Child Protection: Significant Harm

Child Protection Significant Harm Child in Need Comparing health & development with a similar child Unlikely to achieve/maintain a reasonable standard of health/development without provision of services or health/development likely to be sig impaired without provision of such service or child is disabled Children’s Act 1989 - welfare of child is paramount, parental responsibility, race, religion, culture, language, interagency cooperation Parental Responsibility Mother automatically has, as does married father. Unmarried father can obtain if mother agrees, though courts or in a will Considerations seriousness of alleged harm, implication of harm, effects on the individual, concerns consistent by diff parties, history and context of concerns Initial Assessment max of 7 days Core Assessment max 35 days Police protection order max 72 hrs Section 47 local authority’s duty to investigate if suspect child is @ risk i.e. if child will be at risk “significant harm” of sent home e.g. single violent assault, neglect of health & development (e.g. recurrent failure to attend clinic), domestic violence (ongoing seeing / hearing ill treatment of other parent) Section 17 Child in Need (see above) – included child “unlikely to achieve full potential without support = disabled children. Can be used to increase support e.g. respite service Part 8 (case review) If child dies, seriously injured or public concern Local Safeguarding Children Board multidisciplinary team to perform part 8 reviews Common Assessment Framework – information gathering exercise. Lead professional is NOT a social worker. Attempt to understand the child in context Child abuse: Neglect Emotional Abuse (includes fabricated illness) Physical Abuse Sexual Abuse Risk Factors include Prematurity, Separation & impaired bonding in neonatal period Children with difficult temperament Chronic illness / disability in the child Poverty / single parent / step-parent or Co-habitee present Male unemployment Domestic Violence Absence of social Support Carer who was abused as a child Parental mental illness Alcohol & substance abuse Large family size Forms of Abuse Physical = Non Accidental Injury Gripping à finger marks & grasp marks Force feeding à finger marks on cheeks, torn frenulum, scratched palate Slap/Hitting à black eyes, bruising, linear marks (+/- buckle marks) Others à bite marks, scratches, cig burns & scalds Swinging à epiphyseal separation of long bones Squeezing à separate periosteum à periosteal haematomas Banging head à skull #, haemorrhage eyes, blindness Shaking à tearing of superficial veins à subdural haematomas Neglect Sexual (vomit, fits, full fontanelle, papilloedema, retinal bleeds, decreased LOC) NB: exclude brittle bones, bleeding disorders, admit child, document everything NB: Explain concerns to parents (aim to keep child with parents) NB: Torn frenulum will bleed a lot initially, then stop quickly. Can occur if toddler falls with juice cup / bottle in mouth Can be deliberate (as punishment), due to ignorance / ineptness E.G. – insufficient food, delay in treating injuries, poorly dressed, home alone Undernourished, FTT, skin & hair dirty, lice, rashes (nappy & skin folds), red puffy hands & feet Most often at the hands of a family member Presentation: disclosure, UTI, abdo pain, soiling, behaviour probs, inappropriate play/language, abuse of another child, bruising on thighs/perineum, rectal/vaginal bleed, GC on swab Action: do not make promises of secrecy, examine only if req (specialist team will examine), consider carefully whether to discuss with parent/carer, call consultant on call, inform social services, follow up & document everything Under age of 12 is ALWAYS rape – not deemed old enough to consent even if Gillick competent 12-16 is “statutory rape” as in theory can consent Emotional Obvious if rejection, hostility etc. Less obvious if lack of care/security Abnormally passive/lethargic behaviour, attention seeking, soiling, eating inedible substances, self-mutilation, delayed social development, speech/lang day Deprivation In repressive atmosphere even fully nourished children can fail to thrive Munchausen’s by Proxy Carer fabricates symptoms à unnecessary investigations & treatment Consider if unexplained signs / only occur when parents present