SAFEGUARDING CHILDREN IN SUFFOLK
GUIDANCE FOR GENERAL PRACTITIONERS, PRIMARY CARE
AND OUT OF HOURS STAFF
INTRODUCTION
General Practitioners have a vital role in all stages of the child protection process. They are in
a position to identify when a parent has problems which may mean they pose a risk to a child.
Their contribution may be essential, recognizing that the welfare of the child is paramount.
WHAT TO DO
New GMC guidance has been issued and sent out in July 2012 entitled Protecting
Children and Young People , the responsibility of all Doctors.
All children and young people* are entitled to protection from abuse and neglect.
Good Medical Practice places a duty on all doctors to protect and promote the health
and well-being of children and young people. This means all doctors must act on any
concerns they have about the safety or welfare of a child or young person.
Child protection is a difficult area of practice that can involve making decisions that are
emotionally challenging, complicated by uncertainty and sometimes go against the wishes
of parents. Doctors should work with parents and families, where possible, to make sure
that children and young people receive the care and support they need. But in cases
where the interests and wishes of parents may put the safety of the child or young person
at risk, doctors must put the interests of the child or young person first.
Failure to act when a child or young person is at risk can have serious consequences for
both the child and their family.
Key points
Be aware of risk factors that have been linked to abuse and neglect and look out for signs
that a child or young person may be at risk. If you are treating an adult patient, consider
whether your patient poses a risk to children or young people.
Keep an open mind and be objective when making decisions. Work in partnership with
families where possible. If you are not sure about whether a child or young person is at
risk or how best to act on your concerns, ask a named or designated professional or a
lead clinician or, if they are not available, an experienced colleague for advice.
Consider whether to make a referral to Children’s Social Care or to ask for a second
opinion where there are features of abuse, neglect, domestic violence, or concern
about sexual abuse. Any disclosure of an acute sexual assault in a young person
13 or over should be immediately referred to the Sexual Abuse Referral Centre, (tel
01473 668974) where Police and Social Care will be involved and the young person
assessed and treated by a Forensic Medical Examiner
In cases where sexual abuse in a prepubertal child is suspected, because there has
been an allegation by a parent or carer, or the child has made a disclosure, a referral to
Social Care should be made. In these cases GPs are advised not to examine the child,
but refer to the Consultant Community Paediatrician. However if the family is
concerned about symptoms, without any allegation, the child should be examined and
relevant swabs/investigations taken.
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If you would like a second opinion, contact the Consultant Paediatrician on call by
phone or if a child requires treatment /admission , send the child to hospital.
Do not send the family to A/E without contacting the paediatricians in case they do
not attend.
In general, babies and those requiring investigation and treatment should be
referred to the hospital, those with bruising, potential sexual abuse or more minor
injuries will be seen by the Community Paediatricians .
Always consider the safety of any children in the household where there is evidence
of domestic violence, or any of the carers have mental health problems
Avoid confronting the family but explain that you are concerned and are referring
for a second opinion
All NHS Trusts have a Named Doctor and Named Nurse for safeguarding.
There are also Designated Doctors and a Nurse who work across the County and can be
contacted for advice through the Safeguarding Department on 01473 264357.
www.suffolkscb.org.uk
Social Care Services Telephone Numbers:
Customer First
0808 800 4005
Out of Hours
0808 800 4005
Professionals Number:
08456 066167
Fax No:
01449 723127
Postal address:
Customer First, Suffolk County Council, PO Box 771,
Needham Market, Ipswich, Suffolk IP6 8WB
NORTH SUFFOLK
The on call Paediatrician
through James Paget
Switchboard
01493 452452
EAST SUFFOLK
The on call Paediatrician
through Ipswich Hospital
Switchboard 01473 712233
Consultant Community
Paediatricians
01473 321209
WEST SUFFOLK
The on call Paediatrician
through WSH Switchboard
01284 713000
Consultant Community
Paediatricians
01284 775075
T
Paediatricians expect and welcome discussions with all referral agencies regarding concerns
about children and provide a 24-hour on call Service across the County. Out of hours, contact
the Hospital Switchboard for access to the on call Paediatrician.
SHARING INFORMATION—GMC GUIDANCE JULY 2012 :
You should normally discuss any concerns you have about a child’s or young person’s
safety or welfare with their parents. You should only withhold information about your
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concerns, or about a decision to make a referral, if you believe that telling the parents may
increase the risk of harm to the child or young person or anyone else. If this is difficult to
judge, or you are not sure about the best way to approach the situation, you should ask for
advice from a designated or named professional or a lead clinician or, if they are not
available, an experienced colleague.
