Aims/Objectives/Background This study aims to evaluate changes to child safeguarding attendances to the emergency department (ED) during the lockdown period 1st of March till 31st May 2020 compared to the same time period in 2019.

The COVID-19 pandemic is the defining health crisis of our time and the first time firm social restrictions have been imposed since safeguarding practices have become embedded in the NHS. The NSPCC reported a large increase in contacts but there remain concerns that vulnerable children are invisible to agencies during this time.

Methods/Design All children (< 18 years) who attended King’s College Hospital’s ED, and were reviewed in the weekly ED safeguarding meeting were included. Data was collected from electronic patient records for different parameters.

Results/Conclusions The total number of children presenting via ED for safeguarding review fell from 865 in 2019 to 355 for the same period in 2020. However, the proportion requiring action by the hospital safeguarding team showed a significant increase (p= 1.5 x 10^-4) suggesting the severity of cases during COVID-19 is worse.

The percentage of stabbings doubled (p=0.04) despite lockdown measures. This may be a contributor to the significant increase in referral to youth workers (p=8 × 10^-4). The number of children attending who were considered high risk due to previous safeguarding concerns dropped by 75%.

As expected, the proportion of household injuries such as accidental ingestion and burns showed a significant increase (p=0.01 and p=0.002 respectively). The proportion of children from outside of our local boroughs was surprisingly higher in 2020 (p=0.03).

The findings show that the number of cases triggering a safeguarding review has dropped during lockdown and raises concerns about vulnerable children who remain hidden. The findings also suggest an increased severity of safeguarding presentations, supporting our fears that the implications of lockdown on vulnerable children is yet to be realised.