The British Medical Association Child Protection Tool Kit.
The British Medical Association (BMA) have an excellent resource called the Child Protection Toolkit which distills essential principles of child protection practice for doctors. This is now hosted on on Paediatric Care Online – an online decision support tool for all frontline practitioners in contact with infants, children and young people.
The BMA set out the basic Principles on ‘card 2’
Basic Principles of Child Protection for Doctors
- In child protection cases, a doctor’s primary responsibility is to the well being of the child or children concerned. Where a child is at risk of serious harm, the interests of the child override those of parents or carers. Never delay taking emergency action (card 7).
- All doctors working with children, parents and other adults in contact with children should be able to recognise, and know how to act upon, signs that a child may be at risk of abuse or neglect, both in a home environment and in residential and other institutions (cards 5 and 6).
- Any doctor seeing a child who raises concerns must ensure follow-on care. In particular, children must not be discharged from hospital without a full examination (cards 13 and 14).
- Efforts should be made to include children and young people in decisions which closely affect them. The views and wishes of children should therefore be listened to and respected according to their competence and the level of their understanding. In some cases translation services suitable for young people may be needed (card 8).
- Wherever possible, the involvement and support of those who have parental responsibility for, or regular care of, a child should be encouraged, in so far as this is in keeping with promoting the best interests of the child or children concerned. Older children and young people may have their own views about parental involvement (card 11).
- When concerns about deliberate harm to children or young people have been raised, doctors must keep clear, accurate, comprehensive and contemporaneous notes. This must include a future care plan and identify the individual with lead responsibility (card 12).
- All doctors working with children, parents and other adults in contact with children must be familiar with relevant local child protection procedures, and must know how to deal promptly and professionally with any child protection concerns raised during their practice (card 7).
- All doctors working directly with children should ensure that safeguarding and promoting their welfare forms an integral part of all stages of the care they offer. Where doctors have patients who are parents or carers, they must also consider the potential impact of health conditions in those adults on the children in their care (card 7).
- Wherever a doctor sees a child who may be at risk, he or she must ensure that systems are in place to ensure follow-up care (cards 1 and 3).
- As full a picture as possible of the circumstances of a child at risk must be drawn up (cards 13 and 14)
- Where a child presents at hospital, inquiries must be made about any previous admissions (cards 14 and 15).
- Where a child is admitted to hospital, a named consultant must be given overall responsibility for the child protection aspects of the case (cards 14 and 15).
- Any child admitted to hospital about whom there are concerns about deliberate harm must receive a thorough examination within 24 hours unless it would compromise the child’s care or wellbeing (cards 14 and 15).
- Where a child at risk is to be discharged from hospital, a documented plan for the future care of the child must be drawn up (cards 14 and 15).
- A child at risk must not be discharged from hospital without being registered at an identified GP (cards 14 and 15).
- All professionals must be clear about their own responsibilities, and which professional has overall responsibility for the child- protection aspects of a child’s care.
Key advice: Royal College of General Practitioners; Safeguarding Children and Young People
Key review findings from systematic reviews
These inform clinical best practice in the Child Protection Companion. All reviews can be downloaded from the Royal College of Paediatrics. As of 2018, 7new studies have been included in this update. Two studies reported on fractures indicative of abuse, two studies described the evidence for radiological dating of fractures in children and three studies discussed which radiological investigations should be performed to identify fractures in suspected child abuse.
- There is also this useful article from the Patient.co.uk site about how doctors can recognise and report child abuse.
- See also the guidance from the GMC ‘Protecting children and young people: the responsibilities of all doctors’