When discussing your concerns with parents, you should explain that doctors have a
professional duty to raise their concerns if they think a child or young person is at risk of
abuse or neglect. You should explain what actions you intend to take, including if you are
contacting the local authority children’s services.
You should give the parents this information when you first become concerned about a
child’s or young person’s safety or welfare and throughout a family’s involvement in
child protection procedures.
You must work with and communicate effectively with colleagues in your team and
organisation and with other professionals and agencies. This includes health visitors, other
nurses, social workers and the police.
You should understand and respect the child protection roles, responsibilities, policies
and practices of other agencies and professionals and cooperate with them. You must be
clear about your own role and responsibilities in protecting children and young people,
and be ready to explain this to colleagues and other professionals.
You must tell an appropriate agency, such as children’s social care services, or the
police, promptly if you are concerned that a child or young person is at risk of, or is
suffering abuse or neglect unless it is not in their best interests to do. You do not
need to be certain that the child or young person is at risk of significant harm to
take this step. If a child or young person is at risk of, or is suffering, abuse or
neglect, the possible consequences of not sharing relevant information will, in the
overwhelming majority of cases, outweigh any harm that sharing your concerns
with an appropriate agency might cause.
When telling an appropriate agency about your concerns, you should
provide information about both of the following:
a the identities of the child or young person, their parents and any other person who may
pose a risk to them
b the reasons for your concerns, including information about the child’s or young person’s
health, and any relevant information about their parents or carers.
The GMC booklet gives clear guidance about issues of confidentiality and consent
and your duties and responsibilities in this respect. There is also guidance on
assessing capacity and determining who has parental responsibility for the child.
MEDICAL RECORD KEEPING
All action taken should be fully documented in the records, with accurate
contemporaneous notes of allegations or remarks by child young person or parents.
A recording must be made for all consultations of who attends with the child.
Consultation with other colleagues should also be carefully recorded.
There should be a clear means of identifying in the record, those children and their
siblings , who are subject of a child protection plan, so that all health professionals
in the practice are aware of this.
All Safeguarding information should be scanned into the record of each child in the
family. Details of the plan will be sent to each practice when there is confirmation
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that the patient is registered, through a response to the CP conference invitation.
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
2. FACTORS IN THE HISTORY WHICH SHOULD AROUSE SUSPICION
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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
3. PARENTAL INDICATORS THAT MAY LEAD YOU TO HAVE CONCERNS REGARDING THE SAFETY OR
WELFARE OF A CHILD
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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
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
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NEGLECT
Physical
Developmental
Behavioural
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:
Medium Suspicion:
High Suspicion:
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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
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
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
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
Some uncertainty
No concerns
(to young person or risk of young
person abusing someone else)
Seek immediate
advice from Child
Protection lead or
Named/Designated
Doctor, or go
straight to next step
Obtain more information on
specific concerns
Is he/she
under 13?
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
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Offer advice, support and treatment;
document discussion
WHAT TO DO FOLLOWING A DISCLOSURE
OF DOMESTIC VIOLENCE
Woman 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 social 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)
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SUFFOLK SAFEGUARDING CHILDREN BOARD
INJURIES TO NON- MOBILE INFANTS
ADVICE FOR GENERAL PRACTITIONERS AND HEALTH VISITORS
ANY BRUISE OR UNEXPLAINED MARK
DON’T DELAY IF YOU ARE CONCERNED
Seek the advice of the on-call Consultant Paediatrician by telephone
This may be through the SpR
Ideally (if a Suffolk child)
consult a Paediatrician
where the child was born
e.g. Ipswich Hospital/
West Suffolk Hospital
DISCUSS:
 No referral to Paediatrician
necessary
 Immediate referral by HV
to CYPS
 Wait for Paediatric
assessment before referral
Give Paediatrician full details of the
unexplained mark and any relevant
background, and agree subsequent action
Paediatrician will reassure or offer an examination of the baby, which in most cases
will be on the same day
Inform those involved including the
parents whether or not a paediatric
opinion is needed
Paediatrician will refer to Children’s
Social Care if concerned about the
infant if this hasn’t been done
Children’s Social Care will hold a
strategy discussion with the
Paediatrician and Police and agree
further plans
IF YOU ARE EXTREMELY CONCERNED ABOUT THE CONDITION OF THE BABY,
IMMEDIATE SAFETY ISSUES DIAL 999
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OR THERE ARE