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 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 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

Child Protection – Who to contact Local Social Work Department Police – Family Protection Unit Child protection service Yorkhill Advice line 0141 201 9225/ 9360