Child Protection Companion

Your handbook on all forms of child abuse, looking across the whole range of medical and social interactions: from examination, to identification, to referral, to court

The Child Protection Companion (CPC) describes the essential context and the pathway of child protection cases, beginning with the medical assessment, a discrete chapter on each form of maltreatment, and continuing through to court and training.

Paediatricians may encounter child protection cases in any setting. The aims of the Child Protection Companion (CPC) are to:

  • Ensure that paediatricians are aware of, and understand, their role in the multiagency safeguarding children process
  • Assist paediatricians in their evidence-based practice and to enable them to recognise, assess, investigate and manage cases of suspected child maltreatment

Focus on the paediatric role in identifying maltreatment and to build upon and complement guidance from other organisations, such as the 2017 National Institute for Health and Care Excellence (NICE) clinical guideline CG89, Child maltreatment: when to suspect maltreatment in under 18s1.

We hope this publication will contribute to the following broader objectives:

  • Raise awareness that safeguarding children is everyone’s business
  • Promote and safeguard the welfare of children
  • Promote multidisciplinary and multiagency working
  • Ensure that paediatricians are acting in accordance with statutory and non-statutory guidance and legislation
  • Ensure that paediatricians know when and how to seek advice from others
  • Inform evidence-based practice where possible
  • Support professionals in this difficult area of work
  • Contribute to improved documentation, information sharing and communication
  • Improve outcomes for, and the wellbeing of, children and young people.

Target audience

This document is aimed primarily at paediatricians working in the UK; however, other healthcare and non-healthcare professionals working in the multi-agency child protection process may also find it useful.

Evidence base

The document is based on the best available evidence at the time of writing and subsequent publication. Where statements are made, they are referenced where possible. It is noted, however, that in many areas there is a paucity of high-quality, reliable evidenced-based research. New evidence, at any time, could invalidate the findings and it is therefore the reader’s responsibility to keep abreast of new literature. It is expected that the reader will be relying on appropriate professional knowledge and expertise to interpret the contents in the context of the circumstances of the individual child.

This document acts as a guidance and should not be used as a prescriptive document. Paediatricians should always act in the best interest of the child or young person using their clinical knowledge, skills and judgement.

All healthcare professionals and paediatricians using the CPC should have due regard to the Good Practice Recommendations and Implications for Practice sections, noting that they have been made based on the current legislation, guidance, research and scientific evidence available to authors at the time of publication. They should be applied and considered in context, and when practitioners are using the references from this document they should be familiar with the entirety of the reference to use it appropriately.

In December 2017 the CPC moved to an online format, where it became a living/dynamic document, facilitating continual editing and updating on a chapter-by-chapter basis in light of the changing scientific evidence base and national strategy, policy, legislation and guidance.

A note at the start of each chapter is provided, indicating its update status and when it was last updated. Chapters remain available in a downloadable PDF format for print.

Chapter updates are overseen by a dedicated RCPCH Child Protection Systematic Reviews and Publications Subcommittee and are led by nominated clinical experts in the specific field. Updates are peer-reviewed and quality assured by expert reviewers, the Royal College of Paediatrics and Child Health (RCPCH) Child Protection Standing Committee and Child Protection Systematic Reviews and Publications Subcommittee. The Publication Co-Leads of the Child Protection Systematic Reviews and Publications Subcommittee provide a final review of the chapter ahead of the subcommittee signing off the update for publication onto PCO UK.

The CPC comprises a mix of policy and evidence-based chapters. Chapters 9 (Recognition of Physical Abuse) and 11 (Neglect) are updated based on evidence from the RCPCH Child Protection Evidence systematic reviews, while chapter 10 (Child Sexual Abuse) is updated based on evidence from the 2015 RCPCH Physical Signs of Child Sexual Abuse evidence-based review publication (also known as the ‘Purple Book’). The remaining chapters are being updated in accordance with current child protection legislation, national clinical guidelines and child protection policies across the devolved nations.

We gratefully acknowledge the significant contributions as an author or a reviewer; or, in many cases, a combination of both, made by the following during the update the latest Child Protection Companion, from 2017 onwards.

Contributing authors, reviewers and consultees of the 2013 edition can be viewed here.

