Curriculum standards

Knowledge guides

LG16: Child safety and maltreatment

Key presentations and conditions

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

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Epidemiology, pathophysiology, and clinical sciences

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

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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.

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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.

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Presentations

Child sexual abuse, such as:
- sexually transmitted infections and their relationship to child sexual abuse
Patterns of inflicted and accidental injury, such as:
- abdominal and thoracic injuries
- burns
- consideration of all injuries in pre-mobile infants
- 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

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, i.e., supports for child and family
prepare a genogram for the understanding of family and social function, including supports and family histories of medical conditions
establish a differential diagnosis
obtain / reconcile different accounts from different sources of information, i.e., 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-based 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
involvement of 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
- developmental, medical, and mental health conditions occurring in the population, including those in gateway clinics
- management of such children long term
Impact of social determinants of health, Adverse Childhood Events (ACEs), neurobiological impacts of exposure to chronic stress, and the importance of supporting resilience
Impact of societal biases in child protection systems
Intergenerational trauma:
- child maltreatment presentations, such as:
  - exaggeration
  - fabrication
  - falsification
  - induction of illness or symptoms
- emotional maltreatment
- exposure to interpersonal violence
- neglect
- special consideration of all injuries in non-ambulatory infants
- unexplained or repeated incidents of non-accidental injury, such as:
  - abdominal and thoracic injuries
  - burns
  - child sexual abuse
  - fractures
  - head injuries
  - intra-oral injuries
  - skin and soft tissue injuries
Legislative requirements
Population health significance of child maltreatment and primary, secondary, and tertiary prevention strategies
Potential risk factors for harm to the child and their siblings within the family / environment
Protective factors, such as positive relationships and supports, 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 scan
- MRI
- radiographic skeletal survey
- ultrasound
Pathology tests, such as tests for:
- bleeding disorders
- bone fragility
- drugs
- genetic conditions
- metabolic conditions
- toxins
Reporting requirements:
- ethical, legal, and professional responsibilities around sharing of information regarding child safety, harm, and protection
- reporting requirements and mandatory reporting obligations
Subspeciality consultations and procedures, including retinal examination
Tests for sexually transmitted infections

Physical examination

Consideration of different injury types and their clinical findings
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
Identification and recognition of the signs of neglect
Identification and recognition of the signs of 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

Awareness of personal reactions to childhood behaviours, disability, family situations, and illnesses, and the impact these may have on professional practice
Child rights
Different types of child maltreatment and child neglect:
- educational
- emotional
- medical
- physical
- supervisory
Effective prevention for child maltreatment
Effects on children of being a perpetrator of violence, victim, or witness
Enablers and barriers to obtaining information in child maltreatment situations
Family and domestic violence
Family dysfunction, including poverty and disadvantages, and impact of social determinates of health
Impact of vicarious trauma on clinician wellbeing
Impact on the long-term health and wellbeing of children involved in the care and protection system
Management of physical and emotional maltreatment
Methods involved in developing a differential diagnosis for maltreatment victims
Parent or carer involvement in shared decision making
Peer review processes and support
Principles and procedures of forensic sample collection, including collection of biological specimens for DNA analysis
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