Doctors told to detain children in hospital if they suspect abuse
Doctors should detain a child in hospital if they suspect abuse and alert key agencies, such as social services and police, according to guidance published today.
Recommendations on child protection issued by the British Medical Association — the first to focus specifically on the role of doctors — say that GPs and consultants should take immediate action when dealing with children who may be at risk.
They include keeping a child in hospital against parental wishes if it appears that injuries are not accidental and the child may be subjected to further harm. The guidelines also advise that in such cases it may be in the best interests of the child to undertake an examination without explicit parental consent.
The recommendations, which are published today for the BMA’s 130,000 members and have been seen by The Times, come in the wake of damning reports on the failure of doctors and health visitors to raise the alarm over the maltreatment of Baby P. The child was seen by a paediatrician hours before he died, but his injuries, including a broken back and ribs, went unreported. A review of shortfalls in NHS care by the Care Quality Commission, the health regulator, is to be published imminently.
The BMA’s Child Protection Tool Kit says that doctors who come into contact with children at risk must inquire about any previous hospital admissions and gain access to all relevant notes and records.
It also advises that any child thought to be at risk must be thoroughly examined within 24 hours of admission and should not be discharged unless a discussion has taken place with social services. The child should also be registered with an identified GP, but hospital admissions at the weekend should not interfere with emergency protection proceedings.
Recommendations involving GPs focus on their importance as frontline staff, with a knowledge of the family history of suspicious cases. The guidance also emphasises the need for written protocols that identify all child protection and patient confidentiality roles at practices. Doctors welcomed the guidance, which they said offered important support in making potentially difficult decisions that may provoke serious confrontations with parents.
However, concerns were raised that parents may stop taking their children to hospital for fear of unwarranted repercussions and the possibility of a medical examination without consent.
Tony Calland, chairman of the BMA’s Medical Ethics Committee, said that the advice underlined the point that doctors must start from a “very high index of suspicion”, with the welfare of the child being paramount.
“Doctors must be suspicious when seeing a child with an injury. You can work back from that point. All of us who are parents have seen day-to-day accidents. But it does the doctor no harm at all to question whether it is an issue of abuse. If you have a very high index of suspicion from the outset, it puts you in the position of making a completely objective judgment. If you don’t think about it you will never diagnose it.”
Dr Calland said that while doctors “did not have to press the nuclear button” of calling on social services, the key questions in the guidance must be asked and necessary alerts made. He added that the guidance would “not necessarily result in more children being retained in hospital, but would make doctors think about whether they should be doing it more frequently”. He continued: “Nobody wants children kept in hospital unnecessarily, but on the other hand we don’t want to have another episode like Baby P to slip through the net.
“What is important to remember is that if [doctors] have concerns about a child who may be at risk of abuse or neglect, they need to act immediately — the best interests of the child must dictate all their actions.”
Rosalyn Proops, child protection officer at the Royal College of Paediatrics and Child Health, said that the guidance would be of particular use to doctors who did not work in paediatrics and emergency care, but who came into contact with suspicious injury cases. While she welcomed the guidance and its careful consideration of patient confidentiality, she said that conducting examinations without parental consent was controversial.
“We should not be examining children unless there is an urgent clinical need. It is either a question of parental responsibility or of issuing an emergency order that provides legal consent,” Dr Proops said.
Frank Furedi, Professor of Sociology at the University of Kent, said that the guidance risked encouraging an over-reporting of cases, making parents much more apprehensive about bringing an injured child into contact with the healthcare system.
“The job of a health professional is to treat a person in the first instance, and that is what they should be preoccupied with. I am really worried about the establishment of default positions because they have the tendency of being over-interpreted and health professionals could become very defensive [about how they interpret them].
“Guidelines that are fairly codified have a tendency to create unnecessary problems and a hypersensitivity. They can make parents more reluctant about contacting health professionals when their child has an injury.”
John Heyworth, President of the College of Emergency Medicine, said that while black and white cases of abuse or accident were straight forward, guidance was most valuable in the grey areas of detection. “Often the concerns are very subtle, and the decisions very difficult. This guidance will give doctors more confidence.”