Medical Assessment Re: Child Protection

Posted on Sunday, 30th Aug, 2015 at 05:49:02 PM
Where the child appears in urgent need of medical attention (s)he should be taken to the nearest A & E department, regardless of age, explanation or any other factors e.g. where there are suspected fractures, bleeding, and loss of consciousness.

Referrals for Medical Assessment by Children's Services/ Police CAIU

In other circumstances the Strategy Discussion should determine, in consultation with the Paediatrician, the need for and timing of a paediatric assessment and who would be the appropriate person to accompany the child.

When such arrangements are necessary, the child and parents must be informed and prepared and careful consideration given to the impact on the child, unless there is good reason not to involve the parent or carer, e.g. preservation of criminal evidence - such decisions should be recorded.

If the Strategy Discussion (at which the doctor is consulted) agrees on a paediatric assessment for a child, consideration should be given to the need for assessments of other children in the household.

This assessment should always be considered when there is a suspicion or disclosure of child abuse involving:
Any injuries to a baby / non mobile child;
A suspicious or serious injury (thought to be non-accidental or an inconsistent explanation);
Any injury or a mark on a child who is subject to a Child Protection Plan, and for which there is no obvious explanation;
Suspected sexual abuse or assault;
Suspected neglect.
A medical assessment involves a holistic approach and considers:
The child's well being, including development, if under five years old and her/his cognitive ability if older;
The extent of any injuries and an opinion as to possible causes;
Diagnosis and treatment;

Information provided by other agencies that is known about the child's family circumstances and history, past medical history and full referral information.

Additional considerations are the need to:
Secure forensic evidence including photographic evidence;
Screen for or investigate medical problems e.g. infection (including sexually transmitted infection), anaemia;
Provide treatment follow up and review for the child (any injury, infection, new symptoms including psychological, contraception);
Create medical documentation;
Provide re-assurance for the child and parent;
Provide professional advice to Children's Services and the Police.
An explicit record must be made of the decision about whether or not to undertake a medical assessment, and its rationale clearly stated.

Only doctors may physically examine the whole child using standard forms to document the assessment. Other professional staff should note any visible marks or injuries on the body map and document details in their recording.

A section 47 Medical must be done within 24 hours of the Stategy Meeting...

Paediatricians must make contemporaneous notes in the Child Protection Medical Report, from which reports / witness statements will be produced.

The examining doctor must provide a written report of her/his medical opinion, which can be used in a Child Protection Conference and/or subsequent legal proceedings. Witness statements should be produced in the same format used by the Police to avoid the Police re-typing them. The report should be sent to both Children's Services and the Police CAIU.

The report should be available in two working days and usually include:
Date, time and place of examination;
Those present;
Reason for the examination, including referral information Carefully distinguish between fact and opinion;
The consent to the examination, whether verbal or written and by whom it was given;
A verbatim record of the carer's and child's accounts of injuries and concerns noting any discrepancies or changes of story;
A verbatim record of information provided by Police and Children's Services;
Documentary findings in both words and diagrams of any injuries or marks including site, size, shape and colour;
The findings relevant to the child, including general medical examination and others, e.g. squint, learning or speech problems;
Information on any injury in the context of a full paediatric assessment of child's growth, development and emotional well being;
Summary of all the findings (history, examination, any investigations undertaken), to be followed by a professional opinion; (e.g. definite abuse, definite non-abuse, high suspicion of abuse, low suspicion of abuse, or non-specific that is equal likelihood of abuse or non-abuse);
Where applicable, to include recommendations for future health care needs and other non-health care needs where relevant. Details of any follow-up arrangements to be made.
The Named Nurse for Child Protection and (if relevant) the Designated Nurse for looked after children should be informed that a medical assessment has taken place. Copies should be sent to the relevant Named/Designated Doctor.

All reports and diagrams should be signed and dated by the doctor undertaking the examination. All the diagrams should have the child's name and record / case number.

The scope and focus of the assessment during the Section 47 Enquiry will be of an assessment specifically addressing the risks for the child(ren) and specifically:
Identify clearly the initial cause for concern;
Collect information from agency records and other agencies;
Describe the family history and that of the child(ren);
Describe the family structure and network;
Evaluate the quality of attachments between child(ren) and carers;
Evaluate the strengths of the family;
Consider the impact of any parental risk factors e.g. domestic abuse, substance misuse and/or mental health issues;
Consider the child's needs for protection;
Evaluate information from all other sources, including any previous assessments;
Consider the ability of parents and wider family and social networks to safeguard and promote the child's welfare;
Possible actions to enhance the strengths in the situation and minimise effects of risk;
Evaluate the risks to the child.

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