tachycardia

Answer 5

• iv access
• fluid bolus
• blood tests
• CT head

Question 6

CT head in shaken baby syndrome shows:

Answer 6

subdural haematoma

Question 7

who requests a Child protection Medical assessment

Answer 7

social services

Question 8

Glutaric acidaemia

Answer 8

• an inherited disorder whereby the body lacks an enzyme and is unable to break down amino acids into energy
• risk of subdural haematoma

Question 9

symptoms and testing for

Ehlers Danlos syndrome

Answer 9

• joint hypermobility
• stretchy skin
• fragile skin: bruises/bleeds easily

Question 10

Osteogenesis imperfecta

Answer 10

• fragile bones: fracture easily
• blue sclera
• dental fragility
• hearing loss

Question 11

management by social services when contacted regarding a safeguarding issue

Answer 11

• interview parents
• social care home visit
• investigate for hx of domestic violence
• involve police
• request child protection medical assessment for siblings
• seek to place children with extended family if assessed and found to require safeguarding from impending harm
• multi disciplinary child protection strategy meeting

Question 12

who decides where a child goes once the child is deemed to be medically fit for discharge

Answer 12

social services

Question 13

Triad of symptoms for shaken baby syndrome

Answer 13

• retinal haemorrhages
• subdural haematoma
• encephalopathy

Question 14

symptoms of shaken baby syndrome

Answer 14

• irritability
• poor feeding
• increased head circumference
• seizures
• reduced GCS
• full fontanelle
• anaemia
• retinal haemorrhages

Question 15

questions when raising a safeguarding issue

Answer 15

Are there any known safeguarding issues?
Is the child on a child protection plan?
Does the child need a Place of Safety?

Question 16

differentials for multiple bruises

Answer 16

• Leukaemia
• Aplastic anaemia
• Post viral aplastic anaemia

Question 17

examination findings of respiratory distress

Answer 17

• widespread expiratory wheeze
• intercostal recession
• harrisons sulcus

Question 18

horizontal groove along the lower border of the thorax corresponding to the costal insertion of the diaphragm

Answer 18

Harrisons sulcus

Question 19

when should the Child Protection Team be involved when there is poor care for a child from a patient?

Answer 19

When the poor care is putting the child’s health at serious risk and there have been repeated attempts by the team to engage with parent that have not resulted in adequate improvement

Question 20

Management for a mother that is unintentionally neglecting her child’s health?

Answer 20

• Calling a “child in need” meeting to help train mother
• Core group of professionals: identified to monitor how well the implantation of the plan goes

Last resort = fostering of child

Question 21

household risk factors for abuse: relating to child

Answer 21

• being the younger child
• increased needs e.g. disability
• low birth weight
• multiple births

Question 22

household risk factors for abuse: relating to parents

Answer 22

• younger parental age
• mental illness
• drug/alcohol abuse
• parental crime
• parents: vulnerable, unsupported
• known mistreatment of animals
• domestic violence
• lower socio economic class
• parents themselves were abused

Question 23

History of an accidental injury

Answer 23

• mechanism consistent with injury
• consistent stories
• no delay in seeking medical attention
• appropriately concerned parents
• one off injury
• injury consistent with childs age/development/mobility

Question 24

History of a non accidental injury

Answer 24

• no mechanism offered or is inconsistent with injury
• delay in reporting the injury
• inconsistent history from parents
• inappropriate reaction from parents e.g. unconcerned/aggressive
• recent injuries
• injuries inconsistent with childs age

Question 25

accidental fractures

Answer 25

- linear skull fractures | - long bone fractures (in children > 5 years)

Question 26

type of fracture that is more commonly due to abuse

Answer 26

non-supracondylar fractures

Question 27

non accidental fractures (5)

Answer 27

- metaphyseal fractures - posterior rib fractures - fractures of different ages - complex skull fractures - long bone shaft fractures (in a non mobile child)

Question 28

non accidental bruises

Answer 28

- face - buttock - back - bruise outlines a particular object - pattern e.g. fingertips

Question 29

features of accidental burns

Answer 29

- asymmetrical - flexures are spared - geographical splash marks

Question 30

features of non accidental burns

Answer 30

- uniform shape (cigarette burn) | - glove + stocking distribution

Question 31

what doe a Child Protection Medical Assessment consist of?

Answer 31

- child must be questioned away from carers - growth chart: body map - Observations: photography e. g. for ?shaken baby syndrome - skeletal survey - ophthalmology review - metabolic testing: glutaric acidaemia - detailed clotting screen - genetic test for Ehlers Danlos

Question 32

who carries out a Child Protection Medical Assessment

Answer 32

at least registrar level Paediatrician and there must be a named consultant

Question 33

differentials for a child presenting with fractures

Answer 33

- accidental injury - osteogenesis imperfecta - copper deficiency - Vit D/C deficiency - Ehlers Danlos syndrome - JOBs syndrome

Question 34

differentials for a child presenting with Burns/scolds

Answer 34

- Accidental - Bullous impetigo - Staphylococcal Scalded Skin Syndrome

Question 35

differentials for a child presenting with bruising

Answer 35

- accidental injury - ITP - meningococcal septicaemia - HSP - Mongolian blue spot - vWD - leukaemia - Haemophilia A + B - Ehlers Danlos - Vasculitis - Petechiae - Coagulopathy

Question 36

presentation of a child from neglect

Answer 36

- failure to thrive - inadequate hygiene - poor emotional development - delay in speech/language development - poor school attendance