ABSTRACT
BackgroundThe impact of Covid-19 on child abuse is widely reported. In Birmingham there has been an increase in strategy meetings occurring for children with alleged physical abuse but it is of concern that this has not corresponded to an increase in child protection medical examinations (CPME) occurring in a community healthcare trust.ObjectivesTo undertake a multi-agency service evaluation to identify the proportion of strategy meetings for physical abuse that led to CPMEs being undertaken, and to understand the reasons for not undertaking CPMEs.MethodsA list of children who had strategy meetings following allegations of physical abuse was obtained for the period 1st to 14th October 2020. Details of CPMEs were obtained from health care records and outcomes of CP enquiries from social care records.ResultsThere were 23 strategy meetings for physical abuse. 2 children were under 4 years, 14 were 4–11 years and 7 were over 11 years. There were 8 females and 15 males.18 children (78%) did not have a CPME following the initial strategy discussion.Social care records showed in 11 cases (48%) after the child/family were spoken to by social care with or without the police, the decision was made that a CP medical was not indicated, mainly because the history was not substantiated or injuries were not seen. This included one 3-year old and four 4-year olds.Two children (aged 8 and 12) retracted their allegations;no information regarding injuries is recorded.In 1 case the mother admitted to smacking the 8 year old child, she stated that she was unaware of the law as the family were new to the UK;there is no documentation with regards to injuries. One 15 year old refused to consent for CPME.ConclusionsCPMEs only occurred for 5/23 (22%) of children following their initial allegation of physical abuse. It is of concern that young children may make a disclosure to a ‘safe’ adult such as a teacher but then when they are unable to repeat the allegation to an unfamiliar social worker or police officer that further medical assessment is not sought.A CPME will not always be offered by paediatricians in cases where there is no visible injury in a verbal child. GMC guidance states that before carrying out a CPME you must be satisfied that it is necessary and appropriate. You must be clear about what will be achieved and whether or not the outcome is likely to affect the proposed course of action.We therefore call for clarity between all agencies with regard to the threshold required for a CPME to occur following referrals received for physical abuse allegations.We recommend that in preschool and younger children with limited verbal skills social workers should refer for a CPME to be undertaken where there is an allegation of physical abuse regardless of whether an injury is seen. In verbal children a CPME should be done when there is a significant allegation even if no injury is seen to ensure there are no hidden injuries.
ABSTRACT
OBJECTIVES: To determine any change in referral patterns and outcomes in children (0-18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years. DESIGN: Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown. SETTING: Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children. PARTICIPANTS: Children aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018-2020. MAIN OUTCOME MEASURES: Numbers of referrals, source of disclosure and outcomes from CPME. RESULTS: There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns. CONCLUSIONS: School closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.