Why are the doctors and nurses concerned?
The doctors and nurses looking after your child are concerned that they have injuries or symptoms that are unusual and might be as a result of them being harmed. The term that professionals might use is ‘non-accidental injury (NAI)’ or ‘suspected physical abuse (SPA)’. Young children are particularly vulnerable to being harmed, and we know that when they present with certain injuries or symptoms we must fully investigate the possibility of NAI / SPA. This is a professional duty and must be done regardless of whether there are other concerns about a parent or family.
What will happen next?
Your child will need some tests to check that they have not got any injuries or problems that we cannot see on examination. The results of these tests will be discussed with you.
In these circumstances, it is the duty of the doctors and nurses to refer to Children’s Social Care (social services) who may involve the Police. A social worker will meet with you and discuss their role. A Strategy Meeting may be held between Children’s Social Care, health professionals and the Police, along with any other agencies who may already be involved with your family. The aim of this Strategy Meeting is to decide between the agencies if any further action is needed to safeguard your child and any other children who may be vulnerable to harm.
It is everyone’s priority to keep your child, or children, safe. Remember that every case is individual, but the aim is to ensure that children live safely with their families wherever possible.
What tests will my child need?
Blood tests
These may be required to rule out a physical problem causing their injuries or symptoms. This will be performed by doctors or nurses who are trained and experienced in taking blood from young children. You will be able to stay with your child and comfort them whilst this procedure is carried out. Whilst this can be upsetting for parents and carers to witness, every effort is made to ensure the least possible distress for your child.
Skeletal survey
This is a series of x-rays of your child’s body which are performed to identify any broken bones, which can occur in young children without any obvious external signs. The x-rays will be performed by specially trained radiographers who are skilled in dealing with children.
A children’s nurse or other qualified healthcare professional will also be present to support you and your child. These x-rays can take up to an hour to perform and will involve around 25 separate x-rays. Your child will need to keep still in specific positions for each image to be taken. You may be asked to help hold your child still or distract them with toys. The staff present will help you to hold your child safely so as to cause as little distress as possible to both you and your child. You will need to wear a special protective apron whilst holding your child to prevent your own exposure to x-rays. If you are or could be pregnant, you must tell the radiographer; x-rays can be potentially harmful to unborn babies.
The radiographers who perform the x-rays will not know the results; the images need to be reported by a consultant radiologist and the results will be discussed with you by the doctor looking after your child.
Sometimes recent injuries are not visible until they start to heal, and will only be seen on x-rays obtained later. The skeletal survey examination is not complete until a second, shorter series of around 8 images has been taken 11-14 days after the first series. You will be given an appointment to bring your child back for these images.
CT brain scan
Injuries to the brain can occur without any apparent injury to the outside of the head. A CT scan of the brain allows such injuries to be seen. The scan is performed by experienced radiographers to produce images of the brain and skull. Your child will need to lie very still, although the scan is relatively quick; it will take around 10 minutes. Occasionally sedation may be required, and this will be discussed with you by the doctor looking after your child. You will not be able to stay with your child during the CT scan if you are, or could be, pregnant. The scans will be reported by a consultant radiologist and the results will be discussed with you by the doctor looking after your child.
We are all exposed to natural background radiation, which is made up of cosmic rays and radon, from some foods and from the ground. Every x-ray gives us a small additional dose of radiation. A skeletal survey is equivalent to a few months’ background radiation. A CT brain scan is equivalent to about 18 months background radiation. These extra exposures to radiation slightly increase the lifetime cancer risk, but the increase in risk is very small. Before any x-ray or CT scan is performed, the potential risks of the radiation are carefully weighed against the benefits of the examination. Your child will not be exposed to any more radiation than is absolutely necessary.
Photographs
In order to keep an accurate record of any visible injuries or marks your child may have, photographs may need to be taken. These photographs will form part of your child’s hospital notes, and will be stored securely. The photographs will be bound by the same strict duties of confidentiality as any other health information. The photographs may be shown to other professionals directly involved in the care of your child as part of any ongoing safeguarding investigation. As part of an ongoing investigation, other doctors with specific skills and experience in safeguarding children may be asked to give their opinion on the cause of any injuries or marks. Copies of the photographs may be released for court purposes on the direct order of a Judge.
Who else can I ask for information and support?
We recognise that this is a very stressful time for parents and we understand you will need help and support. Within the hospital, if you have any concerns or questions about what is happening please ask to speak to the nurse and doctor looking after your child. Your GP and Health Visitor will also be informed about what is happening and will be able to provide additional support.
Further information about x-rays and radiation can be found at;
NHS choices – Radiation www.nhs.uk/conditions/Radiation/Pages/Introduction.aspx
Gov UK – Radiation; risks from low levels of ionising radiation www.gov.uk/government/collections/radiation-risks-from-low-levels-of-ionising-radiation
Contacts
Named Doctor for Safeguarding Children 0191 4452192
Named Nurse for Safeguarding Children 0191 4452049