Table 2 Quality standards and recommendations
DomainQuality standards/recommendations for good practice
Development of guidelinesAll local protocols must concur with Local Safeguarding Children Board (LSCB) guidelines and with national guidelines (Working together to safeguard children; what to do if you’re worried a child is being abused)
All protocols should indicate clearly the author(s); Trust and Local Safeguarding Board endorsement; date of publication; date for review; and any evidence base used
Protocols should be clearly laid out with appropriate subheadings and a contents or index to enable staff to identify information quickly
References and sources of further information should be clearly signposted
Protocols should be brief, ideally no more than 4 pages in length, with a single page flowchart summarising the procedure to be followed
Child centerednessThe welfare of the child must be the prime consideration throughout any departmental protocol
For any child attending an emergency department, the first responsibility of the staff is to attend to that child’s needs. Medical treatment, including treatment of injuries and administration of analgesia, should not be delayed because of concerns about possible child abuse or neglect
Roles and responsibilitiesProtocols should incorporate both nursing and medical management
Child protection is everyone’s responsibility. All staff must be able to act on their concerns
There should be a clear description of different professionals’ additional responsibilities in relation to child protection
Staff should know who to contact if they have concerns about possible abuse or neglect
Each department should have opportunities for regular liaison with an experienced child protection practitioner
IdentificationThere is currently no evidence that any screening tools help in the identification or management of child abuse
If a checklist is used to aid recognition of possible child abuse, it should be brief (no more than 8 items), specific and clear in its use. Staff should be reminded that a checklist may act as an aide-memoire, and should not exclude the use of clinical acumen
The presence of a child’s name on the child protection register, or any other database, should not be used as an indicator of risk, nor should it be used as the sole basis for decision making in relation to possible concern. It is nevertheless an important piece of information that may or may not be directly relevant to the presentation
All emergency department attendances should be notified to the child’s primary care team
Referral processIf a member of staff has concerns about a child’s welfare, they should discuss these concerns with a senior colleague
If, following discussion with a senior colleague, concerns persist, the practitioner should refer the child to social services, following this up in writing within 48 h
There should be clear plans for emergency management if there are immediate concerns about the safety of a child, or if a child is removed from the department inappropriately
Subsequent managementIf a child needs admission to a ward, there should be clear procedures which include full handover and transfer of responsibilities. Do not assume that the initial concerns will be followed up by the inpatient team
No child for whom there are concerns about possible maltreatment should be discharged from the department without a clear plan of management, including appropriate follow up
For minor injuries units and other small units, procedures need to be in place to facilitate good liaison between the small unit and any larger referral unit providing support and secondary care; small units should be able to evaluate and act on child protection concerns in accordance with local LSCB guidelines
Interagency working, information sharing, consent and confidentialityStaff should be encouraged to share concerns with other agencies, to respond to requests for information in relation to child protection, and to question other professionals where there are differences in opinion
Concerns about possible child abuse or neglect should normally be shared openly with the parents or carers unless to do so might further increase the risk to the child, or could compromise any criminal investigation
Consent to examination or any investigations should normally be obtained from a person with parental responsibility and from the child, providing he/she is competent to give such consent