Adolescence & Safeguarding

Dr Michelle Arora

Consultant Paediatrician, Addenbrookes Hospital

Director of Studies (Clinical Medicine), Clare College, University of Cambridge

MRCPCH/DCH Foundation of Practice (FOP) exam preparation:

Live workshop for overseas candidates April 2021
Scenario 1
A 15 year old girl is seen at 2am in the emergency department .
She took 32 paracetamol tablets 20 hours ago. Her serum
paracetamol level is high and above the level treatment should
be started. Her INR is also prolonged. Her parents are
uncontactable. She refuses to consent for treatment.

What is your next step?

o A: Accept her refusal for treatment

o B: Admit to the paediatric ward for a CAMHS assessment
o C: Discuss with child psychologist
o D: Discuss with children’s social care
o E: *Start treatment anyway
Capacity to consent
• 16y or over – assume
capacity Retain

• Less than 16y old –

depends on maturity,
understanding & Understand Use
complexity

Communicate

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-
for-doctors/0-18-years/making-decisions#paragraph-24
Consent: GMC guidance
• You can provide emergency treatment without
consent to save the life of or prevent serious
deterioration
• Under 16y- refusal is not binding if the treatment is
though to be in young person’s best interests or the
situation is life threatening.
Medicolegal definition of an emergency

• It takes at least 2 hours to obtain a declaration

from the court

• Emergency = any unforeseen situation requiring

medical action before this time to safeguard the
life of a patient or to prevent serious harm
Scenario 2
• Following on from the previous case, what is the
correct treatment for her paracetamol overdose?
o A: *N-acetyl cysteine
o B: Flumazenil
o C: Naloxone
o D: Desferrioxamine
o E: Activated charcoal
Poisonings
Drug Antidote
Paracetamol N-acetylcysteine
Opioids Naloxone
Benzodiazepines Flumazenil
Iron Deferrioxamine
Warfarin Vitamin K
Copper Penicillamine
Scenario 3
A 14 year old boy is brought into the emergency
department by police after being found next to a bridge
claiming he wanted to end his life.
He has self harm marks to his forearms. Before he can be
fully assessed he absconds from the department.
What is the next best course of action?
o A: Ask hospital security to bring him back
o B: *Telephone the police
o C: Discuss with children’s social care
o D: Contact his parents
o E: Discuss with CAMHS
Definitions (RCEM, June 2018)

• Absconds - “Left the ED at any time without

informing ED staff and is at risk of harm to self or
others either through neglect or deliberate
means”
• Self-discharge – left ED after informing staff
• Left before treatment – left before treatment but
has been assessed by a decision-making clinician
• Did not wait – left before assessment by a
decision-making clinician
Scenario 4
A 16 year old girl is admitted to the paediatric ward
with abdominal pain. She discloses to a health care
professional that she has been sexually assaulted by
another resident in the care home where she lives.
What is the next best course of action?
o A: *Refer to the SARC
o B: Refer to CAMHS
o C: Discuss with her parents
o D: Discuss with Gynaecology
o E: Refer to sexual health clinic
Sexual Assault Referral Centre (SARC)

• Special facility where recent victims of sexual

assault can receive immediate help and support
including access to forensic medical examination

• Individual process of referral to the SARC will vary

depending on the commissioning group but
generally involves discussion with Police and/or
children’s social care
Child sexual exploitation
• Offered gifts, drugs, money, status or affection in exchange for
performing sexual activities

• Suspect if:
o Inappropriate sexual behaviour
o Frightened of some people, places or situations
o Sharp changes in mood, character or behaviour
o Having money or gifts they won't explain
o Physical signs of abuse
o Alcohol/drug misuse
o Sexually transmitted infections, pregnancy
o Older boyfriend or girlfriend.
o Missing from home or care, or stopping going to school
o Involvement in criminal activities (drugs or shoplifting)
Child sexual exploitation – risk factors

• Chaotic or dysfunctional household

• History of abuse
• Gang association
• Learning disabilities
• Drug or alcohol misuse
• School absence
• Receipt of gifts from unknown sources
• Poor mental health
• Self-harm NHS England, 2015
Scenario 5
During more detailed history taking, the 16y old girl
states that her periods are regular but she has some
spotting in between periods. She developed purulent
vaginal discharge around the same time that her pain
started.
What is the most likely diagnosis?
o A: *Chlamydia
o B: HIV
o C: Herpes simplex
o D: Syphilis
o E: Bacterial vaginosis
Sexually transmitted infections

STI Symptoms Treatment

Chlamydia Vaginal discharge Azithromycin or
Mid-cycle or post-coital bleeding doxycycline
Gonorrhoea Vaginal discharge Ceftriaxone
Mid-cycle or post-coital bleeding
Herpes simplex Blisters or open sores in genital or Acyclovir
rectal region
Syphilis Chancre or ulcer at infection site Benzylpenicillin
Human Papilloma Genital warts Imiquod cream
Virus Vaccination in UK 2008