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Categories of abuse
- Physical abuse
- Emotional abuse
- Sexual abuse
- 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.
- 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
- Signs of neglect (general hygiene, dermatitis, poor clothing, poor medical care, malnutrition(evidence of failure to thrive)
- Consider maltreatment where there has been a delay in presentation.
- Bruising, burns, old fractures and injuries
- Bruising or Burns and scalds in the shape of an object – fingertips, hand, ligature, stick, teeth mark or implement such as belt buckle,thermal injuries- iron, cigarette end
- Any bruising, Lacerations, abrasions, Burns and scalds on a non-mobile baby (especially facial bruising).
- Bruising or petechiae in the absence of a medical condition which do not have a suitable explanation
- Multiple bruises, lesions, Lacerations, abrasions and scars
- Bruises, lesions, Lacerations, abrasions, and scars of similar size and shape
- Bruises, at sites where accidental bruising is unusual: face, eyes, ears (bruising around the pinna may be subtle), the ‘safe triangle’ of the neck (the neck and top of the shoulder), inner arms, buttocks, abdomen, groins – areas usually covered by clothing.
- Bruising suggestive of strangulation on the neck.
- Human bites,Animal bites
- fractures: different ages.,The explanation is not consistent with the injury.,occult fractures on X-ray.,The child is not independently mobile.
- There are associated retinal hemorrhages, rib or limb fractures, or other associated injuries.There are multiple subdural haemorrhages.
- Behavior: detached, depressed, hostile, defensive
- Drug affected,
- poor eye contact
- 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