1

“Significant harm which is caused to a child by the actions of a parent or other carer who deliberately fabricate symptoms in a child which would not otherwise be present.”

Safeguarding Children in whom Illness may be fabricated or Induced (DOH 2008)

2

• Fabrication – signs and symptoms past medical history

• Falsification – hospital charts and records; specimens of body fluids; letters and documentation

• Induction – by a variety of means

3

At the point of “dawning” practitioners should consult a Named Nurse/Doctor without delay for advice.

The child must be made safe whilst the investigation is ongoing.

Suspicions should not be discussed widely.

The parent/family must not be informed.

When, in discussion with the Named Professional, it is thought that there is some foundation to suspect the abuse, a referral must be made to Children’s Social Care

4

Conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person.

May include not giving child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate.

May feature age or developmentally inappropriate expectations.

Overprotection and limitation of exploration and learning or preventing the child participating in normal social interaction.

Seeing/hearing ill treatment of another.

Serious bullying (including cyber-bullying) causing children to feel frightened or in danger.

May involve exploitation or corruption.

6

“Sexual exploitation of children and young people under 18 involves exploitative situations, contexts and relationships where young people (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities.

Child sexual exploitation can occur through the use of technology without the child’s immediate recognition; for example being persuaded to post sexual images on the Internet/mobile phones without immediate payment or gain.

In all cases, those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources.

Violence, coercion and intimidation are common, involvement in exploitative relationships being characterised in the main by the child or young person’s limited availability of choice resulting from their social/economic and/or emotional vulnerability.

2009 Guidance

Going missing for periods of time or regularly coming home late;

Regularly missing school/not taking part in education;

Appearing with unexplained gifts or new possessions;

Associating with other young people involved in CSE;

Having older boyfriends or girlfriends; Suffering from sexually transmitted infections; Mood swings or changes in emotional

wellbeing; Drug and alcohol misuse; Displaying inappropriate sexualised behaviour.

2009 Guidance

9

Neglect is the persistent failure to meet a child’s basic, physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance misuse. Once a child is born, neglect may involve a parent or carer failing to: provide adequate food, clothing and shelter; protect a child from physical and emotional harm or danger; ensure adequate supervision; ensure access to appropriate medical care or treatment.

WTSC 2013

10

• Dirty clothes/skin/nails/odour;

• Chronic infestation;

• Hair matted or thin;

• Chronic nappy rash;

• Infected sores (especially in skin folds);

• A long history of illness, accidents, ingestions and repeated hospital admission;

• Delay in presentation to health professionals.

1. Listen and observe

2. Seek an explanation

3. Record what is observed and heard and why this is a concern

4. Either consider, suspect or exclude child maltreatment

5. Record actions taken and the outcome

CG89 When to suspect child maltreatment: quick reference guide

Available at:

<http://guidance.nice.org.uk/CG89/QuickRefGuide/pdf/English>

Listen carefully and take it seriously Reassure children they are right to tell Negotiate getting help and obtain help quickly Do not jump to conclusions Ask open questions Do not make promises you cannot keep – in

particular, never promise confidentiality Do not make the child repeat what he or she has

said to another member of staff

In addition to previous slide – Try to ascertain if the perpetrator may still pose a risk to children. If so, you have a responsibility to protect those children

Encourage and support the adult in disclosing as much information as they are willing and refer the child/ren to Social Care Services

Provide information about services Ask adult to consider a formal disclosure to the Police

It is your last patient on Friday afternoon before a Bank Holiday.

Whilst carrying an examination on a 6 week old baby boy you notice what appears to be a fading bruise on his forehead and another on his left cheek. You draw these to the attention of his mother who says that she does not know how they were caused, but thinks he might bruise easily. She thinks he may have hit himself with a toy.

Are these marks significant. What action will you take in the short term?

You discuss the child with the Paediatric SpR on call and agree to send the child to CAU. The mother explains that she needs to collect the other children from their granny’s and she’ll take him up as soon as she has done so.

After you have made the referral whose responsibility is it to ensure they arrive at the hospital?

You are asked by the Health Visitor to examine a 3 year old child who has a badly infected toe.

Mother reports that the child injured his toe two

to three weeks previously, and for the last five to six days it has been red and inflamed and obviously causing the child some distress.

