What happens when your child needs a child protection medical examination

We understand that this process can be worrying, but we will explain everything and listen to you and your child’s concerns.

Because this is a legal process, it is very important that you understand what we are doing and why, so please ask questions as we are here to help.

The Children & Midwifery Safeguarding Team and staff at the hospital are guided by the following key principles:

• Children have a right to be safe and should be protected from all forms of abuse and neglect.
• Safeguarding children is everyone’s responsibility.
• It is better to help children and their families as early as possible, before issues escalate and become more damaging.
• Children and families are best supported and protected when everybody works together.

What is safeguarding?

Safeguarding is the action that is taken to promote the welfare of children and protect them from harm.

Safeguarding means:

• Protecting children from abuse
• Preventing harm to children’s health or development
• Ensuring children grow up safely and well cared for.

Why do we safeguard?

The Leeds Teaching Hospital Trust is committed to protecting the children and young people using our services from harm, abuse or neglect.

Your child has come to hospital with something that can’t be explained or which national guidance tells us may be because your child has been harmed. Our job is to help work out if there is a reason for the concern and if we can treat or resolve that worry by asking you and other agencies for help.

What is our responsibility in safeguarding children?

The Children Act 1989 and 2004 makes it a legal duty for all Leeds Teaching Hospital staff to protect all children under 18 from the risk of significant harm. Our legal duties include safeguarding and promoting the welfare of all children and young people to make sure they grow up happy and healthy.

If there is a concern about the safety or welfare of your child we will follow our child protection policies and the procedures as set by the Leeds Safeguarding Children Partnership (LSCP).

Consent

You will be asked to confirm you have ‘parental responsibility’ and then provide consent for us to undertake any assessments that are needed. We will also make sure you understand what is happening with each process and why.

We may also ask your child for their consent as long as we feel they fully understand what is involved.

If you or your child refuse to give consent for the child protection medical examination then we may discuss this with Children Social Care and/or the Police to ensure your child’s safety.

There are occasions when your consent is not legally needed, because the law requires us to share certain medical information if it is in the child’s best interest.

Working in partnership to safeguard your child

We understand that it is upsetting to have concerns raised about a child’s safety and wellbeing. We always try to work in partnership with parents and carers to offer support. We ask that you cooperate with us and the other agencies involved in the best interests of your child.

Child Protection Medical Examination

We need to complete a ‘Child Protection Medical Examination’ to check for any signs of harm that may have happened to your child. A chaperone will always be present when a senior doctor undertakes these tests to ensure your child’s safety.

Children Social Care are always informed if we do a ’Child Protection Medical Examination’ as they have a legal duty to investigate our child protection concerns.
The allocated Social Worker involved will talk to you about the child protection process and any decisions they have to make about your child’s safety, including when your child can safely leave the hospital.

Sometimes we have to discuss our medical concerns with the Police, but we will usually tell you if we are going to do this.

The next sections will explain some of the tests and investigations we may need to complete with your child as part of this process.

Radiology Information

As part of the child protection medical examination different types of x-rays may be needed. The Radiographers will explain the examination that your child needs and there will be an opportunity for you to ask any questions.
X-rays are a type of radiation. Everybody is exposed to small amounts of natural background radiation from the soil, food and air we breathe.

Radiographers take the X-rays for the child protection medical examination which may include a skeletal survey and CT head. The amount of radiation used in a skeletal survey is the same as a few months background radiation. For a CT head, the amount of radiation used is more than an ordinary X-ray of the chest or body and is equal to the natural radiation we receive from the atmosphere over a period of approximately three years. The Radiographers make sure the smallest amount of X-rays is used in a skeletal survey. The risk from this radiation dose is low, and the benefits of your child having the scan outweigh these risks. Any concerns regarding radiation risk can be highlighted to the Doctor looking after your child.

Radiologist (Doctors specialising in X-rays) will review the Skeletal Survey or/and CT Head. The report will be sent to the Doctor who is looking after your child. The results of the Skeletal Survey or/and CT Head will not be provided when you attend the department.

Skeletal survey

A skeletal survey is a number of X-rays, taken to look for any fractures or broken bones. Babies can have broken bones without any signs on examination which is why this test is done.

