Recognise Abuse or a Child at Risk

Last Updated on by FRCEM Intermediate

Categories of abuse

  • Physical abuse
  • Emotional abuse
  • Sexual abuse
  • Neglect

Risk factors

  • History of abuse: Previous history of child maltreatment in the family (health visitors and social workers may have useful information).
  • Domestic violence. Also domestic/marital conflict, and history of violent offending in the family.
  • Family psychiatric history: Mental health disorders, learning disability, physical illness or disability in the carers.
  • Drug or alcohol misuse: Drug or alcohol misuse in the carers – especially if unstable or chaotic drug misuse.
  • Unemployment: Housing or financial problems.
  • Life-limiting illness: Disability or long-term chronic illness in the child.
  • Single parents, especially if immature or unsupported.
  • History of animal/pet maltreatment.
  • Child or siblings are known to authorities: Children in the care system.
  • Some children are vulnerable to being “lost” by the system – for example, where the families are homeless or asylum seekers, or where children are carers or young offenders.

Assessment

History

  • History of presenting complain — consistency of injury with the mechanism
  • Other injuries sustained
  • Past History:? other injuries
  • Developmental history
  • Social circumstances: socio-economic status, illicit drug dependence, other dependents
  • Failure to provide access to appropriate medical care or education(do not administer prescribed medication,failure to attend appointments, failure to engage with immunisations,screening and reviews,Unjustified poor attendance at school)
  • Consistencies in mother’s history; correlation with other sources
  • Collateral history important. Liaise with GP and other sources

Examination of Child

  • Observe the mother’s interaction with the child
  • Vital signs & GCS
  • Neurological examination including fundoscopy for retinal haemorrhages
  • Developmental: physical (height, weight & head circumference) and neurological

General examination:

    • Injuries that dont fit the history
    • Multiple fractures in various stages of healing, or different types of injuries
    • Injuries that are likely to be inflicted
    • Evidence of poor caretaking
    • Sudden onset of altered mental status not attributable to medical illness
    • Any bruising in a child that is not yet cruising
    • Bruising to the pinna, neck, or abdomen
    • Injury to the genitalia
    • bruises
      • Buttocks, trunk, genitals, ears and back of hands.
      • Bilateral, symmetrical or geometric
      • Bruise resembles shape of an instrument (e.g. belt buckle, hand knuckles, spoon)
      • Multiple bruises of various colours on the same area
    • Burns- patterns that mimic objects-especially hot plates, hair straightening irons, steam irons, cigarettes et
    • abusive head injury and may happen by shaking- retinal haemorrhages than subdural haemorrhage therefore look for SDH in a child with retinal haemorrhages

 

Emotional abuse occurs when an adult harms a childs development by repeatedly treating and speaking to a child in ways that damage the childs ability to feel and express their feelings. Signs include:

  • Parent or guardian constantly criticizes the child
  • Child shows extremes of behaviour and displays anxiety
  • delayed physical, emotional, or intellectual development
  • compulsive lying and stealing
  • displays feelings of worthlessness
  • eating hungrily or hardly at all
  • Attention seeking
  • reluctance to go home
  • rocking, sucking thumbs or self harming behaviour
  • fearfulness when approached by a person known to them

Mother

  • Behavior: detached, depressed, hostile, defensive
  • Drug affected,
  • unkempt
  • poor eye contact

Management

  • Manage the injuries accordingly
  • if NAI suspected – safeguard Children
  • Inform named professional for child protection in a hospital or a consultant pediatrician
  • Refer to the local child social services.
  • if a risk of immediate serious harm, inform to the police
  • Notify the GP of hospital/A&E attendances

READ: https://patient.info/doctor/safeguarding-children-how-to-recognise-abuse-or-a-child-at-risk

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