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Safe guarding children

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Child abuse both physical and sexual has been increasing all over the world. I think this is mainly because parents with young children are isolated and are finding it hard to cope on their own. Political and media hype has resulted in doctors and other agencies involved in the care of children ignoring or not trained to recognise early signs. This often result is prolonged agony and may result in tragic consequence. When these neglected children grow -up and decide to go on a rampage killing innocent people, the leaders and media use the opportunity to promote themselves and criticise the offender. I have personally experienced the difficulties of defending my ethical duty and know how difficult this can be to stand alone and defend the care of a helpless children. I have published this slide presentation to teach every responsible adult to help protect the life of innocent children. Let us stop breeding monsters and create a world filled with joy and laughter of happy children.
Transcript
  • 1. Does Child Protection Matter?<br />WWW.CALL111.COM<br />
  • 2. Overview<br /><ul><li>Why is child protection important?
  • 3. What are the Obstacles to overcome?
  • 4. Categories of Child Maltreatment
  • 5. The Risk Group
  • 6. Parent-child interaction
  • 7. What do I do when I have concerns?
  • 8. Whom do I speak to locally?
  • 9. What can happen to you if you refer?
  • 10. What will happen to the child if you do not refer?
  • 11. How to reduce Your Risk
  • 12. Assessment Questionnaire</li></li></ul><li>Statastics<br />
  • 13. Reporting Sources of Abuse<br />
  • 14. Child Maltreatment<br />Physical and psychological symptoms & signs<br />May present with more than one type of abuse <br />May be observed in child-carer interactions<br />Concerns may arise before child is born<br />
  • 15. Categories of Child Maltreatment<br />Physical abuse<br />Sexual abuse<br />Neglect<br />Emotional abuse<br />Fabricated illness (“Munchausen's by Proxy”)<br />Mixture of the above<br />
  • 16. Abuse Cycle<br />Tension Building<br />Communication breakdown, victim becomes fearful & feels the need to placate the abuser<br /> Incident<br />Verbal, emotional, physical abuse, anger, blaming, arguing, threats and intimidation<br />Honeymoon Period<br />Incident is “Forgotten” and no abuse occur. The calm phase <br /> Reconciliation<br />Abuser apologise, give excuses, blames the victim, denies abuse occurred, say it wasn’t as bad as the victim claims<br />
  • 17. Perpetrators by Relationship to Victims<br />
  • 18. Who Are At Risk?<br />History of physical or sexual abuse (as a child)<br />Teen parents<br />Single parents<br />Emotional immaturity<br />Poor coping skills<br />Low self-esteem<br />Substance abuse<br />Known past history of child abuse<br />Lack of social support (community)<br />Extended family<br />Domestic violence<br />MOD Personals<br />Lack of parenting skills<br />Lack of preparation for the stress of a new infant<br />Depression or other mental illnesses<br />Multiple young children<br />Unwanted pregnancy<br />Denial of pregnancy<br />Prematurity of child<br />
  • 19. Effects – Short & Long term<br />
  • 20. Obstacles to identify maltreatment<br />Concern about missing a treatable disorder<br />Fear of losing positive relationship with family<br />Wrongly blaming a carer<br />Divided loyalties to adult and child<br />Breaching confidentiality<br />Personal safety<br />Complaints<br />
  • 21. Features of Physical Maltreatment<br />Unexplained bruising or petechiae<br /><ul><li>Pattern of bruising</li></ul>Human bite mark<br />Unexplained lacerations, abrasions or scars<br />Unexplained burns or scalds<br />Unexplained Oral, facial & head injuries<br />Cold injuries / hypothermia<br />One or more unexplained fractures<br />
  • 22. Non-Accidental : Accidental Injury<br />
  • 23. Suspicious Bruising<br />In a non mobile child<br />Shape of a hand, grip, stick, ligature, specific implement, etc<br />Multiple or in clusters<br />On non-bony parts of the body<br />Around the neck, wrists & ankles<br />Facial bruising or retinal haemorrhages<br />
  • 24. Pattern of Bruising<br />Maguire S; Arch DisChild EducPract Ed 2010;95:170-177<br />©2010 by BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health<br />
  • 25. Think& Ask Why?<br />
  • 26. Suspicious Burns or Scalds<br />Absent or unsuitable explanation<br />Burns in a child who is not mobile<br />On the back of hands, soles, buttocks or back<br />Cigarette burns (usually on exposed areas)<br />Solid object burns (iron, electric fire)<br />Immersion burns of buttocks & legs<br />
  • 27. Pattern of Scalding<br />Maguire S; Arch DisChild EducPract Ed 2010;95:170-177<br />©2010 by BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health<br />
  • 28. Cigarette Burns<br />
  • 29. Suspicious Fractures<br />Absent or unsuitable explanation<br />Fractures in non-mobile children<br />Multiple fractures at presentation<br />Spiral or metaphyseal fractures<br />Fractures of different ages (including occult)<br />Skull fractures in infants (boggy scalp swelling)<br />Facial fractures<br />
  • 30. Other suspicious physical injuries<br />Head injuries<br />Intracranial (particularly < 3 years)<br />Chronic or multiple sub-dural haematomas<br />Eye injuries & retinal haemorrhages<br />Oral injuries <br />teeth, torn frenulum<br />Signs of spinal injury<br />Unexplained Intra-abdominal injuries<br />
  • 31. Features of Sexual Abuse<br />Unusual sexualised behaviour pre-pubertal<br />Persistent / recurrent genital & anal symptoms<br />Anogenital warts (no vertical transmission)<br />Genital, anal or perineal injuries & FB’s<br />Persistent abdominal pain<br />Constipation without medical cause<br />STD in a child younger than 13 years<br />Hep B, HIV (no vertical transmission)<br />Pregnancy in a child under 13 years<br />