The skeletal survey involves taking approximately 35 X-rays of your child’s whole body. It may take an hour to complete the skeletal survey which is performed in the Paediatric X-ray department. You will be present and will be asked to hold your child still for the X-rays to make sure the images we take are clear. You will be asked to wear a protective apron to protect yourself from the X-rays.

The skeletal survey is not painful but it can be distressing for a child to be kept still for this long. If your child has a favourite toy or comforter, please bring this with you. There is always a nurse or Social Worker available to look after your child if you do not wish to hold your child. Some children are given medication to help them relax.

Many fractures are invisible in the first few days after they happen, and only become visible when they start to heal. This may take 11 days or more for them to be seen. This is why more x-rays are therefore taken around 11-14 days later in a further examination. This second skeletal survey will be similar to the first one, however the number of X-rays taken will usually be less.

Computed Tomography Head scan (CT Head)

A CT head scan uses X-rays to create detailed images of the skull and brain. Lots of pictures are taken and analysed by a computer. We do a CT scan to check for any signs of a brain injury or damage.

The CT head scan usually takes less than 10 minutes. It is very important that your child remains still for the scan. It may be necessary for your child to be given some medication to help them relax. You will be able to discuss this with the Doctor looking after your child.

Tests

Blood, urine (wee) tests or swabs may be needed to look for any other medical cause for the concerns we might have. Sometimes there is a delay in the results coming back because we send them to a special laboratory in another hospital to be looked at.

Examination of the Eyes

With babies and small children, it is very difficult to be certain whether or not there is a head injury because they cannot tell us if they have a headache. An eye doctor (ophthalmologist) will examine the back of the eye (retina) which is directly connected to the brain.

A small instrument may be needed to help keep your child’s eyelids open for the examination. The eye doctor will need to put drops in your child’s eyes to dilate the pupil (the black spot in the centre). A light is shone on the inside of the eye to look for bleeding in the back of the eyes; this gives us a clue to any bleeding or injury to the brain.
This is completely safe and only takes five minutes. If your child’s eye examination is not normal the eye doctor will need to do more tests with a special camera.

Medical Photography

If it is felt photographs are required this may be completed by our specialist medical photography team. All medical photographs are stored on the trust secure Medical Image Manager programme.

Intimate or sexual abuse examination

A senior doctor may need to look at your child’s genital area as part of the general child protection medical examination. However, if it is suspected or been disclosed that your child may have been sexually abused, they will be seen by specially trained doctors and nurses at the SARC (sexual abuse referral centre). Information will be given to you if this is thought to be needed.

The rights of the child are:

• to be safe and protected from harm, abuse or neglect
• to be heard and have their views and feelings considered
• to appropriate confidentiality
• to be protected and supported
• to be kept informed and updated according to their age and understanding
• to ask for explanations and to raise concerns
• to consent or refuse medical examinations as long as they fully understand what is involved
• to have an interpreter if needed
• to have a chaperone

Your rights:

• to be heard
• to be supported
• to be kept informed and involved
• to ask for explanations and appropriate confidentiality
• to seek legal advice and complain
• to have an interpreter if needed
• to request a chaperone

Looking after and sharing information about your child

The Child Protection Medical Report and any forms we complete to document our examination are stored securely within your child’s medical records. Our findings are shared with Children Social Care and the Police if necessary.

In order to gather information we may contact your child’s GP, Health Visitor, School Nurse, or other agencies that may help.

We have updated our Privacy Notices in line with the data protection legislation (General Data Protection Regulation (GDPR)/Data Protection Act 2018. For more information about how we use your personal data please visit our website at:

http://www.leedsth.nhs.uk/patients-visitors/patient-and-visitor-information/how-we-use-your-data/

Who do I speak to if I need further information?

Please speak to the nurse looking after your child who will contact the Consultant Paediatrician in charge of your child’s care.

If you need more information about the child protection process, please contact the Social Worker appointed to the child’s care if applicable.

If you are unhappy with the healthcare your child has received please make contact with:

Please remember

• There is no such thing as a silly question – we will always listen, so just ask.
• If you don’t understand what we are doing or why, keep asking us to explain until you do understand.
• Feeling upset is only natural, but please remember our staff are just doing their job.

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