Safeguarding - non-accidental injury and neglect Flashcards
(33 cards)
What is the most common type of intentional burn injury?
Scalding by immersion in hot water
What factors make you suspect intentional over non-intentional burns?
Distribution of intentional injury:
- Lower limbs especially feet
- Bilateral
- Buttock/perineal
- Posterior burn significantly associated with abuse
Patterns of intentional injury:
- Symmetrical
- Clear upper limits
- Skin fold sparing
- Circumferential
Apart from hot water/drinks what else can be the cause of burns in children?
- Domestic irons e.g. palm of the hand
- Hairdryers
- Cigarettes or lighters e.g. hands, trunk; would match the shape of top of lighter or roundness of a cigarette
- Grease/oil
- Frostbite to feet
- Light bulb
- Curling tongs
- Glowing knife
What are some intentional burn mimickers?
- Dermatitis
- Caustic burn (detergent)
- Pressure/friction injuries
- Walking on hot surfaces
- Insect bites
- Photodermatitis - sun exposure following chemical contact like perfume
- Infections e.g. SSSS, bullous impetigo, toxic shock, tinea capitis
- Eczema
- Congenital insensitivity to pain
- Haemangiomas
Name 3 intentional burns without malicious intent.
Common in South Asian and Somalian populations
- Traditional remedies for illness
- Hot boiled egg to the skin/face for bruising
- Moxibustion - moxa hern, burning yarn or cigatette in Chinese medicine
- Cupping
What age group is accidental bruising uncommon in?
Pre-mobile infants i.e. not crawling or no independent mobility
What sites is accidental bruising most common in?
- Shins and knees
- Back of head
- Front of face (T of forehead, nose, upper lip and chin)
Which parts of the face is it uncommon to have accidental bruising?
Cheeks and around eyes
Which parts of the body are common sites for non-accidental bruising?
- Cheeks
- Ears
- Neck
- Genitalia
- Buttocks
- Head
What are some characteristics of bruising suggestive of physical child abuse?
- in children who are not mobile
- away from bony prominences
- face, abdomen, arms, buttocks, ears, neck and hands affected
- clusters of bruises
- uniform shape of bruises
- imprint of implement or lgature
- petechiate in the absence of bleeding disorders
What type of imaging can be used to see old bruises?
Ultraviolet photography may show two to ten month old injuries
What can be an iatrogenic cause of retinal haemorrhages in an emergency in a child?
Cardiopulmonary resuscitation although there is only weak evidence to support this
May also be as a consequence of delivery in the infant is less than 42 days old (esp in vacuum delivery or with forceps)
https://www.rcpch.ac.uk/resources/child-protection-evidence-retinal-findings
What is a common cause of retinal haemorrhage in non-accidental injury?
Shaking a baby
Who is usually the point of call if you have a safeguarding issue?
Safeguarding team or a social worker team who receive, triage and action new referrals within 24 hours
What are the 4 potential outcomes after you contact the safeguarding team?
- No further action required
- Case suitable for early help
- Assessment of family done and child becomes a Child in Need (CIN) under Section 17 of the Children Act 1989
- Child has sustained or is at risk of significant hard and child protection proceedings must be started under Section 47 of the Children Act 1989
What does Section 47 of the Children Act 1989 say?
Section 47 of Children Act 1989 – Requires the local authority to co-ordinate an investigation where a child has been subject to or is at risk of significant harm. The aim of this multi-agency enquiry is to decide whether any action is required to safeguard and promote the welfare of the child. Usually the police CAIT (“Child Abuse Investigation Team”) is involved.
What does the Section 17 of the Children Act 1989 say?
An assessment of the family is carried out leading to the child becoming a Child In Need (CIN)
What should a referral about a safeguarding concern include?
Why, what, where, when and who? The referral needs to be factual, but should include an opinion about why you are concerned, or the perceived risk to the child.
- Name, date of birth and address of the child, parents , siblings and any other household members
- Addresses of all places the child spends time
- School/ Nursery/ GP name and address
- Concerns that have lead you to refer the child on this occasion
- Have there been any previous concerns that you know about? Previously known to Social Care? Name and number of social worker/ family support worker?
- Where the child is now and how can they contact you
- Any other children in the household who may at present be at risk
What two pathways are available to remove children from a harmful environment?
Police powers of protection/police protection order (PPO) - not a court order but police can temporarily house a child in ‘a place of safety’ for up to 72 hours but parent retains parental responsibility
Emergency protection order (EPO) - issued by court and authorises the local authority (applicant) to remobe child from home or prevent removal from hospital. Can last up to 8 days but parent retains parental responsibility
What is the significance of EPO/PPO in the medical setting?
Parents retain parental responsibility so you must gain their consent before performing the child protection medical or investigations/interventions
What does a child protection medical assessment involve?
History and examination by a paediatrician. Used to pick up injuries and unmet health needs.
1. Medical proforma- most trusts will have their own version. It can act as a prompt to remind you of what questions to ask. Remember to use the child’s own words as much as possible. Consent must be gained, and ideally written consent is best.
2. Growth chart- good practice to document the height and weight especially if there are child protection concerns.
3. Medical Photography- generally, this requires written consent and needs to be done via the hospital’s medical illustration department. This isn’t always available out of hours- in some hospitals A&E may have a camera that can be used for this purpose
4. Body mapping
Who decides whether a child protection plan is needed?
Children’s social care team at a case conference (AKA initial child protection conference ICPC) within 15 working dats of the case.
What does a child protection plan include?
This is a document by local authority and should specify how to:
- Ensure the child is safe and protected from further harm
- Promote the child’s health, welfare and development
- Support the family to protect and promote the child’s welfare, provided this is in the child’s best interests.
What is section 31?
Care order - issued by court to remove the child from their home and share parental responsibility between the parents and the local authority. Lasts until the child is 18, adoption, or until the court deems it unnecessary.