  • 32. Features of Neglect<br />Personal Hygiene<br />Severe & persistent infestations<br />Nutrition<br />Failure to Thrive<br />Anaemia<br />Failure to seek medical advice<br />Failure to administer prescribed medications<br />Lack of supervision<br />Child being left in unsafe living environment<br />Injuries<br />
  • 33. Features of Emotional Maltreatment<br />Fearful or withdrawn<br />Low self-esteem and severe mood changes<br />Aggressive or oppositional behaviour<br />Over-friendliness to strangers<br />
  • 34. Parent-Child Interactions - Potential causes for concern<br />Domestic Violence (including substance abuse)<br />Negativity or hostility towards the child<br />Rejection or scapegoat of the child<br />Emotional unresponsiveness towards the child<br />Inappropriate threats or disciplining<br />Exposure to frightening or traumatic experiences<br />Manipulating child to fulfil adult’s needs<br />Carer consistently prevents access to the child<br />
  • 35. When to suspect child maltreatment<br />Absent or unsuitable explanation for injury<br />Changing explanations with time and/or carer<br />Seeking medical attention<br />Delay<br />Multiple A&E attendances<br />Multiple injuries of different ages<br />Injuries in a non-mobile child<br />Particular pattern<br />Child’s behaviour<br />Inappropriate sexual activity or STD<br />Features of neglect present<br />
  • 36. What to do if you suspect child abuse<br />Seek an explanation<br />Look for supporting evidence of abuse<br />Discuss with a colleague<br />Gather collateral information from others<br />Record in detail all actions taken & outcomes<br />Implement local Safeguarding procedures<br />
  • 37. Who to talk to at a local level<br />Share information with other professionals!<br />Paediatric Consultant of the Week (COW)<br />Named Doctor for Safeguarding Children<br />Named Nurse or Midwife for Safeguarding<br />Community Paediatricians<br />Paediatric Liaison Health Visitor<br />Paediatric Social worker<br /> (Intranet: Safeguarding Children Policy page 19-21)<br />
  • 38. What Happens if You Report<br />Parent’s will be angry , abusive and complaint to PCT<br />Pray you don’t see meet the parents in the town centre<br />Never tell any patient where you live (your life is at risk)<br />SHO in the hospital will not listen to your concern and suggest you to call Registrar<br />Nurse taking the call not helpful, will ask you to call back<br />Community Paediatricians often are not available or will not defend your action<br />Community Paediatricians don’t have any power to stop you vindicated / criticised<br />Paediatric Liaison HV ask too many questions but will offer no solution<br />Attending social service meeting is simply a waste of time<br />Paediatric Social worker telephone is busy and you won’t get any help either<br />If you refer a child of an army personal (MOD) – you may be court marshalled <br />Don’t waste time informing GMC they are too busy chasing Registration fee<br />Be prepared to be terminated from locum job contract if the parents complaint.<br />Make sure you have MPS / MDU cover in case your suspicion was wrong<br />
  • 39. What Will Happen If You Ignore<br />
  • 40. What Happens if you Ignore?<br />The child will suffer for a long time, “its not fair”<br />Family may break-up and the child will be neglected<br />Child may die and then the media will hound you<br />The child may sue you for ignoring when he/she grows up<br />Your colleagues will criticise you for ignoring<br />You will be haunted with a memory for ignoring<br />Your partner will hate you if they hear what you did<br />I have been through all the trauma for referring a child to Paediatric assessment but I will do it again if I see a child with a history of ? abuse <br />
  • 41. If you have information that is important in ensuring a child’s welfare and to protect them from harm, ”You Have ADUTY To Share This”<br />
  • 42. How To Reduce Your Risk <br />Ask another doctor, staff or nurse to see the child and document their comments.<br />Document spots, scratches and bruising in the notes and ask the witness to initialize<br />Never tell parents that you need 2nd opinion or mention social service<br />Never take a picture using your mobile phone<br />Ask Paediatric Registrar in the hospital to review (never ask SHOs)<br />If the switchboard puts the call through to SHO, just disconnect and call back.<br />Never call hospital when the patient is in your room & send letter to hospial by fax or <br />Make sure the parents address and telephone numbers are updated & correct<br />Do-not examine teenagers without a chaperone (they may complaint against you)<br />Never believe the story from parents if the clinical feature are consistent with abuse<br />Please document time and duration of the consultation.<br />If you are working in MOD, make sure you read their protocol (often they don’t have one)<br />Don’t bother calling Social service, they will know less than you<br />Remember to call Paediatric registrar and ask what they did before you leave surgery.<br />
  • 43. Assessment Questionnaire<br /> IS THE CHILD:<br />aggressive, defensive or oppositional?<br />cover around adults or otherwise show fear of adults?<br />act out, displaying aggressive or disruptive behaviour?<br />destructive to themselves or others?<br />show fear of going home, possibly by coming to school too early or not waiting to leave school?<br />fearless, in some cases taking extreme risk?<br />described as “accident prone”?<br />cheat, steal or lie (possibly indicating expectations at home are too high?<br />a low achiever and unable to expend the energy required to learn?<br />have difficulty making good friends their own age?<br />child wear cloths that cover their body even when the weather is warm (not cultural reason)?<br />behave immature or regressive manner?<br />Dislike or shrink from physical contact (such as pat on the back while offering praise)?<br /> If The Score >10 : Does not indicate abuse but will need referral to Paediatrics for assessment<br />
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