RCPCH committee members

Child Protection Standing Committee

  • Dr Alison Steele – RCPCH Officer for Child Protection (from 2018)
  • Dr Elaine Burfitt
  • Dr Simon Clark
  • Dr Marianne Cochrane
  • Dr Peter Green
  • Dr Gayle Hann
  • Dr Paul de Keyser
  • Dr Alison Livingstone
  • Dr Kate McKay
  • Professor Jacqueline Mok (to 2018)
  • Dr Claire Meager
  • Ms Pam Miller
  • Dr Lorna Price
  • Dr Fiona Straw
  • Dr Linda Teebay
  • Dr Emilia Wawrzkowicz
  • DR Vicki Walker

Child Protection Research & Publications Sub-Committee

  • Dr Alison Steele – RCPCH Officer for Child Protection (from 2018)
  • Dr Emilia Wawrzkowicz – Assistant Officer for Child Protection (Publications) (from 2019) / Co-Lead for Publications (to 2019)
  • Professor Alison Kemp
  • Dr Francesca Norris
  • Dr Ingrid Prosser
  • Dr Rebecca Sands
  • Dr Paras Sharma
  • Dr Hilary Smith (retired)

Contributing authors, reviewers and consulteer (2017 update onwards)

  • Dr Folashade Alu
  • Dr Richard Brown
  • Dr Elaine Burfitt
  • Dr Nicola Cleghorn
  • Dr Steve Cronin
  • Dr Sarah Dixon
  • Dr James Fraser
  • Dr Karena Fraser
  • Dr Gayle Hann
  • Dr Jenny Harris
  • Dr Deborah Hodes
  • Ellie Johnson
  • Professor Jacqueline Mok
  • Dr Alison Mott
  • Dr Aideen Naughton
  • Dr Christine Park
  • Dr Lorna Price
  • Dr Carolyn Sampeys
  • Dr Lynn Snow
  • Dr Ian Sugarman
  • Dr Alison Steele
  • Suma Surendranath
  • Dr Linda Teebay

RCPCH support staff

  • Sara Haveron
  • Alison Firth
  • Melissa Ashe
  • Lisa Cummins
  • Kerry Garfitt

Copyright of the Child Protection Companion (CPC) publication is held exclusively by the Royal College of Paediatrics and Child Health (RCPCH) and complete or large-scale reproduction of the material contained in this document for the purposes of profit-making is strictly prohibited.

The RCPCH recognises that terminology referred to throughout the CPC is based primarily on English law, legislation and guidance. Where appropriate, consideration has been given to the differences in policy and practice in Scotland, Wales and Northern Ireland and the legal differences in Scotland.

The CPC is for use by healthcare professionals and paediatricians in child protection cases. It is based on the best available evidence at the time of writing and subsequent publication. New evidence, at any time, could invalidate the findings and it is therefore the reader’s responsibility to keep abreast of new literature. It is expected that the reader will be relying on appropriate professional knowledge and expertise to interpret the contents in the context of the circumstances of the individual child.

It is worth noting that those using this publication must use their own clinical judgment when assessing each individual child, as each case is different and must be considered carefully on its own merits. All information and evidence provided within the CPC should be used in conjunction with other appropriate and up-to-date literature and, where necessary, supplemented by expert advice.

The authors of the CPC have attempted as far as possible to use relevant, up-to-date and interactive links to other guidance and publications, and this will be reviewed on a regular basis where possible.

All healthcare professionals and paediatricians using the CPC should have due regard to the Good Practice Recommendations and Implications for Practice section, noting that they have been made based on the current legislation, guidance, research and scientific evidence available to authors at the time of publication. They should be applied and considered in context, and when practitioners are using the references from this document they should be familiar with the entirety of the reference to use it appropriately.

All paediatricians should recognise the boundaries of their own knowledge and expertise and seek further guidance from colleagues such as Named and Designated Professionals (e.g. safeguarding) in the event of complex cases.

If you wish to seek permission to reuse RCPCH-copyrighted material, please visit the dedicated page ‘Rights and permissions for reuse of RCPCH-copyrighted material’ for more information.

References

(1)

NICE (2017). Child maltreatment: when to suspect maltreatment in under 18s (update). Available from https://www.nice.org.uk/guidance/cg89