5.7 Child Protection Medicals

If there are allegations that a child may have been physically or sexually abused, consultation will take place between child protection unit based at the local hospital and social care manager to arrange a child protection medical. This is usually following a strategy meeting (Section 47 enquiries).  

If the child is suffering from a serious injury or requires treatment, medical attention must be sought immediately by either calling an ambulance or taking the child to the Minor Injuries Unit or Emergency Department of the local hospital. The duty Consultant Paediatrician must be informed of the nature of the concerns and a referral must be made in accordance with this procedure as soon as practicably possible.

If the referral relates to a situation in which a crime has or may have been committed, including sexual or physical assault or physical injury caused by neglect, the social worker receiving the referral must discuss the referral with the Police at the earliest opportunity. The Police, in consultation with Children’s Social Care Services and any other agencies involved with the child, must consider whether there should be a criminal investigation and/or a Children’s Social Care Services led intervention.

This will need to be discussed carefully and a decision made at a Strategy Meetings.

Strategy meetings will be convened when it is suspected that a child has suffered significant harm. Children’s Social Care, Police, Health, Education, Early Help Services will be invited to meet, as will any other involved agencies. Information will be shared by all agencies to enable decisions to be made to determine if the threshold has been met to commence a section 47 enquiry and whether this will be single or joint agency.

If any actions for particular agencies are identified during the meeting these will be clearly recorded and subject to specific time scales and updates will be required throughout the section 47 enquiry period (5 working days). The above procedure also applies to pre-birth strategy meetings.

Children who do not normally reside in Sefton.

If the referral relates to a child who is temporarily visiting the area of another local authority or in a hospital or Looked After outside of the local area, the local authority/Police for the area where the child actually is at the time have prime responsibility for an initial response to the referral. (Including strategy meeting if required) 

The referral should be passed to that authority immediately for them to follow the necessary procedures and to undertake a Section 47 Enquiry and/or take any immediate protective action that is necessary. They will be responsible for liaising with any other Children’s Social Care Services as necessary.

Before undertaking such enquiries, the child’s home authority must be consulted and agreement sought on who is best placed to undertake the enquiries. Where this is consistent with the child’s immediate protection needs, it may be agreed that the child’s home authority will respond to the referral.

For those children from other local authority areas, who are the subject of Child Protection Plans, there must be consultation with the responsible Lead Social Worker.

Any relevant personnel from another local authority or agency should be consulted and invited to attend the Strategy Meeting or invited to contribute to the Strategy Discussion.

Comprehensive enquiries must be undertaken with the host local authority and any agencies to which the child is known. This must include checking whether the child has a Child Protection Plan.

All enquiries should be confirmed in writing.

The Strategy Discussion/Meeting, clarifying roles, responsibilities and timescales for actions, must be recorded on the relevant Forms and copies of the record distributed within ONE working day, to all relevant parties.

Where agencies or individuals anticipate that prospective parents may need support services to care for their baby or that there may be risks to the unborn baby, a referral to Children’s Social Care Services through the Children's Help and Advice Team (CHAT) must be made as soon as the concerns are recognised. There will be no delay based in assessing an unborn child based on length of pregnancy.

Where the concerns centre around an aspect of parenting behaviour, for example substance misuse, the referrer must make clear how this is likely to impact on the baby and what risks are predicted.

The following are some areas to consider when making a referral for a unborn baby:

• There has been a previous unexplained death of a child whilst in the care of either parent;
• A parent or other adult in the household has been convicted for violent conduct, against a child or within the home environment.
• The mother, father or a sibling in the household has a Child Protection Plan;
• The mother, father or a sibling has previously become cared for by court order as a result of concerns regarding Significant Harm;
• The degree of domestic violence and abuse known to have occurred is likely to significantly impact on the babies safety or development;
• The degree of parental substance misuse is likely to significantly impact on the babies safety or development;
• The degree of parental mental illness/impairment is likely to significantly impact on the babies safety or development; 
• There are serious concerns about the prospective parents’ ability to care for themselves and/or to care for the child, for example where the parent has no support and/or has learning disabilities;
• Any other concern exists that the baby may be likely to suffer Significant Harm, including a parent previously suspected of having Fabricated or Induced Illness in a child, or a prospective parent who has been the subject of fabricated or induced illness as a child themselves.

Delay must be avoided when making referrals to ensure the family have

• Sufficient time for a full and informed assessment and intervention to be effective;
• More time to contribute their own ideas and solutions to concerns and increase the likelihood of a positive outcome to assessments;
• The early provision of support services so as to facilitate optimum home circumstances prior to the birth.
• Sufficient time to make adequate plans for the babies safety if required

Prospective parent/s should be informed of the referral and their agreement sought were possible.

See also: Pan-Merseyside Pre-Birth Protocol and Information Sharing in Sefton