Presentations
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Child sexual abuse, such as:
- sexually transmitted infections and their relationship to child sexual abuse
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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:
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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
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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
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Imaging (radiology), such as:
- bone scan
- CT scan
- MRI
- radiographic skeletal survey
- ultrasound
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Pathology tests, such as tests for:
- bleeding disorders
- bone fragility
- drugs
- genetic conditions
- metabolic conditions
- toxins
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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
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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
