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DATE PATRON HRH The Princess Royal Child Protection Companion 2013 A.M Kemp, A.M Mott.

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Presentation on theme: "DATE PATRON HRH The Princess Royal Child Protection Companion 2013 A.M Kemp, A.M Mott."— Presentation transcript:

1 DATE PATRON HRH The Princess Royal Child Protection Companion 2013 A.M Kemp, A.M Mott

2 Editorial Board Professor Alison Kemp Dr Alison Mott Dr Amanda Thomas Nick Libell (RCPCH) Laura Green (RCPCH) Anne Rusinak (RCPCH)

3 History Originated from a practitioners clinical manual produced in Leeds. The 2006 Companion was produced by the Child Protection Special Interest Group and was based on evidence, research and practice at the time.

4 Contributing authors, reviewers and consultees Dr Folashade Alu Dr Monika Bajaj Ms Sonya Baylis Prof Nick Bishop Ms Sally Bradley Dr Rachel Brooks Dr Paul Davis Dr Geoff DeBelle Dr Margaret deJong Mr Sam Evans Dr Joanne Gifford Dr Danya Glaser Dr Lindsay Groves Dr Jenny Harris Dr Jean Herbison Dr Deborah Hodes Dr Diana Jellinek Prof Alison Kemp Mr Nick Libell Dr David Low Dr Ian Maconochie Dr Sabine Maguire Professor Jacqueline Mok Dr Alison Mott Dr Aideen Naughton Dr Sheila Paul Dr Ximena Poblete Dr Colin Powell Mr Charles Prest Dr Rosalyn Proops Dr Karen Rogstad Dr Peter Sidebotham Dr Alan Sprigg Dr Alison Steele Dr Corina The Dr Amanda Thomas Dr Elspeth Webb Dr Mike Williams

5 Aims of Child Protection Companion Primarily for UK Paediatricians 1. In their role in the multiagency safeguarding children process 2. Assist the recognition, assessment, investigation and management of suspected child maltreatment 3. To build upon and complement national guidance, policy and practice documents

6 FORMAT: RCPCH Child Protection Companion Hard copy –£25 to RCPCH members –£32 to non RCPCH members Online version –Free to RCPCH members –One year subscription £20 to non RCPCH members Online and print bundle –£39 to non RCPCH members

7 1.Introduction 2.Responsibilities of paediatricians 3.Working Together to Safeguard Children. 4.Childrens rights 5.Good practice recommendations 6.The medical assessment and admission to hospital 7.Consent, Confidentiality and Information sharing 8.Parental factors 9.Recognition of Physical Abuse 10.Child sexual abuse 11.Neglect 12.Emotional abuse 13.Perplexing presentations (including FII) 14.Abuse in special circumstances 15.Infant and Child deaths 16.Records and reports 17.Photo documentation 18.Court proceedings: giving evidence 19.Training and support 20.Appendices

8 UK wide document Terminology is based primarily on English law, legislation and guidance. Where appropriate the differences in policy and practice in Scotland, Wales and Northern Ireland and the legal differences in Scotland are referenced Written in accordance with UNCRC UK wide document

9 Landmark documents Makes reference and hyperlinks to over 50 key documents e.g. Child protection legislation Children Act, Health and Social Care, Children Act Scotland Clinical Guidelines NICE guidance 2008, RCR/RCPCH Radiology guidelines Professional practice guidelines GMC publications 2012/13, RCPCH clinical competency document, BMA Toolkit Government reports Kennedy report, Munro review, Laming progress report 2009 Regional PRUDIC (Wales), Choosing to Protect 2009 (NI), A Guide for getting it Right for every Child (Scotland) Landmark Documents

10 Evidence base Bruising Fractures Oral injury and bites Burns and scalds Abusive head trauma Haemorrhagic retinopathy Visceral injury Emotional neglect and emotional abuse: preschool children Dental neglect NICE guidance RCPCH FII document Published systematic reviews and studies Evidence base

11 Each chapter includes good practice recommendations aiming to set Audit standards Local and national child protection health care provision National standards

12 Medical assessment Communication with child and family Be sensitive to the childs needs The child should: understand the reasons for assessment be able to express their wishes and feelings participate in decisions affecting them be given the opportunity of speaking alone Communication with multiagency team Verbal information to childrens social care and police should be followed up in writing with a formal report within 3 working days

