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To reduce the transmission of COVID-19, the UK Governments issued social distancing measures to minimise morbidity and mortality rates to enable health services to operate effectively for people both with this illness and other serious health conditions.
However, social distancing measures have adverse effects and are disproportionately affecting children, who are likely to experience milder symptoms compared to adults if they contract COVID-19. The sources of support that were previously available to most children and young people, including school and a network of friends and extended family members, have been removed. Additionally, there has been an increase in family stress for households facing additional financial and social pressures from COVID-19. This inevitably will lead to more children and young people suffering abuse and neglect and this is happening hidden in homes where it is difficult to prevent, detect or intervene in a meaningful manner.
This is a UK-wide statement and its purpose is to provide suggestions to paediatricians who are influential in safeguarding partnerships as to what these partnerships should consider doing now and in the surge and recovery phase of the COVID-19 pandemic. The RCPCH outlines key considerations on how to act to safeguard children and young people and address their emerging physical and mental health needs.
We have considered how best to safeguard the welfare of three broad groups of children and young people as outlined below.
1. All children and young people
We are aware that:
- The numbers of children presenting to health services has declined because of the “stay at home” messaging and fear of hospitals being sources of contagion.1
- Children are presenting late to services and anecdotally often more unwell.
- There will inevitably be sequelae for children’s physical and mental health and emotional wellbeing.
- There will also be a need to catch up with routine health appointments, including immunisations, following the easing of lockdown.
What can be done?
- Messaging to the general public that while they do need to stay at home, they should present to health services when they are unwell. For example:
- We have produced an information poster for parents (PDF) with advice for when a child becomes ill, which can be promoted locally.
- Some areas have set up text messaging to families on this issue through GP texting services to remind people that if they or their children are unwell, they should present to health services.
- Signpost to helplines and online resources that children, young people and their families can access to address the mental health issues that they are facing.
- Check whether the everyday services that young people rely on, such as sexual health, are still operating and communicate this to them.
- Begin recovery planning now for the easing of lockdown. This should include a strategy for how to catch up with routine health appointments and the likely increased demand for mental health services.
2. Children and young people already recognised as vulnerable to abuse and/or neglect
This group is identified as being vulnerable by virtue of their complex social and/or health needs. This includes those in Local Authority care, on Child Protection/Child in Need Plans, and/or have Education, Health and Care Plans/Statements of Special Educational Need/Additional Learning Needs framework/Co-ordinated Support Plan. They are already living in families identified as requiring additional support.
We are aware that:
- This group are now at much higher risk of harm because of the increased level of stress in families, their reduced access to normal support services and the significantly reduced amount of professional and community oversight.
- Schools remain open to those identified as vulnerable; however, we know that most of these children are not taking up their school places.2
- The majority of initial and review health assessments for looked after children (LAC) are currently being performed remotely.
- There is likely to be an increase in the numbers coming into the care system, and increased foster and adoption placement breakdowns. This group of children are additionally most likely to have the increased health needs already identified for all children and young people.
What can be done?
- Encourage families to send this group of children into school as long as they do not have shielded status.
- Continuing outreach work into home environments by a variety of professionals is very important. Although telephone and video calls to parents and young people are helpful, they cannot replace home visiting. Decisions about home visiting must be informed by risk assessment for both vulnerability and illness. It is essential that professionals have adequate access to appropriate PPE (personal protective equipment) and are trained how to use it, in order to reassure families and children about the safety of such a visit and to protect professional staff.
- Facilitate those children and young people who are able to communicate with professionals via telephone or social media to do so if they are distressed or in danger. Young people tell us they prefer to communicate with already trusted adults. Young Carers are a particular group that need additional support at this time.
- LAC initial and review health assessments are currently almost all being performed by collation of health data remotely. They require risk rating now for whether they should be performed at a later date face to face and should be categorised in terms of post lockdown priority. Similar processes are in place for adoption medical assessments and SEND (Special Educational Needs and Disability) health assessments.
- Begin recovery planning to identify resources needed and prioritisation to catch up with the increased work that will be required following lockdown.
3. Children who are now vulnerable to abuse and/or neglect but have not yet been recognised or referred
This is the most concerning group and extremely difficult to reach as they are now much more hidden. Unfortunately, we won’t be aware of the scale of the issue.
We are aware that:
- Despite the increased stress in families and reduced resources and support for families, there appear to be both reduced numbers of referrals to police and children’s social care, as well as referrals for Child Protection Medical assessments.3
What can be done?
- Prepare for a surge in referrals whenever pupils begin returning to school and ensure a suitable out-reach plan is made for those that do not return, such as those shielding.
- Think of ways we can best empower children and young people to reach out to society through helplines, social media and known trusted adults.
- Ensure that all those potentially seeing children are up skilled to recognise signs and symptoms and are able to report concerns in this COVID-19 environment, such as pharmacy staff, contact tracers, swab takers and NHS volunteers.
- Ask communities to remember that we all have a duty towards children and communicate with them about the need to protect children and the supportive approach to families that can usually be taken. This could be done via a national or local campaigns that informs communities about when and how to report concerns about the welfare of children and young people.
What can RCPCH do for you?
RCPCH is committed to supporting paediatricians in service delivery to all children. We recognise that the current challenge is considerable and therefore we wish to support paediatricians to meet the health and wellbeing needs of all children during this difficult time.
We have and can:
- Provide up to date guidance
- Share innovative ways of working
- Signpost to appropriate support resources
- Advocate at a national level on what you and partners require to fulfil your roles.
- RCPCH Wellbeing hub
- Contact point to both inform RCPCH of issues and ask for clinical advice: email@example.com
- National Network for Designated Health Professionals for England and equivalent in the nations
RCPCH resources for the public:
Helplines for children and young people:
Emotional health and wellbeing support:
General public safeguarding information and support:
- 1. Hornton J. Covid-19: A&E visits in England fall by 25% in week after lockdown. BMJ 2020; 369:m1401. doi:10.1136/bmj.m1401 pmid:32253175
- 2. Department for Education. Coronavirus (COVID-19): attendance in education and early years settings. Accessed 7 May 2020 www.gov.uk/government/publications/coronavirus-covid-19-attendance-in-education-and-early-years-settings
- 3. Safeguarding Board Northern Ireland. Safeguarding Board highlights drop in referrals for children that may have experienced harm during COVID-19. Accessed 7 May 2020 www.safeguardingni.org/safeguarding-board-highlights-drop-referrals-children-may-have-experienced-harm-during-covid-19