Safeguarding Update
Some legal insights into child safeguarding cases
For those who might not know, my wife is a lawyer. More specifically, her area of interest is child social care and she works closely with child social services and paediatricians. She’s seen it all, and despite doing less legal work since becoming a mother, she often shares some incredible insights on legal practice and how healthcare professionals can be better prepared for possible safeguarding issues.
I came across this useful article from the BMJ and asked her about her view on child safeguarding having dealt with safeguarding issues on the other side. She shared some good insights. This weeks newsletter aims to recommend some helpful practices to spot safeguarding red flags early.
Firstly, safeguarding primarily concerns itself with child maltreatment. This is a more encompassing term that is adopted by organisations like the WHO and is what the UK government uses when adjudicating in cases. This includes a number of domains of abuse including:
Physical Abuse - involves physical harm or injury to a child.
Emotional or Psychological Abuse - concerned with behaviours that harm a child’s emotional development of self worth.
Sexual Abuse - involves sexual activity with a child including exploitation or exposure to inappropriate sexual material.
Neglect - failure to meet a child’s basic needs for health, education, nutrition, shelter, and safety.
Exploitation - Using a child for labor or other purposes in a manner that benefits others and is detrimental to the child’s development.
How Does Child Maltreatment Present?
Physical Abuse:
Obvious injuries are… obvious but here social services and the legal world look for “sentinel injuries.”
This is where after abuse has been determined, the patient is examined in order to find injuries that could have have suggested abused before it was actually realised. This allows a timeline to be established and personnel or services taken into account.
Sentinel injuries include bruising in odd locations (ears, neck, abdomen), skin injuries in the pattern of an object and injuries not in keeping with the patients developmental age.
Practically speaking, all children should be examined and simple sentences such as “no bruises” should be documented to demonstrate that you have looked for these.
Sexual Abuse
This is difficult terrain. Unlike physical abuse where the signs of such abuse can remain on the patient for some time, sexual abuse is different. It occurs over time and due to the nature of the genitalia, signs of such abuse may not be obvious. Aside from disclosure, most issues of sexual exploitation are realised retrospectively after establishing a timeline of presentations.
This includes repeated presentations with conditions such as vulvovaginitis, discharge or vaginal bleeding. Children may also exhibit odd, sexualised behaviours. You could also consider using more objective questionnaires such as the Greenbaum’s six-item questionnaire,
Currently, there is a huge case load for cases of sex-trafficking. These are primarily present in areas with low socioeconomic status as well as places with large migrant populations.
Neglect
This involves a number of areas including physical, emotional, supervisory, medical, dental, and educational neglect. As you can imagine, these are lie on a spectrum. For example, I see a number of children in clinic with poor dental hygiene which from many peoples perspective would be classed as neglect. But there are other signs that tell me that the child is loved but the parents require some dental education.
Ultimately go with your gut. There is very little guidance on when/when not to report neglect but if something doesn’t feel right - you may find that you need to involve other services whether it be a senior colleague, social services or others.
These services will interview the child and the parents to establish whether neglect has taken place. It is not the job of healthcare professionals to do this. Our role is to only make a referral and this is where our accountability lies.
If you suspect any of the above it is important to let the caregiver know. It is best to be subtle in investigating any injuries or behaviours whilst being explicit concerning any action you mean to take. If you intend to make a referral then let the caregiver know so they are aware. They might not be happy but it is your duty to be transparent.
How Should We Document for Patient who are Suspected of Abuse?
My wife has to go through hundreds of case notes of clinicians in the context of child safeguarding. Here are some tips she recommends as well as the general literature:
Always write down who is accompanying a child e.g. mother, grandfather etc.
If you’re writing something verbatim, be sure to include speech marks.
Write down the factual details of the discussion and avoid giving your own opinion. For instance, document that you have informed the caregiver of a safeguarding referral but avoid writing about their reaction e.g. anger, sadness etc.
If you feel something is odd, document it. For instance, if the child is unkempt then mention this in the notes so a future clinician can follow up on this.
In the same light, avoid giving your direct impression e.g. rash on cheek suggesting physical abuse. Simply document rash on cheek.
Write down the name/contact number or role of any organisation you decide to refer a patient to.
Hope that’s been useful! Until next time…
CPD Elderly Care Masterclass
Winter is in full swing with a frosty spell all week. During this period we are bound to see an increase in elderly care presentations including chest infections, falls, fractures and more. It is for this reason we have invited Dr Aidan Nixon, IMT3 in elderly medicine who will deliver a masterclass on the latest practice in elderly care. He will cover:
An approach to managing multiple co-morbidities: diagnosis, investigations and management
Admission and discharge considerations in the elderly population
Safeguarding and social issues in the elderly
Frailty & cognitive impairment: A pragmatic approach
Polypharmacy and de-prescribing in the elderly
Emerging services: virtual ward
This will be held LIVE on Sunday 1st December 2024 between 10:00-1300. However, if you can’t make it then the presentation will be recorded to view for 60 days. You will also receive an externally accredited CPD certificate.
We sincerely hope to see you there :)
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