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

and child protection orders) to protect them and safeguard their welfare. The
research studied 50 cases of children less than two years referred to the
Reporter. These children had difficult family backgrounds:
Most parents were unemployed.
Two thirds of the children had parents with drug and or alcohol addictions.
Over a half of the children’s parents had mental ill health.
Three quarters of children had parents with histories of offending and 10%
of fathers had been charged with sexual offences.
20% of children had a parent who had been in prison.
A range of services and professionals were involved with the children and their
families – pre- and post-birth of the child.
However, not all parents were prepared to engage with the services being
offered and that was especially the case of parents who had very chaotic
lifestyles. For 20% of the cases there were serious concerns about males in the
child’s home due to their volatile, adverse and violent behaviour. Half of the
families had housing problems with poor or inadequate accommodation,
homelessness and transient lifestyles and there was evidence that parents
chaotic lifestyles were impacting on their children.
Infants (i.e. children under the age of one year) may present with various
potential child protection concerns as above and there must be a low threshold
for raising concern and for suspicion of abuse particularly where infants present
with injuries. For example “those who don’t cruise, rarely bruise” (Sugar, Taylor
and Feldman, 1999).
A systematic review of the international literature in infants under the age of six
months suggests that any bruising on an infant under six months must be fully
evaluated and a detailed history taken to ascertain the consistency with the
injury. Non-mobile children should not have bruises without a clear and usually
observed explanation. There are a range of physical injuries, that in their own
right if presented, in an infant should immediately prompt the practitioner to
ensure that full history is taken, general examination and full investigations are
performed, including full photography and progression to look for internal injuries.
The presence of an injury in an infant frequently indicates more severe abuse
and the possibility of other internal injuries must always be considered, for
example brain or abdomen or bony skeleton. Any inconsistent history for an
injury must raise suspicion. Even where a potentially plausible accidental history
is provided for any concerning injury in an infant the fullest information must be
sought from primary, secondary and tertiary health services, as well as from
social work and other agencies as appropriate, prior to discharge of a child from
an inpatient or out patient health setting. Many instances have been described
particularly through serious case reviews where accidental histories have been
accepted from a parent or carer without attempt to validate the history via a third
party or without gleaning further information. Many of these cases where this
rigour has not been applied have resulted in more serious injuries occurring to
those infants, sometimes within weeks and or months and some have resulted in
death. These are particularly high risk cases. In light of this, some Health Boards
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