CHILD PROTECTION GUIDANCE
FOR HOSPITAL MEDICAL STAFF
WEST SUFFOLK HOSPITAL
2012
INTRODUCTION
All those who come into contact with families in their everyday work, including those who do not
generally work with children and young people, have a duty to safeguard and protect them,
including the unborn child. You may have a concern about a patient, which has implications for
the welfare of a child.
You should always consider the safety of any child in the household where there is evidence of
domestic violence.
WHAT TO DO
New GMC guidance for 0-18 yr olds was issued to all Doctors in October 2007.
Paragraphs 56-61 are relevant to Child Protection:
“Your first concern must be the safety of children and young people .You must inform an
appropriate person or authority, where there is risk of abuse or neglect, when it is in the child’s
best interest or necessary to protect other children. You must be able to justify a decision NOT
to share such a concern having taken advice from a named or designated doctor for child
protection, or a defence or professional body. You should record your concerns and discussions
for taking this decision in these circumstances. You will be able to justify raising a concern, even
if it turns out to be groundless, if you have done so honestly and on the basis of reasonable
belief.”
ACTION
The West Suffolk Hospital has a policy for safeguarding children. Please see the Pink
Book on the Trust Intranet
Please contact the Named Nurse to discuss and arrange the required level of training
ALWAYS DISCUSS YOUR CONCERNS WITH A COLLEAGUE
EXPERIENCED IN CHILD PROTECTION
Consultant Paediatrician of the week/on call via switchboard
Named Nurse for Safeguarding 01284 712808 or via pager
REMEMBER
That an allegation of child abuse or neglect may lead to a criminal investigation, so do
not attempt to investigate the situation yourself or ask a child leading questions.
You are advised to make careful notes about the situation and with whom you have discussed
it.
Do not promise to maintain confidentiality.
2011
Social Care Services Telephone Numbers:
Customer First
0808 800 4005
Professionals Number:
08456 066167
Fax No:
01449 723127
Postal address:
1.
INDICATORS FOR CONCERN
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Any unexplained bruise or mark in a non-mobile baby
An episode of cyanosis or collapse
Disclosure of abuse to GP either by child or parent
Injuries inconsistent with the history given, or unexplained injuries
Recurrent injuries
Unexplained failure to thrive
Features of neglect or emotional abuse
Allegations or medical findings suggestive of sexual abuse
Premature birth/young parents/multiple births
Actual or suspected multiple episodes of domestic violence
Parental drug and alcohol misuse
FACTORS IN THE HISTORY WHICH SHOULD AROUSE SUSPICION
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3.
Customer First, Suffolk County Council, PO Box 771,
Needham Market, Ipswich, Suffolk IP6 8WB
Inappropriate delay in seeking medical advice
Multiple and mixed injuries
Complicated history
Apparent fabrication of symptoms
Variable history
Inappropriate parental reaction
Abnormal interactions between child and parent
Unusual degree of hostility or over-friendliness to staff
Concerning comments made by the child
PARENTAL INDICATRS THAT MAY LEAD YOU TO HAVE CONCERNS REGARDING THE SAFETY OR WELFARE OF
A CHILD
 Mental health difficulties
 Learning disorder difficulties
 History of sexual offending
 History of violence
 History of previous children being referred for child protection concerns or being removed under care order
 Parental fabricated illness
Frequent visits to health professionals for advice – could be a cry for help
2011
PHYSICAL ABUSE
Findings on examination which should arose suspicion and prompt referral
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Bruising of different ages in places where accidental causes are unlikely i.e. soft tissues/flexor surfaces of limbs
Linear bruising/imprint bruising
Scalds and burns which do not look accidental
Bite marks
Mouth injuries/torn frenulum
Bilateral eye or ear injuries
Head injuries incompatible with history obtained i.e. fall from low surface
Abdominal bruising or injuries
Genital bruising or injuries
Any bruise in non-mobile baby which is unusual or unexplained
Always refer non-mobile babies with unexplained bruises for a Paediatric opinion as they may have more serious
underlying injuries
NEGLECT
Physical
Developmental
Behavioural
2011
In the infant:
In the pre-school child:
In the school child:
In the teenager:
Failure to thrive
Significant weight loss
Unexplained bruising
Severe nappy rash
Frequent hospital admissions
Recurrent and persistent
infections
General delay
Failure to gain weight/height
Physical features of FTT
Poor hygiene
Failure to gain height/weight
Poor hygiene
Failure to gain height/weight
or obese
Poor general health
Delayed puberty
Poor hygiene
Delayed language
Poor attention
Socially immature
Learning difficulties
Lack of self esteem
Poor coping skills
