Makindo Medical Notes

Description: Child abuse refers to any action or inaction that harms or poses a risk of harm to a child. It can be physical, emotional, sexual, or involve neglect. Recognizing and managing suspected child abuse is a critical responsibility for doctors.

Types of Child Abuse

• Physical Abuse: Infliction of physical harm, such as hitting, shaking, or burning.
• Emotional Abuse: Persistent emotional maltreatment, which may involve belittling, threats, or constant criticism.
• Sexual Abuse: forcing or enticing a child to take part in sexual activities, whether or not they are aware of what is happening.
• Neglect: Persistent failure to meet a child's basic physical or psychological needs, such as food, shelter, and medical care.

Clinical Assessment

Doctors should maintain a high index of suspicion when assessing any child, particularly if the history is inconsistent or if injuries do not match the explanation provided.

History Taking

• Obtain a detailed history of how injuries occurred. Look for discrepancies or vague explanations.
• Note the child’s behaviour during the consultation. Are they fearful or excessively withdrawn?
• Assess developmental milestones and look for neglect or poor care.
• Ensure to take a thorough social history, including information about the family’s living conditions, parental mental health, and substance misuse.

Physical Examination

• Look for bruising in unusual areas (e.g., torso, ears, neck, or buttocks) and at different stages of healing.
• Assess for burns or fractures, particularly if the injury patterns suggest non-accidental trauma (e.g., cigarette burns, immersion burns).
• Examine for signs of sexual abuse (e.g., genital trauma, sexually transmitted infections).
• Check for malnutrition, poor hygiene, or signs of neglect (e.g., inappropriate clothing for the weather).

Investigations

• Blood tests: look for medical conditions (e.g., coagulation disorders in cases of unexplained bruising).
• Imaging: Skeletal survey or CT/MRI to identify hidden fractures, especially in children under 2 years.
• Swabs: Genital swabs if there is suspicion of sexual abuse, in accordance with safeguarding procedures.
• Forensic examination: In cases of suspected sexual abuse, refer for forensic examination as per local protocols.

Management Approach: Immediate Actions

• Ensure the child is in a safe environment. If there is immediate danger, involve social services or the police.
• Document findings thoroughly, including photographs of injuries where appropriate (with parental consent or in line with safeguarding policies).
• Do not confront the alleged abuser, but ensure that your concerns are acted upon promptly.

Referral and Safeguarding

• Referral to Child Safeguarding Teams: Immediately refer the case to your hospital's safeguarding team or the local authority's child protection team.
• Follow Local Safeguarding Protocols: All health professionals in the UK have a duty to follow safeguarding protocols, including the UK government's "Working Together to Safeguard Children" guidance.
• Multi-Disciplinary Approach: Collaborate with social workers, child protection officers, and other healthcare professionals. Safeguarding meetings (e.g., case conferences) are essential in managing these cases.
• Follow-Up: Ensure appropriate follow-up care for the child, which may include ongoing medical treatment, psychological support, and monitoring of their safety.

Legal and Ethical Considerations

• Confidentiality: The child’s welfare takes priority over confidentiality. Information should be shared with relevant agencies if a child is at risk.
• Child Protection Plans: If abuse is confirmed, the child may be placed under a Child Protection Plan, which includes measures to ensure their safety.
• Reporting Obligations: As a doctor in the UK, you are legally obliged to report any suspicion of child abuse to safeguarding authorities.