The mother apologises for the state of the child, who is dressed in dirty clothes, and all exposed areas are also covered in dirt. She says he had been playing outside when the Health Visitor visited and insisted he was taken to the doctor.

cont…

Mother is seven months pregnant, looks tired and unwell and has a fading bruise on her left cheek. You note she has an older child aged 5 who is at school.

Discuss the issues raised by this scenario and prioritise your actions.

The receptionist witnesses a mother of two young children aged 3 and 5 hitting them across the head in the waiting room of your surgery. The children had been very noisy and disruptive in the waiting room whilst waiting to see the doctor.

What should the receptionist do? What should the doctor/nurse do?

The Practice Nurse is told by a patient that a man that she knows is a sex offender has moved in to live with her next door neighbour who has three young children.

What should the GP/Practice Nurse do?

GP is contacted by telephone. The caller says she works for Children’s services and needs some information about a family where a child may be at risk. She says that she will require photocopies of the child’s notes and that a colleague will drop into the practice in the morning to collect the copied notes.

What is your response?

Sam is 14. He has a life limiting condition and the family understand that he is unlikely to reach adult life.

The family call the medical centre first thing in the morning , leaving a message to tell you that Sam died in the night.

What should you do? Who should you inform?

Mrs. Roberts brings her granddaughter, 14 year old Alice, to see you. She is requesting contraception for Alice.

Alice is a physically mature girl who is home educated. She is polite and quiet in clinic and appears to be content playing with a Barbie doll.

Mrs Roberts is concerned that Alice is a little immature. She feels Alice would be safer on the pill.

Mother brings her 12 year old daughter to surgery. The 12 year old has disclosed to her that she has had sex two weeks previously. She will not disclose the identity of the other person and has refused to speak to the Police.

What should you do, who would you take advice from and what advice would you give the mother?

A baby is brought for routine

immunisations by a woman who describes herself as his auntie.

Should the immunisation be given? What are the issues that need to be

considered?

Referral to Social Care

Assessment

Strategy Meeting/ Discussion

Initial Child Protection Conference

Core Group Meetings to develop Child Protection Plan

Review Child Protection Conference/s until Plan no longer required

-Identification of concerns-Timely & detailed referral

Sharing of proportionate information re children & parents/carers

Attendance (if possible)

- Submission of reports regarding all children &relevant information re parents/carers- Attendance (if possible)

GPs unlikely to be member of Core Group

Submission of reports regarding all children and relevant information re parents/carers

CP PROCESS ROLE OF GP

i. Policies and Procedures

ii. Training

iii. Access to advice and support

iv. Inter-agency partners

Wyllie E., 2010

North Yorkshire LSCB Procedures(supporting protocols including Pre-Birth

Protocol)www.safeguardingchildren.co.uk

City of York LSCB Procedureswww.saferchildrenyork.org.uk

NYLMC Child Protection Guidelines

Practice Policy

Over a three year period, professionals should receive refresher training equivalent to 1 – 1.5 PAs/sessions (for those at Level 3 core this equates to 0.5 PA per annum).

Training, education and learning opportunities should be multi-disciplinary and inter-agency, and delivered internally and externally. It should include personal reflection and scenario-based discussion, drawing on case studies and lessons from research and audit. This should be appropriate to the speciality and roles of the participants.

RCPCH (2010) Intercollegiate Document http://www.rcpch.ac.uk

/safeguarding

Lead GP for Safeguarding within practice

Named Doctor or on-call paediatrician

Designated Doctor or Nurse - role is to provide advice, support and supervision (consulting your Designated professionals does not constitute a child protection referral).

‘Hypothetical’ discussion with Children’s Social Care or Police – no names

Are contact numbers readily available?

Identify key individuals from your local partner agencies (Children’s Social Care; Protecting Vulnerable Person’s Unit; Women’s Refuge, etc.)

Are local contact numbers readily available to all staff in the practice?

RCPCH Toolkit (2011) - ContentsAim of the Toolkit

What is Safeguarding? Who is Responsible? Why is Safeguarding Necessary in General Practice?

Barriers Barriers to Children Telling Monitoring and Reviewing Parental Responsibility Practice Policy and Procedure Working in Partnership with Parents

Domestic Violence

Thank you and good luck!