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Guidance for safeguarding the welfare of children

Maryam Fernandez
RGN BA(Hons)
Education and Development Officer for Practice Nurses
Chingford, Wanstead and Woodford PCT

Practice nurses routinely see children and young people in their practice as patients or as they accompany their carers/family members during consultations. Although the contact may be brief there may, on occasion, be concerns felt for the welfare of the child. Indirectly, there may also be concerns for the impact an adult may have on a child's welfare. The concerns may be regarding the child's health, actual (or risk of) significant harm, abuse or neglect, or a combination of these. All nurses who come into contact with children or adults whose lives impact on a child have a duty to protect and promote their safety and wellbeing and need to be aware of what to do in such a situation.
To address this issue the Department of Health has issued a guide - What to do if you are worried a child is being abused(1) ­- to help in the process of responding to the systematic failure of multiagency child protection services following the Victoria Climbié Inquiry.(2) It replaces previous documents aimed at health ­professionals who may have child protection concerns. The document focuses on:

  • What to do if you have a child protection concern.
  • What happens after informing someone of your concerns.
  • Further contributions that may be necessary from you in the process.
  • How you should share information.
  • Background information about legislation within which child welfare operates.
  • The processes for safeguarding children (there are flow charts to illustrate).

To enable nurses to take the appropriate action they need to be aware of what actually constitutes a child protection concern. Children in need are defined, as per the Children Act 1989, as those who are unlikely to achieve or maintain satisfactory health or development without provision of services.(3)
Significant harm is defined in the guide as the threshold justifying intervention in family life in the child's best interest. However, careful assessment of the child's circumstance and discussion with all agencies and individuals involved is necessary in order for ­decisions to be made.
Physical, sexual and emotional abuse is also defined in this document, as is neglect. In addition, the four key processes of assessment, planning, intervention and review in working with children in need and their families/carers are explained. Practice nurses may be involved in the process:

  • As a direct result of acting on their own concerns.
  • After being approached by social services to ­provide information or take part in an assessment even though they may not have made the initial referral.
  • By the provision of help or service as part of the planning and review of progress stage.

The Climbié Inquiry highlighted that all practitioners should be familiar with the child protection procedures and protocols of their organisation/trust.(3) If there are none, then this needs to be addressed immediately. In addition, each trust should have a designated child protection nurse who should be contactable across the organisation to give guidance on the steps to take.
The importance of accurate and secure record-keeping of child protection concerns is also emphasised by Lord Laming's comments in the Climbié Inquiry report. There is a duty and responsibility to communicate your concerns in writing to the appropriate professionals, following up all oral communications in writing and recording the outcome of the referral. Share and discuss your concerns with your manager and other professionals, keeping records of your actions and outcomes of discussions.
Local Area Child Protection Committees (ACPCs) bring local authority, social workers, health professionals and police together to enable effective interagency information sharing in child protection. Urgent action to safeguard a child requires an immediate discussion with social services and police. The flow charts provided in the Department of Health guidelines illustrate what action to take when concerned about a child's welfare in different contexts.(1)
Communicating with the child is of key importance, especially when there are special needs and/or a language preference other than English. The Department of Health guidelines suggest communication should be appropriate to the child's age, ­understanding and preference. Nurses should seek advice to ensure that the safety of the child or any potential investigation is not put at risk by the nature of the communication, nor should they ask a child leading questions.
The Royal College of Nursing's own recently published booklet Child protection - every nurse's responsibility provides guidance for all nursing staff, focusing on how to recognise abuse and neglect in children and the subsequent role and responsibility of a nurse to act accordingly.(4)
The booklet highlights possible signs of child abuse/neglect that nurses should be aware of, yet warns of the complexity of events that can be damaging to a child. The common signs include:

  • Physical signs such as slap marks, bruises and bite marks, especially in unusual areas.
  • Poor hygiene, physical care and not seeking ­necessary healthcare.
  • Parents having unrealistic expectations of their child, overprotectiveness.
  • Behavioural signs like fear of adults, aggressive behaviour and self-harm activities.
  • Inconsistencies in adults' explanation of any injuries.
  • The child's repeated attendances at healthcare ­settings with injuries.

The RCN booklet also reminds nurses of the duty to act should there be concerns regarding a colleague's behaviour that may impact on a child.
The Climbié Inquiry also highlighted that nurses need training in recognising child abuse, and the RCN emphasises that this should be mandatory, updated yearly and be specialised for those with child protection roles.
The Nursing and Midwifery Council's Code of conduct states that all nurses have a duty and responsibility to act in the child's best interests, informing appropriate personnel if there are child protection concerns.(5) Nurses have a responsibility to familiarise themselves with these latest guidelines and their local and trust child protection policies, while their employers have a duty to set up and maintain clear policies and procedures in a supportive infrastructure.

  1. Department of Health. What to do if you are worried a child is being abused. London: Department of Health; 2003. Available from URL:
  2. The Victoria Climbié Inquiry: report of an inquiry by Lord Laming. London: The Stationery Office; 2002. Available from URL:
  3. Children Act 1989. London: HMSO; 1989.
  4. Royal College of Nursing. Child protection - every nurse's responsibility. London: RCN; 2003.
  5. Nursing and Midwifery Council. Code of conduct. London: NMC; 2002.

To obtain the Department of Health summary guide What to do if you are worried a child is being
abused, call 0870 155 5455 and quote the code 31815. Or ­download from
The RCN guidance Child protection - every nurse's ­responsibility is available by ­calling 0845 772 6100, quoting the code 002045.Or download from
For child ­protection-related courses and evidence-based information about child protection Child protection helpline:0800 800 5000
The NSPCC with de Brus Marketing Services has an interactive distance learning programme on child protection awareness ­specifically for people who work in healthcare.
For more ­information ­telephone 01926 436219