Accidents, poisoning and child protection

Question 1

What environmental factors increase the risk of accidents, poison and abuse?

Answer 1

Poverty
Poor quality, overcrowded homes
Lack of safe environment for play
Poor parenting skills (psychiatric illness, drugs, alcohol, violence, lack of social support)

Question 2

Are burns more serious in children?

Answer 2

Children are scalded at a lower temperature than adults, as their skin is thinner

Question 3

How would you assess a burn?

Answer 3

ABCDE
Any smoke inhalation?
Depth of the burn
Surface area of the burn
Involvement of special sites

Question 4

How do you calculate the surface area of a burn?

Answer 4

Should use a surface area chart.

The palm and adducted fingers cover about 1% of the body surface.

Question 5

Which special sites should be assessed after a burn?

Answer 5

Burns to the face.
Those to the mouth may compromise the airway from oedema
Hands/joints may cause functional loss from scarring

Question 6

How would you manage a burn?

Answer 6

Relieve pain (analgesics)
Treat shock with IV fluids
Provide wound care (covered in plastic wrapping to reduce pain from contact with cold are and reduce the risk of infection)

Question 7

What is the prognosis of near drowning?

Answer 7

Up to 30% of fatalities can be prevented by skilled on-site resuscitation. Even unconscious, fixed-dilated pupil children can survive. Children who have inhaled water should be admitted into hospital.

Question 8

Why should children who have swallowed water in a near drowning event be admitted to hospital?

Answer 8

To be observed for signs of respiratory distress from pulmonary oedema after 1-72 hours from secondary surfactant.

Question 9

How would you manage wound management in a dog bite?

Answer 9

Copious wound irrigation, toilet and debridement
Removal of foreign bodies
delayed wound closure, especially on limbs, due to increased incidence of infection
Raise and immobilise limb
Regular wound review
Tetanus booster
Prophylactic antibiotics (Co-amoxiclav)

Question 10

What are the sub-groups poisoning can be caused by?

Answer 10

Accidental (majority)
Deliberate self-harm
NAI
Iatrogenic

Question 11

What age is accidental poisoning most common?

Answer 11

Young children, peak age of 30 months. Inquisitive toddlers are unaware of the danger of taking medicines, household products and eating plants.

Question 12

What are some potentially harmful poisons in children?

Answer 12

Alcohol, acids and alkalis, bleach, digoxin, batteries, iron, paracetamol, petrol, salicylates and tricyclic antidepressants

Question 13

What are the different types of child abuse?

Answer 13

Physical abuse, emotional abuse, sexual abuse, neglect and fabricated illness

Question 14

What does physical abuse consist of?

Answer 14

Hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child

Question 15

What does emotional abuse consist of?

Answer 15

Persistent emotional maltreatment of a child resulting in severe and persistent adverse effects on the child’s emotional development.

Question 16

How does emotional abuse make the child feel?

Answer 16

That they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of the other person.

Question 17

What does sexual abuse consist of?

Answer 17

Forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening.

Question 18

What does neglect consist of?

Answer 18

Persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development.

Question 19

What might the parent or carer fail to provide in neglect?

Answer 19

Adequate food and clothing
Shelter, including exclusion from home
Protection from physical and emotional harm or danger
Adequate supervision, including the use of inadequate caregivers
Access to appropriate medical care or treatment

Question 20

What is fabricated illness?

Answer 20

A broad term used to describe a group of behaviours by parents or carers but usually the mother (80%) which cause harm to children

Question 21

What are the types of fabricated illness?

Answer 21

Verbal fabrication

Induction of illness

Question 22

What is verbal fabrication?

Answer 22

Parents fabricate symptoms and signs in the child, leading to the doctors treating and causing harm to the child when they’re not ill

Question 23

What is the induction of illness?

Answer 23

It is when the parent or carer makes the child ill
(suffocation, administration of noxious substances, excess administration of ordinary substances [salt], excess use of medication)

Question 24

What are the risk factors for child abuse

Answer 24

Child: failure to meet parental expectations, resulted from forced, coercive or commercial sex
Parent/carer: mental health problems, parental indifference, alcohol/drugs
In the family: step-parents, domestic violence, multiple/closely spaced births, social isolation, young parental age
Environment: poverty, poor housing, unsavoury neighbourhood

Question 25

In what situations should the possibility of neglect be considered?

Answer 25

Consistently misses important appointments
Lacks needed medical or dental care, immunisation or glasses
Seem ravenously hungry
Is dirty
Is wearing inadequate clothing in cold weather
Is abusing alcohol or other drugs
Says there is nobody at home

Question 26

In babies, what behaviour may point towards emotional abuse?

Answer 26

Apathetic, delayed development, non-demanding

Described by the mother as ‘spoiled, attention seeking, in control, not loving her’

Question 27

In toddlers and preschool children, what behaviour may point towards emotional abuse?

Answer 27

Violent, apathetic, fearful

Question 28

In school children, what behaviour may point towards emotional abuse?

Answer 28

Wetting, soiling, relationship difficulties, non-attendance, anti-social behaviour

Question 29

In adolescents, what behaviour may point towards emotional abuse?

Answer 29

Self-harm, depression, oppositional, aggressive and delinquent behaviour

Question 30

What sort of fractures are more likely to be inflicted?

Answer 30

Any facture in a non-mobile child
Rib fractures
Multiple fractures
Multiple fractures at different ages
Sometimes: skull fracture in young child, long bone fractures in a young but mobile child

Question 31

What sort of bruises are more likely to be inflicted?

Answer 31

In the shape of a hand or object
On the neck that look like strangulation
Around the wrists or ankles that look like ligature marks
Bruise to the buttocks in a child less than 2 years or any age without a good explanation
Sometimes: bruising to the trunk with a vague history

Question 32

What sort of burns are more likely to be inflicted?

Answer 32

Any burn in a child who is not mobile
A burn in the shape of an implement (cigarette, iron)
A ‘glove or stocking’ burn consistent with forced immersion

Question 33

What sort of bites are more likely to be inflicted?

Answer 33

Bruising in the shape of a bite thought unlikely to be caused by a young child

Question 34

What are the physical symptoms of sexual abuse?

Answer 34

Vaginal bleeding, itching, discharge

Rectal bleeding

Question 35

What are the behavioural symptoms of sexual abuse?

Answer 35

Soiling, secondary enuresis

Self-harm, aggressive or sexualised behaviours, regression, poor school performance

Question 36

What are the medical conditions that should be excluded in an overly bruised child?

Answer 36

Coagulation disorders

Mongolian blue spots on the back or thighs

Question 37

What are the medical conditions that should be excluded in a child that suffers from repeat fractures?

Answer 37

Osteogenesis imperfecta, type 1 is autosomal dominant so there may be a family history

Question 38

What are the medical conditions that should be excluded when a scald or cigarette burn is suspects?

Answer 38

It may be misinterpreted bullous impetigo or scalded skin syndrome