Child Protection

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 • 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 • 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 0141 201 9225/ 9360