Medical Doctors – Basic principles of child protection and reviews of evidence

• 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)

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.

Further reading

• 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’