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Child Protection. Dr Sarah Hill. Case Hx. 12 month old boy Seen in A&E at 2.45 am Bank holiday Mon Brought by mother Reported to have been thrown to the floor by Mum’s partner’s mother’s friend At a party Fell onto face. Case Hx. Nose bled briefly Conscious throughout Well baby - PowerPoint PPT Presentation
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Child Protection
Dr Sarah Hill
Case Hx
12 month old boy Seen in A&E at 2.45 am Bank holiday Mon Brought by mother Reported to have been thrown to the floor
by Mum’s partner’s mother’s friend At a party Fell onto face
Case Hx
Nose bled briefly Conscious throughout Well baby Small red mark on forehead No x-ray taken Admitted for observation overnight
Case Hx
A&E staff report Mum under the influence of alcohol or drugs
Ward staff report child to be dirty & unkempt
Mum returns home, assaults her partner & is arrested
Siblings accommodated with Grandmother
Case Hx
Skeletal survey & CT head normal Mum on remand Discharged to care of Grandmother Referred to General Paed clinic 6 months
later with poor weight gain Attends clinic with foster mother Gaining weight
Case Hx
1yr later increased access Behaviour deteriorates +++ Period of assessment Access stopped Behaviour settles Plan to go for permanency
Questions to answer today
What is child abuse? Why do I need to know about child
protection? What do I need to know about child
protection?
What is Child Abuse?
“ Child abuse involves acts of commission or omission, which result in harm to the child”
“ Abuse or neglect may occur in the family, a community or an institution (home,school,hospital,street)
Child Protection Companion – RCPCH 2006
Categories of Child Abuse
Physical Hitting, throwing, shaking, burning, scalding, poisoning,
drowning, suffocating, fabricating or inducing symptoms
Neglect Failing to meet basic physical / psychological
needs
Emotional Persistent emotional ill treatment
Sexual Forcing / enticing a child to take part in sexual activities
Why do I need to know about child protection?
It is the duty and responsibility of all doctors in contact with children to be aware of and competent to deal with child protection concerns at a level appropriate to their role
How do doctors get involved?
Come across child abuse as part of day to day work
Asked to examine a child as part of a child protection investigation
Neglect
Neglect
Neglect
Neglect
Failure to provide Food Shelter Clothing Healthcare Supervision Stimulation
Neglect - Signs
Dirty, poorly clothed Nappy rash, impetigo, lice, scabies Failure to thrive Untreated or under treated medical conditions Poor dental health Repeated accidents Developmental delay
Physical Injury
Bruises Bites Burns Breaks
Bruising - Site
Bruising - Patterns
Slap marks Fingertip bruises Ring marks Pinch marks Strap/ belt marks Imprints of implements
Bites
Paired crescentic bruises/abrasions Always non accidental - not always a child
protection issue! Does size matter?
Burns & Scalds
Contact burns Scalds
Dipping injury Cigarette burns
Emotional Abuse
…actual or likely severe adverse effects on the emotional and behavioural development of the child caused by persistent or severe emotional ill treatment or rejection.
Emotional Abuse
Often difficult to spot All abuse involves some emotional abuse Few children on register because of E.A
alone
Emotional Abuse – psychological consequences
Low self esteem Difficulties in relationships
With peers / family / authority figures Difficulties in giving & accepting affection Often impulsive & aggressive Can be frustrated, anxious & non-
compliant
Sexual Abuse
“Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening” Working Together DoH
Vast majority of abusers are from within the family
Surrounded by secrecy
Sexual Abuse
Non Contact Flashing, showing of pornography, taking photos
Contact Touching Masturbation Digital penetration Vaginal or anal intercourse Prostitution
What would prompt us to investigate?
Disclosure by child Concern from carer Change in behaviour Sexualised language/behaviour Medical symptoms Presence of STI
The Child Protection Process
Information gathering Multiagency investigation
Social work Police Health
GP, HV, Mental Health Services, Addiction Service Education
Child Protection Process
Information sharing Case Discussion Case Conference
Child Protection Process
Voluntary involvement of SW PACT team Intensive HV support
Child Protection Process
Registration Child’s name added to Child Protection Register
Categories of registration Physical Injury Physical Neglect Non Organic Failure to Thrive Emotional Abuse Sexual Abuse
Child Protection Process
Accommodation Voluntary CPO
The Legal Process
The Proof Hearing Before a Sheriff To establish “grounds” Level of proof – on balance of probability
Criminal Proceedings Sheriff or High Court Level of proof – beyond all reasonable doubt
Child Protection – Who to contact
Local Social Work Department Police – Family Protection Unit Child protection service Yorkhill
Advice line 0141 201 9225/ 9360
