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.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
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.
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.
Presentations
- Child abuse, including, but not limited to:
- emotional abuse:
- fabricated illness or induced illness by proxy
- neglect
- physical abuse
- sexual abuse:
- sexually transmitted infections
- emotional abuse:
- Symptoms and signs of inflicted / non-accidental injury, such as:
- abdominal and thoracic injuries
- burns
- chest injuries
- injuries in pre-mobile infants
- fractures
- genitourinary injuries
- head injuries
- intra-oral bleeding and injuries
- perplexing presentations (PP) and fabricated or induced illness (FII) in children
- poisonings
- skin and soft tissue injuries, including:
- bruises
- 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 history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Biopsychosocial risk factors
- 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
- Impact of societal biases in child protection systems
- Legislative requirements
- Population health significance of child maltreatment, and primary, secondary, and tertiary prevention strategies
- Potential risk factors for harm to children 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
- Consideration of differential diagnosis or pathologies contributing to severity of presentation:
- bleeding disorders
- bone fragility
- drugs
- genetic conditions
- metabolic conditions
- toxins
- Imaging (radiology), such as:
- bone scan
- CT
- MRI
- radiographic skeletal survey
- ultrasound
- Investigations:
- differential diagnosis to presentations of child maltreatment
- role of investigations to assess for acute injury
- Pathology tests to assess injuries and consider other potential differential diagnosis
- Subspeciality consultations and procedures, including retinal examination
- Time critical forensic specimen collection with chain of evidence / forensic sampling techniques
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
- 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 four 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
- Discussion of sensitive issues with family
- Family dysfunction, including poverty and disadvantages, and the impact of social determinants of health
- Features of inflicted injury:
- history
- patterns of injury
- risk factors
- Parent and/or carer involvement in shared decision making
- Peer review processes and support
- Principles of advocating for children
- Reporting requirements:
- ethical, legal, and professional responsibilities around sharing information regarding child safety, harm, and protection
- reporting requirements and mandatory reporting obligations
- Psychosocial hazards:
- impact of vicarious trauma on clinician wellbeing
- impact on the long-term health and wellbeing of children involved in the care and protection system
- Medicolegal aspects:
- appropriate conduct of an expert witness
- courts, and the role of those:
- involved in the criminal justice system
- responsible for child protection, family law, and appeal
- legal considerations for treatment
- paediatric medical experts and their role in writing medicolegal reports, contributing to case conferences, and testifying in court in cases of child maltreatment
- principles and procedures of forensic sample collection, including collection of biological specimens for DNA analysis
- provide evidence to assist investigations, including swabs and photographs
Maltreatment and intergenerational trauma and conflict
- Intergenerational trauma and conflict:
- 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 inflicted / non-accidental injury, such as:
- Abdominal and thoracic injuries
- Burns
- Child sexual abuse
- Fractures
- Head injuries
- Intraoral injuries
- Child maltreatment presentations, such as:
- Maltreatment:
- Behavioural or emotional presentation as a consequence of current or previous maltreatment, and the impact of neglect over time
- Different types of child maltreatment and child neglect:
- Educational
- Emotional
- Medical
- Physical
- Supervisory
- Effective prevention of child maltreatment
- Effects on children of being a perpetrator, victim, or witness of violence
- Enablers and barriers to obtaining information in child maltreatment situations
- Family and domestic violence
- Local, state, and national policies, procedures, and services related to child protection
- Management of physical and emotional maltreatment
- Methods involved in developing a differential diagnosis for maltreatment victims
Specific management issues
- Appropriate injury reporting, separate to reporting to child safety agencies, such as making an ACC claim in Aotearoa New Zealand
- Disclosure and history-taking environment must be safe, including culturally safe, taking into consideration:
- Age
- Developmental stage
- Safe environment post-disclosure
- Referrals:
- Appropriate referral pathways to ensure time-critical specimens are collected within the appropriate timeframe, and non-time-critical specimens are performed in a planned, coordinated manner
- Non-accidental injury and appropriate referral processes, such as knowing legislative processes and keeping thorough documentation
- Mental health / social support referrals as appropriate and available
- Sexual health:
- Emergency contraception provision and counselling
- Sexually transmitted infection testing, and post-exposure prophylaxis