'Child abuse and neglect consists of an act of commission or omission that ... R leg abducted and shortened. Bruising to Knee. Facial bruising. Abrasions to mouth. ... – PowerPoint PPT presentation
4 Child abuse and neglect consists of an act of commission or omission that endangers or impairs a childs physical and or emotional development
Physical Abuse
Sexual Abuse
Emotional or Psychological Abuse.
Neglect.
5 Physical Abuse
Excessive discipline.
Severe beatings.
Shaking.
Cigarette burns.
Strangulations.
Female genital mutilations.
Bruising.
Lacerations.
Burns.
Fractures or dislocations.
Head injuries.
Internal injuries.
6
History of previous harm.
Social or geographical isolation.
Abuse of neglect of sibling.
Domestic violence.
Substance abuse.
Functional parenting deficiency.
Behaviour management problems.
Unrealistic expectations.
7 General Indicators.
Conflicting accounts of injury.
Child discloses.
Family or friend discloses suspected abuse.
Poor concentration.
Sleeping problems.
Sudden behaviour changes.
Unexplained illnesses, headaches etc.
8 Specific Indicators in the Child
Facial, head neck bruising.
Welts or lacerations.
Inconsistent explanation.
Marks or bruising showing shape of object.
Bite marks.
Multiple injuries.
Bruising of differing ages.
Ingestion of poisons, alcohol other drugs.
Fractures or dislocations under 3 years.
Burns and scalds.
Head injury in the non-mobile child.
9 Specific Parental Indicators
Direct admission.
Family history of violence.
Past history of own maltreatment.
Repeated presentations.
Marked delay.
Inconsistent account of events or cause of injury.
10 Response
Under the Children and Young Persons (Care and Protection) Act.
DoCS notification.
Helpline 24/7
Faxed report . Risk of Harm.
Emergency Pager or 000.
11 Annas Story
2 years.
Referred to local hospital from Child health nurse.
Night terrors.
O/A at 4pm.
Multiple facial bruising.
Abrasions to abdomen, R thigh and arm.
Obs stable.
Wgt. (3rd Percentile) Ht. 75th .
Reports thrashing, screaming and biting self.
Referred to Maitland
Arrived Maitland 1913.
Alert, interactive.
Paediatric review.
Admitted for observation Paediatric Unit 2240hrs.
Difficult to settle but uneventful night.
Reviewed by Paediatrician in am.
Abdominal bruises.
Bruises to forehead.
Inconsistent bite mark.
Bruising L scapula.
12 Social History
Anna lives with mother and fiancé.
Visits father 2 out of 3 weekends.
Paternal Gparents overseas.
Maternal Gparents interstate.
Moved.
No other siblings.
Recently Anna wary of fiancé.
13
Discharged 4 days later into mothers care.
Ophthalmology, head CT and bloods normal.
Bone scan Increased uptake L scapula.
Skeletal survey normal.
No concerns re. growth.
Discharge plan
Review Maitland Paediatrician 2 weeks
Home visit Child Protection Team.
Community Health.
Child Protection Team at JHCH notified.
DoCS notification.
Bloods.
Cranial CT.
Ophthalmology review.
Transfer.
14 2nd Presentation.
2 weeks later.
O/A
Nausea vomiting.
Reluctant to move R arm or R leg.
Facial bruising to L eye.
Bloods unremarkable.
Transferred to Maitland.
15 Clinical Findings
Pale and lethargic.
Unable to lift arm.
R leg abducted and shortened.
Bruising to Knee.
Facial bruising.
Abrasions to mouth.
NO history of trauma.
NO explanation.
NO recent visits.
ENT and Abdo NAD.
16 Radiological Findings
R Humerus
R Distal radius
R proximal tibia.
Admitted to Paed. Unit 0030hrs.
IV fluids.
Analgesia.
Bed rest.
Cares by Nursing Staff.
DoCS notification in am.
17
Transferred to JHCH next day.
Bone scan reveals.
R Humerus
R distal radius
R ulna
Tip R scapula
L midshaft ulna.
R distal femur
R proximal tib/fib.
18 Where did we go wrong?
How could this have been prevented?
Whats the use?
19 What was done correctly?
Identification of indicators
Facial bruising
Night terrors
Inconsistent bite mark.
Combative.
Mothers concerns.
Isolated.
Appropriate Action.
Referral.
JHCH child protection team.
DoCS notification.
Discharge follow up.
Baselines established.
History established.
20 Observations/ Documentation.
Full repeated OBs.
Nursing History.
Sequence of events.
Appropriate documentation
21 (No Transcript) 22
Thankyou
Any questions?
23 References NSW Health Intranet. Child Protection. NSW Department of Community Services Website www.community.nsw.gov.au/preventing child abuse and neglect. Child Safety Australia www.childsafetyaustralia.com.au 24 (No Transcript) 25 (No Transcript) 26 (No Transcript)
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