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