The challenges of child safeguarding

Editors of the Child Protection Companion Dr Fiona Straw and Dr Becky Sands discuss their work in child safeguarding, the challenges facing paediatricians and the work of the College in this area.

Our background

Dr Fiona Straw

Fiona would say that the speciality of safeguarding children and young people chose her, rather than her choosing safeguarding. ‘In 1994, soon after I started as a first year paediatric SHO, an eight year old girl was admitted with unexplained abdominal pain. A couple of days into her admission, whilst her mother was off the ward, she told me that she was being sexually abused. The overwhelming sense of responsibility to get it right for this little girl is something that has never left me. It is this feeling that drives me to ensure that my safeguarding practice is based on the best available evidence.’

Dr Becky Sands

Becky’s path to a career in safeguarding was also driven by experience during her training of child protection cases when she raised concerns about a mechanism of injury accepted as accidental in a baby on the ward. This case indirectly led to the development of a new Consultant role combined Acute Paediatrician / Designated Doctor for Safeguarding Children.

Our work

We worked together as Designated Doctors for Safeguarding Children in Nottinghamshire and having attended the College’s CPEC (Child Protection Examination to Court) course, we were invited to be faculty members for future courses. This course provides an excellent update on the evidence base regarding child abuse and neglect as well as advice on writing court reports and giving evidence in family court proceedings. Listening to colleagues talking about the process of reviewing the evidence base inspired us to get more involved with the work the College does to support this important work. We received training on critical appraisal skills to become expert reviewers for the College, proving opinion on papers considered for inclusion in future systematic reviews.

As editors of the Child Protection Companion (CPC) we have the opportunity to ensure that all paediatricians have access to practical advice and guidance that they need to perform this often challenging work to a high standard. The CPC originated from a practitioner’s clinical manual produced in Leeds before being updated in 2006 by the Child Protection Special Interest Group (CPSIG). Over the years this has evolved to the current CPC hosted online in the RCPCH Child Protection Portal. Its role is to put the evidence collated in the systematic reviews into practical advice and guidance.

Despite child protection being everyone’s responsibility it remains an area of practice which often proves testing to paediatricians from those in training to those with years of experience. The CPC provides a mix of policy, evidence based and best practice advice on all aspects of the work done by paediatricians from recognition, examination, report writing and legal aspects. It supports paediatricians to take the evidence base and apply it to the clinical situation, ensuring that any opinion provided is in line with current best practice, evidence base and in accordance with a responsible body of opinion (the Bolam test). The challenges faced are certainly no less during the current pandemic and the CPC is a source of support at a time where there may be less opportunity for face to face supervision and support from colleagues.

A recent example of this interplay was provided in our joint presentation along with Dr Ingrid Prosser, Systematic Review Lead, at the 2020 College’s annual scientific meeting ‘But it’s only a little bruise’. We reviewed the evidence base for bruising in pre mobile babies through to its application to support an appropriate multi-agency response when a child presents with a bruise. This contentious area still provides significant practical challenges for paediatricians but we hoped that by reviewing the research evidence we could empower colleagues to be able to respond to these challenges in the best interests of the child.

Being involved in the extensive and forward looking work that the College does around child protection has not only supported our clinical practice but has also given us opportunities to influence the way that paediatricians practice. It has also given us the confidence that next time we hear those words from a child telling us they are not safe, we are more likely to know how best to protect them.

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