Safeguarding Lecture

Question 1

Risk factors for abuse

Answer 1

• Drugs and alcohol
• Domestic abuse
• Parental MH condition
• Child disability
• Carers learning disability
• Single parents - no one else to protect child

Question 2

Referral for non-mobile baby who presents with injury

Answer 2

Referred to childrens safeguarding/childrens social care team to allow for assessment - even if explanation for injury

Question 3

What are child protection plans?

Answer 3

• Plans created after child protection case conferences
• Can be related to physical, sexual, emotional abuse or neglect
• Can then be downgraded to child in need plans

Question 4

What makes you suspect potential abuse from history?

Answer 4

• Lack/inconsistent explanation
• Does not fit with developmental age
• Time delay of presentation without explanation
• Inappropriate child/carer response
• Previous history unusual injury
• Known to social care
• Repeated was not brought

Question 5

Types of physical abuse

Answer 5

• Bruises
• Lacerations
• Head injury
• Fractures
• Burns
• Bites

Question 6

Ear bruising - key point

Answer 6

• Ensure examine them
• Most bruises here are due to NAI

Question 7

Differentials for bruise/dark pigmented mark on skin

Answer 7

• congenital melanocytic naevus
• Reobserve in weeks time - bruises will change

Question 8

Common non-abusive bruises locations

Answer 8

• Knees/shins
• Bony prominences - front of body, if on head = forehead

Question 9

Bruising - non abusive bruising key points

Answer 9

• Increases with age
• Small (<15mm)
• Directly correlate with increased mobility
• Uncommon in non-mobile baby

Question 10

Abusive bruises characteristics

Answer 10

• Head commonest site
• Seen over soft tissue areas
• Occur in clusters
• Imprint of implement
• Amongst other injuries at different stages of healing
• Larger

Question 11

Non-accidental head injury - how common?

Answer 11

• Commonest cause of death in physical abuse - 95% of severe head injury <1yr is inflicted
• Most commonly seen in infants under 6 months
• 1/3 die, 1/3 permanent disability

Question 12

Symptoms of non-accidental head injury

Answer 12

• Poor feeding
• Lethargy
• Fits
• Respiratory difficulties
• Sudden death
• May be no external signs of abuse

Question 13

What life threatening non accidental injury can have no evidence of external injury?

Answer 13

Subdural haemorrhage

Question 14

Shaken baby syndrome signs

Answer 14

• Retinal haemorrhages
• Rib fractures
• Subdural haemorrhage

Question 15

Spiral fracture to femur cause

Answer 15

• Rapidly abducting and twisting leg

Question 16

What investigations are done in children under 2 years of age who present with ?NAI

Answer 16

• Skeletal survey
• CT head
• Opthalmology assessment
• Blood tests - clotting ?bruising cause - for court and management of child

Question 17

Deliberate cigarrette burn vs accidental

Answer 17

• Deliberate - crusting around egde, full circle
• Accidental - drag mark on where cigarette removed, lack crusting on edge

Question 18

Differential for burn appearance of childs skin with blisters

Answer 18

Epidermolysis bullosa

Question 19

How to tell adult vs children bites?

Answer 19

• Children - less eliptical, tends to occur on arms/limbs when steal toys etc
• Adult - specific structure, can get specialist advice if needed

Question 20

Oral injury causes

Answer 20

• Parents forcing bottle/dummy into mouth
• Can be from running and falling

Question 21

What is perplexing presentations?

Answer 21

• Previoulsy called fabricated induced illness
• Involves parents now to explain that child appears to have medically unexplained symptoms that need further investigation

Question 22

Guidelines for reporting and safeguarding in leicester

Answer 22

Leicestershire and Rutland Safeguarding Children Partnership