Emotional immaturity
School failure
Attachment disorder:
anxious, avoidant
Socially unresponsive
Food scavenging
Overactive
Aggressive and impulsive
Indiscriminate friendliness
Seeks Physical comfort from
strangers
Food scavenging
Poor relationships
Overactive
Aggressive
Withdrawn
Unusual patterns of
defecation or urination
Destructive
Truancy
Smoking
Alcohol and substance
misuse
Sexual promiscuity
Destructive behaviour
PATTERNS OF EMOTIONAL ABUSE
Rejecting:
Isolating:
Terrorising:
Ignoring:
Corrupting:
The child’s needs are not acknowledged
The child is excluded from normal social interaction
The chills is verbally assaulted
The child is deprived of essential stimulation
The child is stimulated to engage in destructive anti-social behaviour
The following age specific guidelines can be used:
0–1
Sleep/feeding problems, irritability, apathetic, dull, anxious attachments
1–3
As above + overactive, aggressive, attention deficit, language delay, indiscriminate affection,
fearful and anxious, inability to play, anxious and ambivalent attachments
3–6
As above + peer relationship difficulties, attention seeking, clingy, school failure, poor social
skills
6 – 12
As above though sleep and feeding problems may resolve inappropriate attachment to carers,
rejected by peers, development of delinquent behaviours, truanting, wetting, soiling, stealing,
bullying
12+
As above + depressions, escalated aggression, anxiety, self-harm, poor self-image,
psychosomatic illness, drug and substance misuses, criminal activities
SEXUAL ABUSE - Levels of concern:
Low Suspicion:
Recurrent UTIs  Recurrent abdominal pain, headaches or other psychosomatic
features  Isolated observation of sexualised behaviour  “Eccentric” sexual patterns
of family interaction without other observable or reported symptoms
Medium Suspicion:
Perineal itching, soreness, pain on micturition, discharge  anal warts  child hinting
that there are secrets he/she cannot talk about  psychiatric disturbances, mutism,
anorexia nervosa, attempted suicide or deliberate self harm  concern about
inappropriate behavioural patterns with other children or adults
High Suspicion:
Semen in vagina, anus or external genitalia  pregnancy in a minor where identity of
father is unknown/concealed  signs of STDs  repeated and frequent sexualised
behaviour  bruises, scratches or other injuries to genital or anal areas, or areas
such as breast and lips  laceration or scarring of anal mucosa into perianal skin
2011
Flowchart for Professionals working with Sexually Active
Under 18’s
Initial or Ongoing Contact with
Young Person
INITIAL ASSESSMENT OF RISK (based on information available)
Consider:
▪ The young person, (including whether they appear to be under 13 because the law treats under
13s differently)
▪ The context of the consultation (including who else is present)
▪ Any information known or forthcoming about their partner
▪ Give advice, support/treatment in line with Fraser competency
▪ Young person should be kept advised of actions being taken where this is appropriate to do so
▪ Act in a timely way, avoiding and minimising delay, ensuring that at all stages you minimise risk
of harm for both the young person and their sexual partner if she/he is at risk of harm
Does this
assessment
leave you with?
Immediate/imminent
concern
(to young person or risk of
young person abusing
someone else)
Some uncertainty
Seek immediate advice
from Child Protection lead
or Named/Designated
Doctor, or go straight to
next step
No concerns
Is he/she
under 13?
Obtain more information
on specific concerns
Further Guidance Needed
Discuss with Child Protection
lead or Named/Designated
Doctor
Yes
No
THEN Activate multi-agency Child
Protection procedures, action accordingly
and document reason for doing so
OR document reason for not doing so
Referral to Children & Young
People’s Services Customer
First/Child Protection Team
2011
Offer advice, support and treatment;
document discussion
WHAT TO DO FOLLOWING A DISCLOSURE
OF DOMESTIC VIOLENCE
The victim reveals she is
experiencing domestic abuse
Reassure, support and give national helpline
numbers and information on local specialist
domestic violence services
Is there an immediate danger to physical or
mental health or to life?
No
Yes
Is it necessary to involve manager/
admit to hospital for treatment/
involve police?
Are there children in the household?
Yes
Follow local multi-agency
guidelines
No
No
Assess risks. How serious is the
incident? Is there a previous history?
Outline the needs for
safety. Discuss a safety
plan and provide
information on support
agencies
Is a report or referral to Children &
Young People’s Services needed?
Child in need/safeguarding procedures
activated
Document accurately in all
cases.
Take photographs if
possible.
Store all information
confidentially
Consider the need to share
information safely, where
necessary (see guidance)
REFERENCE:
Guidance for dealing with Domestic
Violence and Incidents of Domestic
Abuse where Children are members of
the household
www.suffolkscb.org.uk
2011