Thinking differently about Child Protection in the ED

Child protection is sadly a huge part of our workload in ED.

As society and the world in general becomes increasingly complicated, it might be outdated to only think of child abuse in the four domains we were traditionally taught about (emotional abuse, physical abuse, neglect, sexual abuse) – there are some forms of abuse or potential harm that don’t sit neatly in any of those corners. Unless we start to think about child protection differently, some very vulnerable children might slip through the net.


Four ‘traditional’ categories of child abuse… outdated?

I write this after attending the RCPCH conference in Liverpool. During the ‘hot topics in PEM’ session, Dr Deirdre O’Donnell from Sheffield Children’s Hospital talked about reframing our thinking around child protection, and it really struck a cord with me.

More and more issues now seem to come under the huge ‘umbrella’ of child protection. Issues that – thank goodness – definitely weren’t issues most of us faced when WE were children/teenagers – I’m talking cyber bullying, online grooming, ‘legal highs’, self harm.

Then there are the global child health issues that increasingly find their way to our emergency departments. FGM, child trafficking, unaccompanied refugees, children who have suffered the effects of war.

Instead of those four neat little boxes, we might need to have a new model which reflects how complex this business of child protection has become.

Dr O’Donnell suggested thinking about a set of ‘bubbles’ with the child at the centre… thinking about these different aspects of a child’s life changes the questions we ask ourselves when thinking about whether they are safe, or whether they are vulnerable to harm.

CP 1

And here’s what I came up with after a couple of minutes of thinking around this new framework:

CP 2

(in case you can’t read the tiny writing):

child – self harm, mental health, disability, vaccines

family – safety, supervision, family members, discipline (inappropriate?), health promotion

relationships – boyfriends/girlfriends/sexuality, understanding of consent? Bullying at school, online relationships, cyber bullying, grooming, sexual exploitation

community – deprivation, austrity, food poverty, gangs, housing, FGM, unemployment, access to services

society – war, refugees, migration, trafficking, radicalisation

Many of these issues would span two or three of the little boxes at the top of the page. Our world and our patients are getting more complex, so our approach to protecting the most vulnerable should adapt with the times.



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