Curriculum standards

Knowledge guides

LG12: Child safety and maltreatment

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

View

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

View

Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable

View

Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

View

Presentations

Patterns of inflicted and accidental injury, such as:
- abdominal and thoracic injuries
- all injuries in pre-mobile infants
- burns
- fractures
- head injuries
- intra-oral bleeding and injuries
- perplexing presentations (PP) and Fabricated or Induced Illness (FII) in children
- poisonings
- skin and soft tissue injuries
- strangulation and suffocation
Child sexual abuse including understanding of:
- genital injury interpretation
- normal genital and anal anatomy, including developmental changes and variations
- normal sexual behaviours of children and young people
- sexually transmitted infections and their relationship to child sexual abuse

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical and biopsychosocial history
conduct an appropriate examination
identify protective factors
prepare a genogram for the understanding of family and social function, including supports and family histories of medical conditions
establish a differential diagnosis
obtain and reconcile different accounts from different sources of information ie parents, health, education and other agencies
plan and arrange appropriate investigations and consultations
document history, examination and investigation findings carefully and accurately
consider the impact of injury and disease on patients and their quality of life when developing a management plan
complete appropriate child safety referrals to statutory child protection agencies
produce peer reviewed medicolegal reports for the child protection and criminal justice system

Manage

maintain knowledge of developments in the evidence-base research around injury interpretation, and child maltreatment prevention and assessment
recommend therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams
involve interagency partners, NGOs, community, and society to promote child wellbeing
consult with other medical professionals and subspeciality experts around opinions and formulation

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Biopsychosocial risk factors
Emotional or behavioural presentation as a consequence of current or previous maltreatment and the impact of neglect over time
Health needs of children and young people in the care and protection systems, such as:
- children in out of home care
- medical, developmental and mental health conditions occurring in the population including those in gateway clinics
- management of such children long term
Intergenerational trauma:
- child maltreatment presentations, such as:
  - emotional maltreatment
  - exaggeration
  - fabrication
  - falsification
  - induction of illness or symptoms in a child
- exposure to interpersonal violence
- neglect
- special consideration of all injuries in non-ambulatory infants
- unexplained or repeated incidents of injury non-accidental injury including abdominal and thoracic injuries, burns, fractures, head injuries, skin and soft tissue injuries, intra-oral injuries, child sexual abuse
Legislative requirements
Population health significance of child maltreatment and describe primary, secondary and tertiary prevention strategies
Potential risk factors for harm to the child and their siblings within the family and environment
Protective factors and how they may help modify risk and augment management
Referral pathways and community and hospital services for vulnerable children and their families

Investigations: the role of investigations to assess for occult injury and medical causes or contributors to presentations of child maltreatment

Forensic tests on biological specimens
Imaging (radiology), such as:
- bone scan
- CT
- MRI
- radiographic skeletal survey
- ultrasound
Pathology tests, such as tests for:
- bone fragility
- bleeding disorders
- drugs
- genetic conditions
- metabolic conditions
- toxins
Subspeciality consultations and procedures (including retinal examination)
Tests for sexually transmitted infections

Physical examination

Documentation of examination findings using body diagrams and photographs
Evaluating parent-child interactions regarding emotional maltreatment
Genital examination including identification of normal genital development and anatomical variants
Identification and recognition of the signs of:
- child sexual abuse
- neglect
- physical abuse
Observe parent-child interaction
Top-to-toe examinations for the detection of injuries (including the significance of sentinel injuries in young infants and children 4 years and younger)

Reporting requirements

Professional, legal and ethical responsibilities around sharing of information regarding child safety, protection, and harm
Reporting requirements and mandatory reporting obligations

Awareness of personal reactions to childhood illness, behaviour, disability, and family situations and the impact these may have on professional practice
Child rights
Different types of maltreatment and neglect:
- educational
- emotional
- medical
- physical
- supervisory
Effects on children of being a witness, victim, or perpetrator of violence
Effective prevention for child maltreatment
Enablers and barriers to obtaining information in child maltreatment situations
Family and domestic violence
Family dysfunction including poverty and disadvantages, and impact of social determinants of health
Impact of bias
Impact of vicarious trauma on clinician wellbeing

Management of physical maltreatment:
- child vulnerability and suspected maltreatment, and impact on the long-term health and wellbeing of all children involved in the care and protection system
- forensic sample collection, including collection of biological specimens for DNA analysis
Methods involved in developing a differential diagnosis for maltreatment victims
Parent or caregiver involvement in shared decision making
Peer review processes and support
Principles of advocating for children
Principles underpinning national, state and local policies and procedures related to child protection
Role of courts involved in the criminal justice system
Role of courts responsible for child protection, family law and relevant courts of appeal
Role of the paediatric medical expert in writing medicolegal reports, contributing to case conferences and testifying in court in cases of child maltreatment