988 Audit of child protection medicals and investigation in children age 0–2 years for the period January – December 2020: a reflection of the Covid-19 pandemic and current literature?. (17th August 2022)

• Record Type: Journal Article
• Authors: Holt, Naomi; Tucker, Juliet; Hiremath, Sonya
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A293
• Page End: A293
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.475
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: The Covid 19 pandemic has directly impacted children and young people experiencing child abuse and neglect. There is concern that conditions created by the pandemic have led to more stress and physical conflict in some families resulting in an increase in children's vulnerability and a reduction in normal protective services. We conducted a follow-up audit at our local District General Hospital (DGH) to monitor a) our adherence to our local protocol on non-mobile infant bruising and b) monitor trends/performance in Child Protection Medicals in 2020 relative to current literature on inflicted injuries in the 0-2 year age group. Methods: All children < 2 yrs meeting the criteria of having undergone a Child Protection medical examination- both Specialist Medical Examination (SME) and Joint Paediatric Forensic Examinations (JPFME), between January and December 2020 were included. Data were collected and reviewed against existing local and national standards including outcome of radiological, laboratory and ophthalmological investigations. Results: There were 42 child protection medical examinations (excluding sexual assault examinations) for children aged 0-2 years from January 2020 until December 2020. Notes for 3 were missing. Of the remaining 39 examinations, 12 were SMEs and 27 were JPFEs. The age range was 3 days to 19 months. 15 infants had a documented concern about Non accidental Injury (NAI) following examination. All 15 had additional radiological investigations. 6 cases had additional findings identified on imaging i.e. a positive result in 40% of those undergoing further investigation. See table 1 . There was a higher rate of positive findings compared to previous years (14% 2018 and 29% 2019). All 6 infants were <6months old. All the infants with head injuries reflected recent literature which describes a higher yield on CT head scans carried out in infants who present with neurological signs, skull fractures, scalp injuries or head and neck bruising None of the cases were actively open to Social Work at the time of presentation. None of the infants were on the Child Protection register. Conclusion: There were less medicals carried out in 2020, likely a reflection of the reduction in face to face contact with health professionals. The pandemic heightened risk factors for abuse which our data appear to reflect. 26% of infants with concerns for NAI following JPFME had head injuries on imaging and 20% had occult fractures on skeletal survey. This is higher than the average yield expected for this age group described in the literature. These audit findings at a local level, support findings published by a large centre for Paediatric abusive head trauma in the UK in 2020. This audit further provides evidence to consider the risk of occult injuries and support the existence of policies and protocols with a low threshold for information sharing and investigation. This also highlights the importance of training those working with families with young babies to support parents with keeping their babies safe and reducing the risk of non-accidental head injuries in the form of standardised training packages for example.