Safeguarding children

Published on 21/03/2015 by admin

Filed under Pediatrics

Last modified 21/03/2015

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5 Safeguarding children

Ros Proops, Jane Black, Richard Beach

Chapter contents

What is meant by ‘child abuse’?

Physical harm

What might make you suspect a child has suffered a non-accidental injury? 
What should you do if you have child protection concerns?
What should happen once someone has raised the possibility of abuse?

Other types of abuse

Neglect 
Emotional harm
Sexual harm
Fabricated or induced illness

The case conference

Information sharing and confidentiality

The common law duty of confidence 
The Human Rights Act
The Data Protection Act

Every week in the UK one or two children die as a result of child abuse. Many more suffer significant harm at the hands of their parents, carers or someone close to them. Only very rarely is the perpetrator a complete stranger.

High profile cases, including the tragic deaths of Victoria Climbié and ‘Baby P’ (Peter Connolly), have highlighted some important weaknesses in the procedures for safeguarding children in the UK. This has resulted in improved awareness and training for all who are concerned with the care of children and more stringent policies and procedures across institutions. The message is clear – safeguarding children is everyone’s responsibility – and that includes you.

What is meant by ‘child abuse’?

The Children Act 1989 introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life in the best interests of children. Significant harm is defined as:

Physical harm

– including shaking, hitting, poisoning, non-accidental fractures, scalds and burns

Neglect

– described as the persistent failure to meet a child’s basic physical and/or psychological needs likely to result in the serious impairment of a child’s health or development

Emotional harm

– described as the persistent emotional ill-treatment of a child resulting in severe adverse effects on a child’s emotional development. This includes the corruption and exploitation of children.

Sexual harm

– such as forcing a child to take part in sexual activities, whether or not the child understands or is aware of what is happening.

In order to protect children from significant harm, we must all be prepared to think the unthinkable and be prepared to question the information given to us about every child we see.

Physical harm

Case 5.1A A boy with a lump on his head

Jack, a 4-month-old baby boy, was taken to his GP by his mother for a routine immunization. The GP noticed a large swelling on the side of his head. The boy’s mother said she had not previously noticed it and had no idea how the lump arose. The GP sent Jack to the local hospital where a skull X-ray revealed a linear parietal fracture. The paediatrician was concerned that this might have been a non-accidental injury and admitted him for observation and further investigation.

What might make you suspect a child has suffered a non-accidental injury?

1 Factors in the history

• No explanation is given as to how a significant injury might have occurred.

• There are inconsistent or differing stories given about the cause of injury

• The explanation given is inappropriate for the child’s expected developmental level. (‘Those who don’t cruise, don’t bruise’ – immobile children are not likely to accidentally sustain multiple bruises on their legs; by contrast, the shins of most 4-year-olds are covered in bruises.)

• The explanation given is incompatible with the injury sustained, e.g. an 18-month-old child has bilateral fractured femurs, where his mother says the injury happened when he did a ‘roly-poly’ on the kitchen floor.

• There is delay in presentation. The normal reaction when a child is injured is to seek medical advice at once. If a child is presented many hours or days later non-accidental injury is more likely.

There are also a number of risk factors which may make a child more vulnerable to abuse, including having very young parents; those living in poverty; a history of drug and/or alcohol misuse in the parents or carers; and a history of domestic violence in the household. Children with disabilities are also at increased risk. However, it is vital to be aware that child abuse is no respecter of social class and can occur in any household no matter how well off or educated the family concerned.

Sexual abuse may present in a variety of ways, including inappropriate sexual behaviour, psychological disturbance and anogenital soreness or discharge. Detailed physical examination looking for signs of sexual abuse should only be undertaken after specialist training.

2 Factors on examination

If child abuse is suspected the child should be carefully examined from top to toe. Is the child content in the carers company? Do they seem well cared for and appropriately dressed? Are they clean? Height, weight and head circumference should be measured and plotted on a centile chart. Whatever the presenting concern the whole child should be examined for bruises, scars or other injuries.

Bruising is common in active children – but is usually on the shins and perhaps the forehead. Bruising to less accessible sites such as the trunk (especially the back) and the cheeks and ears is suspicious of child abuse.

Although it is impossible to age bruises accurately, a pattern of bruising on different sites and of different colours should cause concern.

Always compare the injury with the history and attempt to reconstruct what might have happened. This can be particularly helpful in assessing burns and scalds.

Linear marks from straps or sticks and circular burns from cigarettes should be identified. On occasion forensic testing can link an injury to the weapon used in an assault.

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