Child Protection Medical and investigations

Guidance for parents and carers

A Child Protection Medical is a full medical assessment of your child, which is carried out due to concerns about their welfare, and to fully investigate any injury. We appreciate this can be a really stressful time; it is important that you and your child’s views are listened to and you understand what is happening. This leaflet aims to outline the process of a child protection medical assessment so you know what to expect and what will be expected of you.

When children come to hospital with certain injuries or symptoms, we must investigate the possibility of non-accidental injury. It is a legal requirement and our professional responsibility to follow safeguarding processes if we cannot identify a valid reason for the injury that your child has sustained, or if there are significant injuries in a non-verbal child, to ensure their safety and best interests. Your child will also be referred to children’s social care.

Consent

• The assessment requires consent from those with parental responsibility prior to commencing. This is ideally written consent (signing the form) but may be verbal.
• In some cases, the child themselves may be deemed to have enough understanding to consent to the assessment
• If you or your child do not give consent the social worker and/or police will first discuss this further with you
• A social worker can seek a court order giving them permission to interview or medically assess your child, without your consent.

The assessment

The assessment will be performed by a paediatrician (children’s doctor) with specialist training and experience in conducting these assessments.

They will ask detailed questions about your child’s current health, past medical history, birth history, allergies, medications, immunisations and development. A detailed social history will be taken; including sleeping arrangements, drug and alcohol use, along with family history of any medical conditions. The doctor will also want to know about your child’s behaviour and progress at school.

Your child will then have a full top-to-toe assessment. This includes their mouth/ throat, heart, lungs, abdomen and nervous system in addition to their skin. To facilitate this assessment your child will need to strip down to their underwear, which can be done in stages if that makes them more comfortable.

• Any scars, marks or injuries that are identified will then be measured and drawn onto body maps in your child’s notes.
• Photographs may be taken with your consent for the purpose of documenting injuries and discussing with other doctors within the CDC. These photos would not usually be shared with other organisations such as police or social services without your consent. In exceptional cases, photographs of the child may be obtained without the consent of a parent or carer if this is in the best interests of the child. This will be documented in the medical notes by the child’s doctors and the parents or carers will be informed that photographs have been taken when it is appropriate to do so.
• More specific investigations such as blood tests, scans or X-rays may need to be done. These will be explained and discussed with you.
• Your child will also be told that the assessment can be stopped at any time if they/ you wish.
• A chaperone / observer may be present during the assessment. Their role is to ensure that everyone in the room is comfortable.

After the assessment

The doctor will explain their findings to you and your child. They will give their opinion and advice on how to help your child stay safe, happy and healthy. They will explain if further tests or treatment are needed such as x-rays, blood tests or scans. The choice of tests will be based on national guidance from the Royal College of Paediatrics. The report and the medical records or photographs may be requested as evidence in court.

If you would like to read the report, you will need to discuss this with your social worker and request to see it with them. Your child may be admitted to the Paediatric Ward for further investigation and observation. You can stay with your child on the ward.

The team from children’s social care, together with the doctors and nurses caring for your child, will hold a meeting to discuss your child’s injuries or symptoms and agree the next steps that will need to be taken. The outcome of this meeting will be shared with you by a social worker and/or the doctor in charge of your child’s care.

Photography

All visible signs of possible physical abuse should be photographed for medical record. This serves as a better record than drawings or other accounts in the hospital notes. The photographs will be taken by professional medical photographers and/ or paediatricians. They will store the photographs on a secure system.

Blood tests

Unexplained or unusual bruises may be symptomatic of bleeding disorders such as haemophilia and leukaemia. All children with a bruise about whom there are concerns of physical child abuse should therefore have a blood test, to ensure that they do not have a bleeding disorder. Blood tests may be taken for some children with fractures or if there are other medical concerns. We understand blood tests can be upsetting so we will make every effort to minimize any distress to your child. You will be able to stay with your child and comfort them while this procedure is carried out.

Eye examination

All children displaying evidence of eye trauma or having a CT scan of the head will have their eyes examined by an ophthalmologist (specialist eye doctor). Your child may be given eye drops 20 to 60 minutes prior to examination. These drops may sting a little for a short period of time. The effect of the drops is to dilate the pupils making it easier to examine the back of the eyes. The ophthalmologist may take photographs of the back of the eyes as part of the examination and will discuss the findings with the paediatric doctors.

Scans

X-rays and Skeletal Survey

Your child may require x-rays to check for fractures, or a full skeletal survey. A skeletal survey is an X-ray examination of the whole body and will involve about 20 separate x-ray images. This can take up to an hour to perform. Your child will need to keep still for each image taken. You may be asked to help hold your child still although toys and other distractions will be available. You may want to bring your child’s favourite toy or comforter to help with this. The examination takes place over two visits about two weeks apart. You will be given an appointment for the second visit once the first appointment is complete.

The skeletal survey is carried out by appropriately educated and trained paediatric radiographers who are skilled in dealing with children. They will help you and your child throughout the examination. A nurse, or other healthcare professional, will also be present to help and support you and your child. The radiographers who perform the X-rays will not know the result. The images will be reported by a consultant radiologist. The results will be discussed with you by the doctor caring for your child.

CT brain scan

Injuries or bleeding within the brain are not always obvious. A CT scan of the brain will allow us to see injuries that are not visible on the outside of the head. It is performed by experienced radiographers and produces images of the brain and the skull. The scan is relatively quick although your child will need to lie very still. Sometimes sedation may be used to help keep your child still and this will be discussed with you by the doctor caring for your child prior to being given.

MRI Scan

If any bleeding is found in the brain, an MRI scan may be organised to monitor this. This scan does not involve any radiation but it does rely on a very strong magnet, so it is important to let the supervising staff know of any metal that may be on or inside your child’s body. The scan will be performed by experienced radiographers. The MRI scanner looks like a CT scanner, but the interior is more like a tunnel. An MRI scan can take up to one hour and is noisy. Your child will need to be perfectly still for this and may need sedation or a general anaesthetic. You will be asked to provide your consent for this procedure to be undertaken. The radiographers who perform the MRI scan will not know the result. The scan will be reported by a consultant radiologist and the results will be discussed with you by the doctor looking after your child’s care.

How much radiation will the tests give my child?

We are all exposed to natural background radiation. Medical investigations that require the use of x-ray do give us a small additional dose of radiation. The radiation from skeletal surveys, for instance, is equivalent to a few months of background radiation. CT brain scans equate to about 18 months of background radiation. Any extra exposure to radiation, in turn, slightly increases the lifetime risk of cancer, although this is a very small increase in risk. Before such investigations, the potential risks of the radiation are carefully weighed against the benefits of the examination by your medical team, keeping in mind your child’s best interests. Your child will not be exposed to any more radiation than is absolutely necessary. If you are or could be pregnant, you must tell the radiographer as x-rays can potentially be harmful to unborn babies, and therefore you may not be able to stay with your child during the scan.

Who should I contact if I have a problem or question?

Speak to the doctor or nurse in charge looking after your child if you have any questions about the child protection medical assessment process.

PALS (Patient Advice and Liaison Service) is a confidential service for people who would like information, help or advice about the services provided by our hospital. Contact PALS via tel 01895 279973 (office hrs), email thh-tr.pals@nhs.net, or visit the PALS office based in the hospital.

What should I do in case of an emergency?

Dial 999 if your child is injured or unwell at home. Speak to the doctor or nurse looking after your child if you are in hospital.