A.M Kemp, A.M Mott
DATE
PATRON HRH The Princess Royal

Editorial Board
•Professor Alison Kemp
•Dr Alison Mott
•Dr Amanda Thomas
•Nick Libell (RCPCH)
•Laura Green (RCPCH)
•Anne Rusinak (RCPCH)

History
• Originated from a practitioner’s clinical manual produced in Leeds.
• The 2006 Companion was produced by the Child
Protection Special Interest
Group and was based on evidence, research and practice at the time.

Contributing authors, reviewers and consultees
•
Dr Folashade Alu
•
Dr Monika Bajaj
•
Ms Sonya Baylis
• Prof Nick Bishop
• Ms Sally Bradley
•
Dr Rachel Brooks
•
Dr Paul Davis
•
Dr Geoff DeBelle
• Dr Margaret deJong
• Mr Sam Evans
•
Dr Joanne Gifford
•
Dr Danya Glaser
•
Dr Lindsay Groves
• Dr Jenny Harris
• Dr Jean Herbison
• Dr Deborah Hodes
•
Dr Diana Jellinek
•
Prof Alison Kemp
• Mr Nick Libell
•
Dr David Low
•
Dr Ian Maconochie
•
Dr Sabine Maguire
• Professor Jacqueline Mok
• Dr Alison Mott
•
Dr Aideen Naughton
•
Dr Sheila Paul
•
Dr Ximena Poblete
• Dr Colin Powell
• Mr Charles Prest
•
Dr Rosalyn Proops
•
Dr Karen Rogstad
•
Dr Peter Sidebotham
• Dr Alan Sprigg
• Dr Alison Steele
• Dr Corina The
•
Dr Amanda Thomas
•
Dr Elspeth Webb
• Dr Mike Williams

Aims of Child Protection Companion
Primarily for UK Paediatricians
1. In their role in the multiagency safeguarding children process
2. Assist the recognition, assessment, investigation and management of suspected child maltreatment
3. To build upon and complement national guidance, policy and practice documents

FORMAT: RCPCH Child Protection Companion
• Hard copy
– £25 to RCPCH members
– £32 to non RCPCH members
• Online version
– Free to RCPCH members
– One year subscription £20 to non RCPCH members
• Online and print bundle
– £39 to non RCPCH members

1.
Introduction
2.
Responsibilities of paediatricians
3.
Working Together to Safeguard Children.
4.
Children’s rights
5.
Good practice recommendations
6.
The medical assessment and admission to hospital
7.
Consent, Confidentiality and Information sharing
8.
Parental factors
9.
Recognition of Physical Abuse
10. Child sexual abuse
11. Neglect
12. Emotional abuse
13. Perplexing presentations (including FII)
14. Abuse in special circumstances
15. Infant and Child deaths
16. Records and reports
17. Photo documentation
18. Court proceedings: giving evidence
19. Training and support
20. Appendices

• Terminology is based primarily on English law, legislation and guidance.
• Where appropriate the differences in policy and practice in Scotland, Wales and Northern Ireland and the legal differences in Scotland are referenced
• Written in accordance with UNCRC

Makes reference and hyperlinks to over 50 key documents e.g.
• Child protection legislation
Children Act, Health and Social Care, Children Act Scotland
• Clinical Guidelines
NICE guidance 2008, RCR/RCPCH Radiology guidelines
• Professional practice guidelines
GMC publications 2012/13, RCPCH clinical competency document, BMA
Toolkit
• Government reports
Kennedy report , Munro review, Laming progress report 2009
• Regional
PRUDIC (Wales), Choosing to Protect 2009 (NI), A Guide for getting it
Right for every Child (Scotland)

• www.core-info.cf.ac.uk
• Bruising
• Fractures
• Oral injury and bites
• Burns and scalds
• Abusive head trauma
• Haemorrhagic retinopathy
• Visceral injury
• Emotional neglect and emotional abuse: preschool children
• Dental neglect
• NICE guidance
• RCPCH FII document
• Published systematic reviews and studies

Each chapter includes good practice recommendations aiming to set
• Audit standards
• Local and national child protection health care provision
• National standards

Medical assessment
Communication with child and family
• Be sensitive to the child’s needs
• The child should: understand the reasons for assessment be able to express their wishes and feelings participate in decisions affecting them be given the opportunity of speaking alone
Communication with multiagency team
• Verbal information to children’s social care and police should be followed up in writing with a formal report within 3 working days

