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Child Protection Dr Sarah Hill.

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Presentation on theme: "Child Protection Dr Sarah Hill."— Presentation transcript:

1 Child Protection Dr Sarah Hill

2 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

3 Case Hx Nose bled briefly Conscious throughout Well baby
Small red mark on forehead No x-ray taken Admitted for observation overnight

4 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

5 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

6 Case Hx 1yr later increased access Behaviour deteriorates +++
Period of assessment Access stopped Behaviour settles Plan to go for permanency

7 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?

8 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

9 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

10 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

11 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

12 Neglect

13 Neglect

14 Neglect



17 Neglect Failure to provide Food Shelter Clothing Healthcare
Supervision Stimulation

18 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

19 Physical Injury Bruises Bites Burns Breaks

20 Bruising - Site

21 Bruising - Patterns Slap marks Fingertip bruises Ring marks
Pinch marks Strap/ belt marks Imprints of implements





26 Bites Paired crescentic bruises/abrasions
Always non accidental - not always a child protection issue! Does size matter?


28 Burns & Scalds Contact burns Scalds Dipping injury Cigarette burns




32 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.

33 Emotional Abuse Often difficult to spot
All abuse involves some emotional abuse Few children on register because of E.A alone

34 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

35 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

36 Sexual Abuse Non Contact Contact
Flashing, showing of pornography, taking photos Contact Touching Masturbation Digital penetration Vaginal or anal intercourse Prostitution

37 What would prompt us to investigate?
Disclosure by child Concern from carer Change in behaviour Sexualised language/behaviour Medical symptoms Presence of STI

38 The Child Protection Process
Information gathering Multiagency investigation Social work Police Health GP, HV, Mental Health Services, Addiction Service Education

39 Child Protection Process
Information sharing Case Discussion Case Conference

40 Child Protection Process
Voluntary involvement of SW PACT team Intensive HV support

41 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

42 Child Protection Process
Accommodation Voluntary CPO

43 The Legal Process The Proof Hearing Criminal Proceedings
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

44 Child Protection – Who to contact
Local Social Work Department Police – Family Protection Unit Child protection service Yorkhill Advice line / 9360

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