GPs' role in child abuse and neglect
mrcgp essentials revision guides to the hot topics
All GPs are likely to encounter children needing protection from abuse or neglect. Child maltreatment may present in a variety of ways
l Health visitors may express concern about a child's welfare
l GPs might detect injuries during a clinical examination
l A patient may disclose possible abuse during a consultation
Although social services are the lead agency for child protection, a key message from the inquiry into the death of Victoria Climbiè is that child protection is everyone's responsibility1. All members of the primary care team have a role to play.
Health professionals must undertake appropriate action if they suspect a child is at risk. Doing nothing is not an option.
What constitutes child abuse?
Child abuse refers to various acts of omission or commission on the part of carers that result in the needs of children not being met. Four categories are now recognised:
l physical abuse
l sexual abuse
l emotional abuse
Child maltreatment is prevalent and there is universal agreement about the detrimental effects on child welfare in general, as well as on development.
How are children protected?
The child protection process as defined by the Government document Working Together to Safeguard Children2 requires all health professionals to:
l Acknowledge the child paramountcy principle the child's safety overrides all other considerations
l Share information as appropriate
l Work in collaboration with other agencies
l The Government document Framework for the Assessment of Children in Need and their Families3 recognises the need to assess children's requirements in accordance with their health and development, the parenting ability of their carers and the characteristics of their family and environment. This document represents a shift in policy away from investigation of established abuse to recognition of children in need and proactive provision of support for families.
The child protection process consists of several steps:
l Detection or suspicion that a child is in need of protection, or recognition that the capacity of parents to meet the needs of their children is impaired as a result of mental illness, drug or substance abuse or domestic violence
l Discussion of concerns with senior colleagues and/or social services
l Inquiries and risk assessment by social services
If there is sufficient concern for further action then:
l There will be an initial planning meeting
l A further inter-agency investigation will be held, which may involve medical examination of the children
l A child protection case conference will be convened to share concerns, assess risk and agree on best way forward
l The children's names may be put on the local child protection register under one or more of the four categories defined above, and a child protection plan will be agreed with specific action points and named people to carry them out
l Review conferences will be undertaken until there is no longer any concern
GPs' roles and responsibilities
l The idea of sharing sensitive information with outside agencies may be daunting. However, all professional bodies, including the RCGP, agree that breaching traditional models of confidentiality is acceptable to ensure children's safety.
l All GPs must keep up to date with local child protection referral protocols and procedures and should participate in child protection training events. It is equally important that all members of the primary care team have at least a basic awareness of child protection issues.
l GPs are rarely required to undertake a definitive diagnostic role in child protection issues. This is the remit of social workers and paediatricians with a special interest in the subject. The GP's role essentially is to monitor and be vigilant for abuse or neglect, and to report concerns. GPs are ideally placed to support vulnerable families.
l It is vital to keep accurate and contemporaneous notes (who said what, what was found on examination, why you are concerned) as they might be needed in court many months later.
1 Lord Laming. The Victoria Climbiè inquiry report. London: HMSO, January 2003.
Also available at
www.victoria-climbiè-inquiry.org.uk/finreport/ finreport.htm [accessed 9/9/03]
2 Department of Health, Home Office and the Department for Education and Employment. Working Together to Safeguard Children:
A guide to inter-agency working to safeguard and promote the welfare of children. London: HMSO, 1999. Also available at www.doh.gov.uk/pub/docs/doh/safeguard.pdf [accessed 9/9/03]
3 Department of Health, Department for Education and Employment and the Home Office. Framework for the Assessment of Children in Need and their Families. London: HMSO, 2000. Also available at www.doh.gov.uk/qualityprotects/work_pro/
project_3.htm [accessed 9/9/03]
Yvonne Carter is professor of general practice and primary care at Queen Mary, University of London, and a GP in Tower Hamlets, London she has a long-standing research interest in the prevention of intentional and unintentional injuries to children and is a former chair of research at the RCGP
Michael Bannon is associate dean in postgraduate medicine at the London Department of Postgraduate Medical and Dental Education, and a consultant paediatrician in community child health at Northwick Park Hospital, Harrow, Middlesex
1 Carter YH, Bannon MJ. The Role of Primary Care in the Protection of Children from
Abuse and Neglect a Position Paper.
London: RCGP, 2003
2 Department of Health. Safeguarding Children: What to do if you're worried a child is being abused. London: HMSO, 2003.
Also available at
[accessed 9/9/03] This is an excellent source of guidance and is essential reading
3 Bannon MJ, Carter YH (eds). Protecting Children from Abuse and Neglect in Primary Care. Oxford: Oxford University Press, 2002
4 Bannon MJ, Carter YH. Paediatricians and Child Protection: the Need for Effective Education and Training. Arch Dis Childhood 2003;88:560-2