Safe guarding children
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Safe guarding children



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.

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.



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  • PS: Slide showing Cigarette Burns has two round spots, the top one is cigarette burn but the bottom one is 'Ring worm (fungus infection). This is like athlets foot and can be treated.
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  • Explanation of different typesFabricated illness I want to mention briefly
  • Spiral # femur commonest in children<1 year accidental 80% , 88% of abusive both most commonly linear and parietal
  • Hygiene: unclean, old clothes, smelly, nappy rash and sores
  • Emotional abuse: rejecting, isolating, terrorising, ignoring, corruptingMight present with soiling/bed-wetting, deliberate self-harm, running away from homeThe child might scavenge or hoard food, might have age inappropriate responsibilities

Safe guarding children Presentation Transcript

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