FRCA Notes

Safeguarding in Paediatrics

The core curriculum asks for us to be able to describe 'signs indicative of a possible need to safeguard the infant, child or young person'.

Resources

  • Child abuse are acts of 'commission or omission', which result in harm to a child
  • It can be categorised as:
    • Physical abuse
    • Emotional abuse
    • Sexual abuse
    • Neglect

  • Child protection is the process of protecting those who are (or may be) suffering from the effects of abuse
  • Safeguarding also encompasses the promotion of paediatric welfare, including prevention of maltreatment

Paediatric factors

  • Children with physical or mental disabilities
  • Those who are 'looked after' i.e. within the care system
    • Local authority homes
    • Foster care
    • Unaccompanied asylum seekers/refugees
    • Within the criminal justice system
    • Care leavers i.e. those under the care of the local authority for a period of 13 weeks, spanning their 16th birthday

Parental factors

  • Learning disability
  • Mental ill health
  • Substance misuse
  • Personal history of receiving abuse as a child
  • Poverty
  • Domestic violence
  • Low capacity

Bites

  • Human bite marks
  • Animal bite mark (i.e. inadequate supervision)

Bruises

  • In the shape of a hand, teeth or implement e.g. ligature/stick
  • Bruising or petechiae not caused by a medical condition without suitable explanation e.g.:
    • Child not independently mobile
    • Bruises in clusters or of similar shape/size
    • Bruises on the eyes, ears, buttocks, neck (strangulation), ankles/wrists (ligature)

Lacerations / abrasions / scars

  • Child not independently mobile
  • Multiple injuries with a symmetrical distribution on:
    • Areas protected by clothing
    • Eyes/ears/face
    • Neck/ankles/wrists (ligature)

Thermal injuries

  • Child not independently mobile
  • Without any or suitable explanation
  • On soft tissue not expected to come into contact with hot object e.g. back of hand, sole of feet, buttocks, back
  • In the shape of an implement e.g. cigarette, iron
  • Indicating forced immersion e.g. buttocks/perineum/glove & stocking distribution/ symmetrical distribution/sharply delineated borders
  • Cold injuries without obvious explanation and/or with unexplained hypothermia

Fractures

  • ≥1 fractures in the absence of a predisposing medical condition
  • Fractures of different ages
  • XR evidence of occult fractures e.g. rib fractures in infants

Intra-cranial injuries

  • Unexplained
  • In those <3yrs old
  • Associated retinal haemorrhage, or rib/long bone fractures, or other associated injuries
  • Multiple SDH ± SAH ± hypoxic ischaemic injury
  • Retinal haemorrhage in absence of other trauma

Other injuries

  • Spinal injury without trauma e.g. found on MRI/skeletal survey
  • Visceral injuries without trauma ± delay in presentation
  • Unexplained oral injury
  • Serious or unusual injury without explanation

Sexual injuries

  • Genital/anal/peri-anal injury without explanation
  • Recurrent ano-genital symptoms without medical cause associated with behavioural/emotional change
  • Foreign bodies in vagina or anus
  • Any STI, hepatitis B/C or pregnancy in a patient <13yrs old

  • Discuss concerns with:
    • Named consultant of the child e.g. surgeon
    • Consultant paediatrician responsible for safeguarding

  • Arrange to meet child & parent post-operatively, prior to discharge
    • Paediatrician or trained nursing staff present
    • Seek explanation for injury (in open, non-judgemental manner)
    • Document what is observed
    • Document what is heard

  • Decide if maltreatment is considered or suspected
  • Take appropriate action e.g. child protection referral to social services if concern