Safeguarding involves all aspects of ensuring the welfare of a child. Child protection involves the process of protecting a child that is at risk of or suffering harm.
The legal framework for child safeguarding is the Children Act 1989. A child is need refers to a child that is likely to need supportive services to maintain their health and development, or is disabled.
Safeguarding is an essential part of the role of anyone working with children. By nature children are vulnerable to abuse and do not have the means to protect themselves or look out for themselves. It is our responsibility as healthcare professionals to take a child-centred approach and look out of the best interests of the child.
This is a summary and overview to help your basic understanding for exams and is not a substitute for safeguarding training you may require for clinical practice. If you have any safeguarding concerns always discuss these with an experienced senior colleague who can advise on the appropriate course of action.
Types of Abuse
A common exam question involves identifying the types of abuse. These are:
- Physical
- Emotional
- Sexual
- Neglect
- Financial
- Identity
Risk Factors For Abuse
- Domestic violence
- Previously abused parent
- Mental health problems
- Emotional volatility in the household
- Social, psychological or economic stress
- Disability in the child
- Learning disability in the parents
- Alcohol misuse
- Substance misuse
- Non-engagement with services
Possible Signs of Abuse
It is worth keeping safeguarding in mind when seeing any child. There are certain signs that should make you consider whether there could be safeguarding issues. This is not an exhaustive list. If in doubt always talk to a senior or someone experienced with safeguarding.
- Change in behaviour or extreme emotional states
- Dissociative disorders (feeling separated from their thoughts or identity)
- Bullying, self harm or suicidal behaviours
- Unusually sexualised behaviours
- Unusual behaviour during examination
- Poor hygiene
- Poor physical or emotional development
- Missing appointments or not complying with treatments
Management
All NHS organisations should have a safeguarding team or safeguarding lead that should be available to assist with safeguarding concerns. Once a safeguarding concern is identified the person that identifies it is responsible for escalating it to someone that can take action on it. It is generally not the role of the doctor or nurse to investigate or manage the concern, but it is their responsibility to refer or pass this on to someone trained and in a position to investigate further and take action.
Generally safeguarding cases are referred to children’s services (social services) who can investigate further and decide what action needs to be taken. Most safeguarding cases don’t involve children being removed from their parents. Usually social services are able to put in extra support and services and follow up over time. If the child is in immediate danger the police may need to be involved. If they are acutely unwell or need a place of safety they should be admitted to hospital.
Maintaining a professional, open, honest and trusting relationship with parents or carers is important, even when they are responsible for the abuse. This will make all aspects of any investigation and management easier, and lead to better outcomes.
There are a number of measures that can be arranged by appropriate professionals to help support families of children with safeguarding concerns:
- Home visit programmes to support parents
- Parenting programmes to help parents develop parenting skills and manage their child’s behaviour
- Attachment-based interventions to help parents bond and nurture their child
- Child–parent psychotherapy
- Parent–child interaction therapy
- Multi-systemic therapy for child abuse and neglect (MST-CAN)
- Cognitive behavioural therapy for children that have suffered trauma or sexual abuse
Last updated January 2020