RCPCH Progress curriculum (domain 9 – Safeguarding)

The RCPCH curriculum ensures that doctors in postgraduate paediatric training in the UK develop their knowledge and skills across all key practice areas.

The safety of all children is paramount and the divine factor of all areas in paediatrics. This domain requires the trainee to consider safeguarding as an essential element of all aspects of paediatric healthcare practice be that with children and young people, parents and carers, other care professionals or colleagues.

These resources relate to the curriculum domain 9 – Safeguarding. They were developed with and by trainees, supervisors and children and young people.

What do children and young people say?

We asked what they think keeps them safe. Here’s some of what they had to say…

“Adults that we know and trust to speak with about things that are going on in our lives”

“Not being judged by services or staff – just because we have a social worker or need a bit of help doesn’t make us a bad person”

How paediatricians use this domain in their everyday practice

Dr Alison Steele, RCPCH Officer for Child Protection and Named Doctor for Safeguarding Children at Great Ormond Street Hospital (GOSH), talks about how safeguarding is an integral part of paediatric management and links to a wider range of paediatric skills and domains. She also explains how to develop and expand your safeguarding skills and evidence base.

Case study example

Case: Patient presenting to acute paediatrics with incidental finding of obesity

Setting: General paediatric on-call

How did the opportunity arise?

You are the paediatric ST4 working the night shift at a busy district general hospital. Your FY2 (foundation year) colleague has just seen a six week old with difficulty breathing. During the examination she notices a bruise on the cheek and asks your advice on further management.

What happened?

As the senior clinician on duty you need to recognise that this finding may well represent non-accidental injury, especially in a non-mobile infant. You need to speak to the parents yourself to ask about the bruise, examine the child fully and document your findings on body maps.

You need to liaise with children’s social care, the safeguarding named nurse and doctor and admit the child for further investigation and speak to the family about the plan. You should also phone and speak to the consultant on call so they are aware of this child and can offer advice on any other immediate management.

How did this support your development?

This situation is not uncommon in paediatrics and can often feel daunting. Being up front with families about the management plan and the reasons further investigations are required can help foster good relationships with them.

This is a situation that demands a multi-professional approach as the observations of all staff looking after this child will be very important. It is also important to make the time to discuss the case with your FY2 and given them a chance to debrief as this may be the first time they have been in this situation.

Any practical tips?

Utilise your hospital’s safeguarding team (named nurse and doctor for child safeguarding) who have vast experience in these kinds of situations and will be able to offer you advice and support.

Make sure you document your findings clearly during or immediately after your consultation, including using body maps. You may have to write a statement, and it is much easier with detailed contemporaneous notes.