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Part 3B: Responding to concerns about child abuse

The child’s voice

Children are clear what they want from an effective safeguarding system. Children have said that they need

  • Vigilance: to have adults notice when things are troubling them.
  • Understanding and action: to understand what is happening; to be heard and understood; and to have that understanding acted upon.
  • Stability: to be able to develop an ongoing stable relationship of trust with those helping them.
  • Respect: to be treated with the expectation that they are competent rather than not.
  • Information and engagement: to be informed about, and involved in procedures, decisions, concerns and plans.
  • Explanation: to be informed of the outcome of assessments, and decisions and reasons when their views have not met with a positive response.
  • Support: to be provided with support in their own right as well as a member of their family.
  • Advocacy: to be provided with advocacy to assist them in putting forward their views.
  • Protection: to be protected against all forms of abuse, exploitation, and discrimination, and the right to special protection and help if a refugee.
Responding to concerns about child abuse is a five step process

Step 1: Listen and observe.

Piece together information you already have:

  • Any history, disclosure, physical signs, symptoms, investigation results.
  • Child’s appearance, behaviour or demeanour.
  • Interactions between parent/carer and child/young person.
  • Concerns from parents/carers.
  • Previous or current safeguarding concerns.
  • Any known additional vulnerabilities in the child e.g. disability, the child is a ‘looked after child’.
  • Information you hold about the family already e.g. parental/carer history, mental health, substance misuse, domestic abuse.

Carry out any appropriate examinations. In cases where there is a concern about non-accidental injuries (NAI), carry out a full body examination. The purpose of examination in these situations in general practice is to try and get a clear picture of what is happening/might have happened to the child and to ascertain the current health and wellbeing of the child in order to take appropriate action.

Note that child protection or forensic medicals should not be carried out by GPs or any general practice clinician in a general practice setting.

Step 2: Ask.

Seek an explanation for any injury, presentation, or concern from both the parent or carer and the child/young person (if possible dependent on age, communication needs, disabilities). For example, if you are concerned that a child has not been brought to multiple health appointments in general practice, you should speak to the parent/carer to discuss your concerns and try to ascertain why this is happening.

Step 3: Consider, suspect or exclude.

  • Consider – child abuse is one possible explanation for the concerns and is included in your differential diagnosis.
  • Suspect – you have a serious level of concern about the possibility of child abuse (you do not need to have proof).
  • Exclude – a suitable explanation is found for your concern.

Step 4: Act.

  • If you suspect child abuse, you should follow your local multi-agency safeguarding processes and make a safeguarding referral to children’s social care (Health and Social Care Trust in Northern Ireland).
  • If you are considering child abuse, you should decide on what further action needs to be taken:
    • Reconsider what you already know about the child and the family, such as health history, any factors which might make the child more vulnerable to abuse, previous safeguarding concerns, parental/carer history, mental health issues, substance misuse, domestic abuse.
    • Consider whether your current concerns add to an already concerning picture.
    • Consider additional support for the child and family, e.g. early help services, emotional and wellbeing services for the child.
    • Gather collateral information from other colleagues and professionals, e.g. colleagues in the practice who might know the family well, practice safeguarding lead, health visitor/school nurse and other health, social care or early help professionals.
    • Discuss your concerns with a more experienced colleague, practice safeguarding lead, safeguarding professionals such as named or designated safeguarding professional or health board safeguarding leads.
    • Ensure your concerns are documented clearly in the record.
    • Arrange review of the child at a date appropriate to the concern, looking out for repeated presentations of worrying features potentially representing child abuse/neglect.
    • As time goes on, if concerns persist even at a low level, consider referral to children’s social services for further assessment of the needs of the child.
  • If you have excluded child abuse at this time, you should continue to exercise professional curiosity and be prepared to once again consider or suspect child abuse should the situation change, or new information come to light.

Note for practitioners working in Wales: all practitioners working in Wales need to be aware of the statutory duty to report.

Step 5: Record.

  • Ensure clear documentation in the child’s record.
  • Record exactly what is observed and from whom and when.
  • Record exactly what has been said by the child/adult/parents/carers.
  • Record all examination findings.
  • Record your concerns.
  • Record what actions you are going to take.
  • Code appropriately.
  • Record in other family member records as appropriate.
  • Mark clinical entry ‘not for online access’ (where applicable to the UK nation you work in).
References
Safeguarding in Wales: Statutory duty to report:

There is a duty to report to the local authority, which will be taken to mean a referral to social services who, alongside the police, have statutory powers to investigate suspected abuse or neglect.

A report must be made whenever a practitioner has concerns about a child under the age of 18 years who:

  • is experiencing or is at risk of abuse, neglect or other kinds of harm; (for further explanations of harm see Section 3 part 1 on significant harm) and has needs for care and support (whether or not the authority is meeting any of those needs).

If any person has knowledge, concerns or suspicions that a child is suffering, has suffered or is likely to be at risk of harm, it is their responsibility to ensure that the concerns are referred to social services or the police who have statutory duties and powers to make enquiries and intervene when necessary.

References
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