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
- 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:
- 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
- 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