13 Medical assessment Training The examining doctor should have level 3 training competences A trainee should be supervised by a consultant or senior paediatrician Timescales Appropriate to type of abuse and requirement for collection of evidential samples: Physical injury: within 24 hours Historic abuse and neglect: according to clinical need and child protection process. Children should not be kept waiting for more than 10 working days without clear mitigating factors agreed by all parties




17 What is new? Improved evidence base Links to Core info website ( Integrated with NICE guidance on recognition of suspected maltreatment Detailed section on haematology investigations Vitamin D deficiency and fractures

18 Haematology assessment In consultation Geoff DeBelle Mike Williams Focus on child and family history Who to investigate? First and second line investigations

19 Assessment of children with occult fractures In consultation with Prof N Bishop Alan Sprigg Stress the history Explanation for injury Excluding bone fragility Investigations




23 Guidance for the general paediatrician on the recognition of suspected CSA and ongoing management All cases of suspected CSA must be referred to paediatrician with the appropriate training and competences Guidelines on Paediatric Forensic Examinations in Relation to Possible Child Sexual Abuse FFLM/ RCPCH 2012

24 Child Sexual abuse: What should you do? What should the general paediatrician do? Recognition Acute or historic? If acute –Assess immediate health needs of child –Examination as soon as possible The timing of the examination is essential in: –Obtaining forensic evidence –Risk assessment for prevention of STIs: prophylaxis for HIV has to be given within 72 hours post assault and is most effective when given as soon as possible –Prevention of pregnancy: emergency contraception can be given up to 72 hours or five days post assault.

25 Child Sexual Abuse Any doctor who undertakes a forensic assessment of a child who may have been sexually abused must be familiar with recent guidance. –The Physical signs of child sexual abuse: an evidence based review and guidance for best practice RCPCH 2008 Currently being updated with publication expected late 2013 Need for child focused service 365 days per year with appropriate facilities



28 Parental risk factors: domestic abuse Domestic abuse Children living with domestic violence are suffering significant harm (Adoption and Children Act 2002) Included in emotional abuse definition –seeing or hearing the ill-treatment of another Domestic violence identified as risk factor in 34% of Serious Case Reviews ( )

29 How safe are our children NSPCC 2013

30 Domestic abuse: Role of paediatrician Routine questioning should be part of the history taking when children are assessed for suspected child abuse and neglect Sensitivity to needs and safety of adult Multiagency process –MARAC (Multi Agency Risk Assessment Committee) Indirect questions: a) Is everything ok at home? b) Is your partner supportive? c) If woman is pregnant: »Are you being looked after properly? »Is your partner taking care of you? Direct questions: a) Do you ever feel frightened of your partner? b) Have you ever been in a relationship where you have been hit or hurt in some way? c) Are you currently in a relationship where this is happening to you?

31 How safe are our children NSPCC 2013


33 Abuse in special circumstances Groups of children at particular risk of abuse Complex topics summarized with relevance to paediatrician Background, existing guidance, identification of key issues and responsibilities of paediatricians Themes: –children living away from home eg Looked After Children –children from minority groups eg Asylum seeking children –focus on young people eg Sexual exploitation


35 Training All paediatricians require ICC Level 3 competences (55 further knowledge, skills, attitudes and values) Trainees should attain ICC competences: F1/F2: Level 1 training ST1-3: Level 2 training ST4-8: Level 3 training

36 Training Child Protection Recognition & Response Level 2: face-to-face. Paediatricians in training (ST 1-3)Child Protection Recognition & Response Child Protection in Practice Level 2/3: onlineChild Protection in Practice Paediatricians in training (ST 4-7) Maintaining and Updating Competences Level 3: onlineMaintaining and Updating Competences Consultant Paediatricians Child Protection: from examination to court Level 2/3: face-to-face. Consultant Paediatricians and senior traineesChild Protection: from examination to court Expert witnesses in Child protection: developing excellence Level 6: face to face. Consultants

37 Peer review, supervision and support Peer review Proactive culture of learning, education and training, case supervision, service improvement including multiagency processes. Support in a non-hierarchical environment, decrease professional isolation, sharing of best practice and understand the complexities of common but uncertain situations. Assurance that case findings and report meet a measure of standard and are more reliable. Royal College of Paediatrics and Child Health (2012) Peer Review in Safeguarding

38 Future developments Development of standards for safeguarding children –Good practice recommendations –Quality assessment framework –Outcomes focused standards Training competences being updated and clarified for trainees Keeping up to date

39 How safe are our children NSPCC 2013



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