Child Protection
Dr Sarah Hill
Case Hx
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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
Case Hx
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Nose bled briefly
Conscious throughout
Well baby
Small red mark on forehead
No x-ray taken
Admitted for observation overnight
Case Hx
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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
Case Hx
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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
Case Hx
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1yr later increased access
Behaviour deteriorates +++
Period of assessment
Access stopped
Behaviour settles
Plan to go for permanency
Questions to answer today
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What is child abuse?
Why do I need to know about child
protection?
What do I need to know about child
protection?
What is Child Abuse?
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“ 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)
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Child Protection Companion – RCPCH 2006
Categories of Child Abuse
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Physical
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Neglect
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Failing to meet basic physical / psychological
needs
Emotional
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Hitting, throwing, shaking, burning, scalding, poisoning,
drowning, suffocating, fabricating or inducing symptoms
Persistent emotional ill treatment
Sexual
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Forcing / enticing a child to take part in sexual activities
Why do I need to know about
child protection?
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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
How do doctors get involved?
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Come across child abuse as part of day to
day work
Asked to examine a child as part of a child
protection investigation
Neglect
Neglect
Neglect
Neglect
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Failure to provide
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Food
Shelter
Clothing
Healthcare
Supervision
Stimulation
Neglect - Signs
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Dirty, poorly clothed
Nappy rash, impetigo, lice, scabies
Failure to thrive
Untreated or under treated medical conditions
Poor dental health
Repeated accidents
Developmental delay
Physical Injury
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Bruises
Bites
Burns
Breaks
Bruising - Site
Bruising - Patterns
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Slap marks
Fingertip bruises
Ring marks
Pinch marks
Strap/ belt marks
Imprints of implements
Bites
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Paired crescentic bruises/abrasions
Always non accidental - not always a child
protection issue!
Does size matter?
Burns & Scalds
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Contact burns
Scalds
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Dipping injury
Cigarette burns
Emotional Abuse
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…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.
Emotional Abuse
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Often difficult to spot
All abuse involves some emotional abuse
Few children on register because of E.A
alone
Emotional Abuse – psychological
consequences
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Low self esteem
Difficulties in relationships
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With peers / family / authority figures
Difficulties in giving & accepting affection
Often impulsive & aggressive
Can be frustrated, anxious & noncompliant
Sexual Abuse
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“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”
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Working Together DoH
Vast majority of abusers are from within
the family
Surrounded by secrecy
Sexual Abuse
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Non Contact
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Flashing, showing of pornography, taking photos
Contact
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Touching
Masturbation
Digital penetration
Vaginal or anal intercourse
Prostitution
What would prompt us to
investigate?
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Disclosure by child
Concern from carer
Change in behaviour
Sexualised language/behaviour
Medical symptoms
Presence of STI
The Child Protection Process
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Information gathering
Multiagency investigation
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Social work
Police
Health
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GP, HV, Mental Health Services, Addiction Service
Education
Child Protection Process
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Information sharing
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Case Discussion
Case Conference
Child Protection Process
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Voluntary involvement of SW
PACT team
Intensive HV support
Child Protection Process
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Registration
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Child’s name added to Child Protection Register
Categories of registration
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Physical Injury
Physical Neglect
Non Organic Failure to Thrive
Emotional Abuse
Sexual Abuse
Child Protection Process
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Accommodation
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Voluntary
CPO
The Legal Process
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The Proof Hearing
Before a Sheriff
 To establish “grounds”
 Level of proof – on balance of probability
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Criminal Proceedings
Sheriff or High Court
 Level of proof – beyond all reasonable doubt
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Child Protection – Who to contact
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Local Social Work Department
Police – Family Protection Unit
Child protection service RHC
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Advice line 0141 451 6605