Safeguarding (Children & Adults)
Summary
Safeguarding is the statutory duty to protect the health, well-being, and human rights of individuals (children and vulnerable adults) to live free from abuse, harm, and neglect. It is a Core Competency for all healthcare professionals. "Doing nothing" is not an option. [1,2]
Clinical Pearls
The Pre-Mobile Baby: "Those who don't cruise, don't bruise." Any bruise in a baby who is not yet crawling or walking is Non-Accidental Injury (Physical Abuse) until proven generally otherwise by a full skeletal survey and multi-agency review.
Triangle of Safety: In child protection, always consider: > 1. The Child's Developmental needs. > 2. Parenting Capacity. > 3. Family & Environmental factors.
Capacity & Adults: Competent adults have the right to make "unwise decisions" (e.g., staying with an abusive partner). However, if there is coercion or lack of capacity, safeguarding overrides this right.
Categories of Abuse
- Physical: Hitting, shaking, poisoning, fabricated illness (FII).
- Sexual: Rape, exploitation, grooming.
- Emotional/Psychological: Humiliation, threats, controlling behaviour.
- Neglect: Failure to provide food, warmth, medical care (e.g., severe dental decay).
- Financial (Adults): Theft, fraud, coercion of wills.
- Modern Slavery: Trafficking, forced labour.
- Radicalisation (Prevent Duty).
Non-Accidental Injury (NAI) Signs
- Delayed Presentation: Seeking help days after the "accident".
- Inconsistent History: "He fell off the sofa" but has a spiral fracture of the femur.
- Specific Injuries:
- Cigarette Burns: Circular, punched out.
- Bite Marks: Oval, teeth spacing.
- Shaken Baby: Retinal haemorrhages + Subdural haemorrhage.
- Defensive Injuries: Bruising on outer arms/back.
- Bruising Patterns: Ears, Cheeks, Neck, Genitals, Buttocks. (Accidental bruises are usually shins/forehead).
| Condition | Features |
|---|---|
| Mongolian Blue Spot | Congenital dermal melanocytosis. Blue/grey on sacrum. Document at birth! |
| ITP / Bleeding Disorder | Easy bruising, petechiae. Gum bleeding. |
| Osteogenesis Imperfecta | Brittle bones. Blue sclerae. |
| Ehlers-Danlos | Hyper-extensible skin, easy bruising. |
The Disclosure
The Consultation
Paediatrics (Suspected NAI)
- Skeletal Survey: Full body X-rays to look for old fractures (ribs, metaphyseal corner fractures).
- CT Head: For intracranial bleeding.
- Ophthalmology Review: For retinal haemorrhages.
- Coagulation Screen: To exclude bleeding disorders.
Adults
- Body Map: Document injuries on a diagram.
- Photographs: (With consent/Police involvement).
Management Algorithm (The 4 Rs)
SUSPICION OF ABUSE
↓
RECOGNISE
- Spot the red flags
- Listen to the disclosure
↓
RESPOND
- Is there IMMEDIATE Danger?
YES -> Call Police (999)
NO -> Keep Safe
- Treat medical injuries
↓
RECORD
- Verbatim quotes ("He said...")
- Fact not opinion
- Body map of injuries
- Date/Time/Who was present
↓
REFER
- Discuss with Safeguarding Lead
- Contact Social Services (MASH)
(Multi-Agency Safeguarding Hub)
- Submit MARF (Referral Form)
1. Information Sharing
- GDPR: Does NOT prevent sharing information for safeguarding purposes. Safety trumps privacy.
- Share what is necessary, proportionate, and relevant.
2. Strategy Meeting
- Multi-agency meeting (Police, Social Care, Health, Education) to decide on plan.
- Section 47 Enquiry: Statutory investigation if child is at risk of significant harm.
- Child Protection Plan (CPP): Formal plan to ensure safety.
3. The Care Act (Adults)
- Local authority has a duty to make enquiries if an adult has care and support needs and is experiencing abuse/neglect.
- Death: Homicide, suicide.
- Long term Trauma: ACEs (Adverse Childhood Experiences) linked to poor health outcomes, addiction, and criminality later in life.
- Early intervention saves lives.
- Many children can remain with family with support (Child In Need), but removal (Foster Care) is sometimes necessary.
Key Guidelines
| Guideline | Organisation | Key Recommendations |
|---|---|---|
| Child Protection | Working Together (2018) | Statutory guidance on inter-agency working. |
| Adult Safeguarding | Care Act 2014 | Legal framework for protecting adults. |
| Competence | NICE | All staff must have Level 1-3 training depending on role. |
Landmark Cases
1. Baby P (Peter Connelly)
- Highlighted failures in communication between agencies (Health, Police, Social Workers). Led to "Working Together" reforms.
2. Victoria Climbié
- 128 injuries noted but missed. Led to the Laming Report.
What is safeguarding?
It means checking that children and vulnerable adults are safe and well cared for. Doctors and nurses have a legal duty to report if they are worried someone is being hurt or neglected.
Why are you asking about my home life?
We ask everyone. Domestic violence, stress, and financial trouble can affect your health. We want to know if you need support.
What happens if I tell you something?
If you tell us you or someone else is in danger, we have to share that with the experts (Social Services) to help protect you. We will usually tell you we are doing this, unless telling you puts you in more danger.
Primary Sources
- HM Government. Working Together to Safeguard Children. 2018.
- The Care Act. 2014.
- NICE. Child maltreatment: when to suspect maltreatment in under 18s (CG89). 2009.
Common Exam Questions
- Paediatrics: "Bruise in 2 month old?"
- Answer: NAI until proven otherwise (CT Head, skeletal survey, social services).
- Fracture: "Specific NAI fracture?"
- Answer: Metaphyseal Corner Fracture (Bucket handle) or Rib fractures.
- Adults: "Key legislation?"
- Answer: Care Act 2014 (Deprivation of Liberty Safeguards - DoLS).
- Process: "Who to refer to?"
- Answer: MASH (Multi-Agency Safeguarding Hub) or Social Services.
Viva Points
- Fabricated or Induced Illness (FII): Formerly Munchausen's by Proxy. Parent exaggerates or induces illness in child for attention/gain. Management requires covert surveillance and careful record review.
- Prevent Duty: What is it? Duty to prevent people being drawn into terrorism (Radicalisation). Part of safeguarding.
Medical Disclaimer: MedVellum content is for educational purposes and clinical reference. Clinical decisions should account for individual patient circumstances. Always consult appropriate specialists.