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Pattern of hospital referrals of children at risk of maltreatment
  1. Ella Rachamim1,
  2. Deborah Hodes2,
  3. Ruth Gilbert3,
  4. Sonia Jenkins4
  1. 1Northern Health Centre, Islington PCT, London, UK
  2. 2University College London Hospital, London, UK
  3. 3Institute of Child Health, London, UK
  4. 4Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Deborah Hodes, c/o Kirsty Phillips, Safeguarding Team, UCLH, 250 Euston Road, 6th Floor Central, London NW1 2PG, UK; deborah.hodes{at}


Background Increasingly emergency departments (ED) and other acute services in the hospital provide first access care, especially out of hours and for poorer families. Studies of detection of child maltreatment in the hospital have focused on children presenting with injury, although maltreatment may be suspected when parents present to the hospital with problems related to violent behaviour, drug abuse or mental health problems.

Methods A consecutive case series is described of patients referred for suspected child maltreatment from one inner-city general hospital after training was given to clinical staff and 2 years after the creation of a new post comprising a full-time, experienced child protection advisor (CPA) on-site to support clinicians with concerns about child maltreatment.

Results There were 44 referrals to the CPA over 2 months in 2005, of whom just under half were initiated by clinicians caring for a parent. 15 referrals came from the ED (five followed a parent presenting to the ED), 14 from maternity obstetric services, and 15 from the neonatal or paediatric wards. Most families (38; 86%) were referred by nurses. One-quarter of referrals were already known to children's social care.

Conclusions Clinicians need to be aware that half the vulnerable children in hospital are identified through one or other parent. It is hypothesised that the availability of an experienced child protection advisor on-site, combined with child protection training, makes it possible for clinicians caring for adults with problems related to violence, drug abuse or acute mental illness, to take action to address the potential vulnerability of their children.

  • Emergency care systems
  • emergency departments
  • mental health
  • mental illness
  • nursing
  • paediatrics
  • non-accidental injury

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.