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Reflective case study 6 year old boy

Appendix 11Case study Child M Case study neglect: There was also a history suggestive of possible fits and vomit found in the toilet. Both her feet were red and a chronic ulcer was found on her left ankle. She also had skin spots on her right shoulder suggestive of sore skin or pressure ulcer. There was no high-dependency bed at the local hospital so she was transferred to another PAHT site in the early hours for ongoing care. She was initially thought to have meningitis or encephalitis-like illness but a lumbar puncture later ruled reflective case study 6 year old boy out.

She had a CT brain scan which showed non-specific dilatation of ventricles fluid-filled cavities inside the brain but MRI scan was normal. She gradually improved and by the next day she was fully conscious and started eating orally.

Subsequent blood tests showed that she had gross nutritional deficiencies. An information sharing form was raised and the SBAR included the following information: The information sharing form was sent by nursing staff on the ward for the attention of the school health practitioner on the day of admission.

The form was forwarded to the named nurse in the community by the hospital safeguarding team. The following Wednesday 5 working days reflective case study 6 year old boy the named nurse contacted the hospital safeguarding team reflective case study 6 year old boy say that the school health practitioner had serious concerns about the child particularly with respect to neglect.

Information shared was that Child M appeared hungry at school in the past and was observed to go looking for food. The school health practitioner had made a referral to CSC in the recent past. The hospital nurses noted that Child M did not have enough clothes provided and appeared quite sad and withdrawn, seeking attention from the nurses intermittently. The referral was rung through to CSC, the referral faxed and confirmation received that the case had been allocated to a social worker the same day.

She said that she was found in the bathroom on 24 April 2013 and had vomited in the toilet.

The mother had taken Child M down the stairs and given her a drink; Child M then had a generalised shake of her limbs which appeared like a fit, lasting about 5 minutes, and stopped on its own.

She also mentioned that Child M was a very fussy eater, like herself. She said that things reflective case study 6 year old boy improved since she the mother had a new partner. Child M was reported to have always had a good appetite but was always small and mother did not think there was anything wrong. On further questioning, while taking a more detailed background history about moving schools twice, mother explained that Child M was previously referred to Social Services due to concerns regarding neglect and not being fed.

The first time it occurred was 4 years ago and prompted a school move. The same thing occurred at the next school over 1 year ago. At this point Child M was also attending school, having wet herself on the way to school and reporting that mother was not changing and cleaning her appropriately.

Previous medical history and background Child M was born by normal delivery weighing 6 pounds 4 reflective case study 6 year old boy.

Social cognition

She was brought to hospital once for possible irritable hip but otherwise remained healthy. Her development was normal and there was no concern about her hearing or vision. She was up to date with her immunisations and not currently on any regular medication. There was no concern about her sleep and she did not have any tendency to self-harm. She last attended school in December 2012. Family history and composition Reflective case study 6 year old boy M lives with her mother and stepdad.

There were two other boys aged 10 months old and 2 years old both to mother and stepdad. There were two other children of stepdad from a previous relationship; a son aged 14 years and a daughter aged reflective case study 6 year old boy years. The 14-year-old son lived in the same household as Child M but the daughter usually lived with her mum and stayed with her dad on Tuesdays and Thursdays.

There were no significant health problems in the family apart from the 14-year-old who suffered from behavioural problems and issues around soiling. A medical was completed and the consultant paediatrician recorded the following: Child M has presented with a seizure which was most likely secondary to low sodium salt level.

This has now corrected but we have the following concerns: She is significantly underweight and short for her age. She has shown a very good appetite and at one point we had to control her oral intake as she was showing signs of refeeding syndrome a condition where chronically malnourished children — if allowed to feed — can develop life-threatening salt depletions.

Child M showed a drop of phosphate and magnesium after starting feeding and a dietitian had to be involved. She has some significant nutritional deficiencies for which a medical cause has not been found so far. She has also shown good weight-gain while an inpatient.

There have been previous concerns regarding neglect and lack of food. The family has also moved schools and now she is getting home schooling. This could have been triggered by professionals raising concerns about neglect. Foster carers were identified and planned a visit that day. No unsupervised contact was allowed between parents and Child M, including telephone contact.

The social worker described the outcome of her visit to the family home where it was identified that there was reflective case study 6 year old boy sign of Child M having lived there. She had no bedroom and would sleep on the landing or in the bath. She was kept away from the kitchen by means of keeping the dogs in there in the knowledge that Child M was scared of them. Child M was discharged later that week.

Follow-up On the 15 July, Child M was reviewed in outpatients clinic by the consultant who treated her in hospital. He documented that her body mass index was now above average, she was at school and seemed much happier.

Systemic analysis Establishing the context The enhanced reporting culture within PAHT and the use of the online information sharing tool had an important impact on this case. Although not a particularly good example of how SBAR can be completed, it provided a clear indication to the named nurse who read it that the level of concern in the hospital was at a different level to the school health practitioner, prompting the telephone call to the trust safeguarding team.

During the following 5 days, concern in the hospital was growing. The fact that the concern was both validated and heightened from another source, the school health practitioner, added to the overall context in which assessments then occurred. This resulted in reflective case study 6 year old boy clarity of reporting from the consultant that helped ensure the application for an Emergency Protection Order was successful.

This case was taken to peer review meeting to highlight the positive lessons learned. The e-mail reply from the consultant stated: Thanks for the lovely email. I indeed felt vey good yesterday seeing her in my clinic happy, thriving and altogether a different girl than when I first met her in the ward. I will love to present her case in any meetings, just let me know in good time. Well done to you and all involved. The social worker repeatedly informed the Reflective case study 6 year old boy of Safeguarding that the only referral they had on the system was that from the school health practitioner several weeks previously.

This supports findings from the audit into section 47 referral cases where some teams could not find the paperwork that followed the telephone referral and of which the trust safeguarding team had a copy. In some cases, they have not and it is sent again. In other cases, the paperwork, which is scanned into the electronic system, is found on a different screen. Further work is required to explore practice of electronically filing faxed referral forms.

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