Medical assessment
Training
• The examining doctor should have level 3 training competences
• A trainee should be supervised by a consultant or senior paediatrician
Timescales
• Appropriate to type of abuse and requirement for collection of evidential samples:
• Physical injury: within 24 hours
• Historic abuse and neglect: according to clinical need and child protection process.
• Children should not be kept waiting for more than 10 working days without clear mitigating factors agreed by all parties

What is new?
• Improved evidence base
• Links to Core info website ( www.core-info.cf.ac.uk
)
• Integrated with NICE guidance on recognition of suspected maltreatment
• Detailed section on haematology investigations
• Vitamin D deficiency and fractures

Haematology assessment
• In consultation
Geoff DeBelle
Mike Williams
• Focus on child and family history
• Who to investigate?
• First and second line investigations

Assessment of children with occult fractures
• In consultation with
Prof N Bishop
Alan Sprigg
• Stress the history
• Explanation for injury
• Excluding bone fragility
• Investigations

• Guidance for the general paediatrician on the recognition of suspected CSA and ongoing management
• All cases of suspected CSA must be referred to paediatrician with the appropriate training and competences
Guidelines on Paediatric Forensic Examinations in
Relation to Possible Child Sexual Abuse FFLM/ RCPCH 2012

Child Sexual abuse: What should you do?
What should the general paediatrician do?
• Recognition
• Acute or historic?
• If acute
– Assess immediate health needs of child
– Examination as soon as possible
• The timing of the examination is essential in:
– Obtaining forensic evidence
– Risk assessment for prevention of STIs: prophylaxis for HIV has to be given within 72 hours post assault and is most effective when given as soon as possible
– Prevention of pregnancy: emergency contraception can be given up to 72 hours or five days post assault.

Child Sexual Abuse
• Any doctor who undertakes a forensic assessment of a child who may have been sexually abused must be familiar with recent guidance.
– The Physical signs of child sexual abuse: an evidence based review and guidance for best practice RCPCH 2008
• Currently being updated with publication expected late 2013
• Need for child focused service 365 days per year with appropriate facilities

Parental risk factors: domestic abuse
Domestic abuse
• Children living with domestic violence are suffering significant harm (Adoption and Children Act 2002)
• Included in emotional abuse definition
– seeing or hearing the ill-treatment of another
• Domestic violence identified as risk factor in 34% of
Serious Case Reviews (2009 -2011)

How safe are our children NSPCC 2013

Domestic abuse: Role of paediatrician
• Routine questioning should be part of the history taking when children are assessed for suspected child abuse and neglect
• Sensitivity to needs and safety of adult
• Multiagency process
– MARAC (Multi Agency Risk
Assessment Committee)
Indirect questions: a) Is everything ok at home? b) Is your partner supportive? c) If woman is pregnant:
» Are you being looked after properly?
» Is your partner taking care of you?
Direct questions: a) Do you ever feel frightened of your partner? b) Have you ever been in a relationship where you have been hit or hurt in some way? c) Are you currently in a relationship where this is happening to you?

How safe are our children NSPCC 2013

Abuse in special circumstances
• Groups of children at particular risk of abuse
• Complex topics summarized with relevance to paediatrician
• Background, existing guidance, identification of key issues and responsibilities of paediatricians
• Themes:
– children living away from home eg Looked After Children
– children from minority groups eg Asylum seeking children
– focus on young people eg Sexual exploitation

• All paediatricians require ICC Level 3 competences
(55 further knowledge, skills, attitudes and values)
• Trainees should attain ICC competences:
F1/F2: Level 1 training
ST1-3: Level 2 training
ST4-8: Level 3 training

• Child Protection Recognition & Response Level 2: face-to-face.
Paediatricians in training ( ST 1-3)
• Child Protection in Practice Level 2/3: online
Paediatricians in training ( ST 4-7)
• Maintaining and Updating Competences Level 3: online
Consultant Paediatricians
• Child Protection: from examination to court Level 2/3: face-to-face.
Consultant Paediatricians and senior trainees
• Expert witnesses in Child protection: developing excellence
Level 6: face to face. Consultants

Peer review, supervision and support
Peer review
• Proactive culture of learning, education and training, case supervision, service improvement including multiagency processes.
• Support in a non-hierarchical environment, decrease professional isolation, sharing of best practice and understand the complexities of common but uncertain situations.
• Assurance that case findings and report meet a measure of standard and are more reliable.
Royal College of Paediatrics and Child Health (2012) Peer Review in Safeguarding

• Development of standards for safeguarding children
– Good practice recommendations
– Quality assessment framework
– Outcomes focused standards
• Training competences being updated and clarified for trainees
• Keeping up to date

How safe are our children NSPCC 2013

How safe are our children NSPCC 2013

How safe are our children NSPCC 2013