National guidance for child protection in Scotland - Scottish ...

Chapter 4 Medical Assessments in Child Abuse
This section:
Outlines which medical specialities examine children and young people.
Sets out the role of:
o GP services
o emergency and urgent care medical services
o emergency medicine services.
Outlines when to request a medical assessment.
Describes the types of medical examination in child protection.
Some medical specialities will regularly see vulnerable children in their practice
(child and adolescent psychiatry, paediatric specialties). Other medical
specialities see adults where risk factors may exist which increase the potential
risk to the wellbeing or actual harm to children and young people (e.g. mental
health, addictions, or learning disability). Some services will see both children
and adults; these include primary care and emergency medicine. In addition,
Obstetrics will deal with pregnant women who may be vulnerable.
The medical, nursing and AHPs who work in these specialities will require to
have high levels of competency and skill in managing vulnerable families and
children, and should complete additional training to ensure they are able to
recognise concerns to wellbeing, the signs and symptoms of child abuse and risk
factors which make child abuse more likely.
All staff should know who to seek further advice and support from if they are
concerned about a child’s care and protection. Medical practitioners will have
specific responsibilities regarding decision making, interpretation of injury and
giving an opinion about the probability of abuse.
All doctors who provide care for children and young people must be aware of the
signs and symptoms of abuse and neglect. They must also be aware of any other
factors which increase the risk of abuse especially parental factors such as
mental health problems, domestic abuse, drug and alcohol addiction, and
learning disabilities.
Doctors must listen carefully to the history from the carer and the child or young
person if it is appropriate and observe the child or young person to take into
account the whole picture of the child or young person. If appropriate, the views
of the child or young person themselves should be taken. They must seek an
explanation for any presentation in an open and non-judgemental manner. The
doctor must record all concerns as well as, exactly what is observed and heard
from whom and when. Doctors must be direct, honest and empathetic with the
parents but focus on the needs of the child or young person especially the care
and protection of the child or young person. After examination, the doctor should
explain any concerns about their observations and indicate their role in the
protection of the child or young person to the parents, and seek senior opinion or
follow local child protection health guidelines to access further advice.
Doctors must speak directly to social work services if they have
a serious concern of abuse about any child or young person.
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