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Child Safeguarding

In this series of articles, medical students from across the country will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance

This article is a simplified version of the GMC guidance – full guidance can be found here.

Imagine you are a GP on a busy day. Your next appointment is with a mother and her child, who she suspects has the flu. You welcome them, and in order to examine the boy, he must lift his shirt so you can listen to his lungs. While listening, you spot numerous bruises, and the boy winces every time you touch him with your stethoscope. Is this a child abuse case? What should you do?

"Child protection is a difficult area of practice that can involve making decisions that are emotionally challenging, complicated by uncertainty and sometimes go against the wishes of parents" ~ General Medical Council

The General Medical Council (GMC) defines abuse as:

"Physical, emotional or sexual abuse, including fabricated or induced illness, and emotional or physical neglect, which has led, or may lead, to significant harm to a child or young person"

19,847 counselling sessions were delivered by Childline in the year ending March 2019, dealing with children suffering from abuse. And these were the children that came forward. Many children still suffer behind closed doors with no help and no one being aware of it.

One of the duties of being a doctor is ensuring the wellbeing of children, and therefore they are required to raise any concerns they have.

So, let’s talk about the above scenario. In this situation, you should always express your concern to the parent. You should do this in a way so that the parent completely understands that it is a part of your duty to ask to ensure that the child is not being abused or neglected, so that no blame or judgement is placed. The only time you should withhold telling the parent any information about your concerns is if you think it will increase the risk of harm to the child, which is a judgement call you will have to make independently. This applies throughout this article.

Doctors should work with parents and families, where possible, to make sure that children and young people receive the care and support they need. But in cases where the interests and wishes of parents may put the safety of the child or young person at risk, doctors must put the interests of the child or young person first. ~ GMC

Sometimes, it may be useful to talk to the child independently too, as having the parent in the room could cause the child to remain silent. This must be done in a suitable environment with another appropriate member of staff present, such as a health professional or someone from a support service.

If you believe that after talking to the parent and child that the situation must be escalated, the parent must should know who you will speak to, what information will be shared and how the information will be handled. The situation can be escalated even if you are not certain. People involved may be worried about confidentiality, especially teenagers. However, it must be explained to them that sharing the information is important in providing safety to ensure consent.

Appropriate agencies to call are the local authority children’s services, the police, or the NSPCC. You should share the identities of the people involved and the reasons for your concerns.

It is vital that all doctors have the confidence to act if they believe that a child or young person may be being abused or neglected. Taking action will be justified, even if it turns out that the child or young person is not at risk of, or suffering, abuse or neglect, as long as the concerns are honestly held and reasonable, and the doctor takes action through appropriate channels ~ GMC

These are difficult ethical scenarios and are always heart breaking to read about. However, if you are faced with an ethics question related to child abuse, the information in this article will be substantial for you to answer the question sufficiently. Also, look for a recent case study which could help you have a realistic perspective.

If you are not sure about whether a child or young person is at risk or how best to act on your concerns, ask a named or designated professional or a lead clinician or, if they are not available, an experienced colleague for advice ~ GMC