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Lucy’s story: a child protection issue?

Current awareness in the media of child protection issues is at an all-time high and, until recently, Janet Webb had failed to see how this might deter parents from bringing their children to health professionals, fearing accusations of child abuse. This was highlighted when Lucy's dad brought her in to see me one Tuesday morning ...

Janet Webb
BSc(Hons) RGN DiPN(Lond)
Practice Nurse, Lindum Medical Practice, London

Issues around child protection and child abuse make big news, and rightly so; bringing the subject into news bulletins on television and in the newspapers makes it a talking point for a while at least, and universal outrage follows each new case where social and health services are found wanting. We are encouraged to be more vigilant, more questioning and suspicious.

Lucy was the human definition of cuteness; nearly four years old and a vision in pink, with pink sparkly trainers, pink and white jeans, a white T-shirt emblazoned with a kitten wearing a diamante tiara, a pink jacket, and pink bobbles holding her blonde pigtails. She wore a huge smile as she settled herself on the chair in my room, clearly enjoying being the star of the moment. Dad stood hunched with hands in his pockets avoiding eye contact. It was immediately apparent why they were attending, the prominent bump on Lucy's forehead neatly matching her pink outfit. Proudly, and rather unnecessarily I thought, she pointed at the bump, saying, "Look!"

Clearly, Lucy could manage to conduct the consultation with Dad lurking in the background keeping a low profile, so I asked, "What happened to your head?" As Lucy, without any hesitation, declared, "I did fall down the stairs!", her dad turned sharply away and began a detailed consideration of the Body Mass Index ready-reckoner on my wall. Suitably impressed, I asked if she had cried, at which she beamed at me and said, "No, but my Daddy did!" Then for emphasis, turned and pointed, adding, "That's my Daddy!"

Glancing at "Daddy", I could see that he was not far from tears again, red-faced now with embarrassment. I asked if Daddy had fallen as well, which Lucy found very funny, saying he hadn't, but had given her a "big hug". It was time to bring in the chief witness, so I invited Lucy's dad to sit down, and asked whether he had seen the fall. He took a big breath before joining the conversation, and then told me how he was following Lucy downstairs that morning. Lucy, chatting as usual, had turned back to him while still walking downstairs, and missed her footing, falling down about 10 stairs, mostly head-first, hitting her head on the post at the bottom.

She had gone with such a bang that he had rushed down after her and gathered her up to hold her and, as she said, hugged her tight. He didn't think she'd been unconscious as he hugged her. She had said, "Ouch, my head!", hadn't seemed floppy, and soon she had wriggled and then rubbed her head. He went on to express the feelings of anxiety, fear, guilt and inadequacy that followed, repeatedly adding, "I should have been more careful, I should have walked down in front of her."

It transpired that Lucy's mum had left them to pursue her singing career when Lucy was a baby, having decided it had all been a terrible mistake and she wasn't ready to settle down. Since then, they had been in sporadic contact while Lucy's mum worked in various shows, holiday resorts and on occasional cruise ships during the summer, and pantomime during the winter. She had no permanent address. Chris, Lucy's dad, had left work to become a full time single parent.

Having checked her over, Chris had first telephoned his own mother for advice, but she had set off for work and instead he got his younger brother. He told Chris that if he took Lucy to the hospital they would be bound to suspect he had beaten her, and would inform social services; Chris hadn't thought of that.
So began a whole new set of worries. Chris managed to convince himself that with the recent publicity from child abuse cases the hospital would be extra vigilant, and would take Lucy away from him, since he was clearly neglecting her welfare. The possibility that he could have beaten her had sickened him.
Panic-stricken, he had decided to manage the injury himself, and had logged on to the NHS Direct website (www.nhsdirect.nhs.uk) to learn that he should seek medical advice for head injuries in the under-fives.

He then tried a general search under "bump on the head" and found the Mayo Clinic site (www.mayoclinic.com). In normal circumstances, this site's balanced and sensible advice would probably have reassured him, but Chris was not enjoying normal circumstances, and read further than the reassuring first few paragraphs to the section advising: "Occasionally, a blow to the head may be severe enough to cause bleeding in and around the brain. This type of bleeding is serious because it can put pressure on the brain." He had failed to continue to the checklist and reassurance that concussion is unlikely, but had printed the page, and had brought it with him to the surgery, along with Lucy, on the basis that he would rather be thought of as a neglectful and irresponsible father than risk any harm to his daughter. He dismissed as ridiculous the idea that he could ever have beaten Lucy, but was ready to admit that her fall was entirely his fault, and was desolate in his guilt.

Most of this unburdening came unprompted and uninterrupted. At the end of his speech, he paused, and we both looked at Lucy, who was sitting quietly between us, swinging her legs and looking around at the animal pictures on my wall. There was no sign of any confusion, photophobia, vomiting or drowsiness. She had complete recall and full use of all faculties.

It seemed important to dispel the myth of health workers taking on the guise of child-catcher. Although this time it had arisen from Chris's overwrought state fuelled by his brother's comments (whether deliberately mischievous or simply ill-chosen), the fact remained that people might be less inclined to seek help out of fear of the consequences. I needed to promote a caring service that Chris would be ready to use again.  

Taking the printout Chris had brought, I went through the list of signs of concussion with him, advising him to seek further assistance if any of them occurred in the next few hours. I commended him for his actions; the idea of ringing his mother had been a good one, as had the NHS Direct website (a pity about his younger brother, however).

We talked briefly about accidents in the home and the need for vigilance, but that most children suffer minor injuries at some stage as part of growing up and learning about life. I told him he'd done a good parenting job so far in raising such a delightful little girl, who I'm sure would have no hesitation in telling everyone if he had ever beaten her, bearing in mind the readiness with which she had spilled the beans on his tears that morning. Ordinarily, I would have been wary of seeming to patronise, but that morning it felt as if Chris wouldn't mind.