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
