Dr Caroline Fertleman discusses the triggers for action when you have concerns about a child's welfare
In part one we looked at how Dr Fertleman presented scenarios that gave the dental team concern about the way children had been treated. In this concluding article we look at situations that might prove a trigger to action – and how we should act.
28-year-old Mike visits the dental surgery for a routine check-up. He brings 7-year-old Johnny along with him. While Mike is in the chair Johnny plays with some toys and becomes frustrated because one of the toys is broken. He brings it to his father who pushes him away saying, “Go away, I’m talking to the dentist”.
As they are leaving Johnny falls over and his father berates him, “Get up, I haven’t got time for this! Do you want to lose me my job? Come on, get up!”
Dr Fertleman asked what we thought about this situation. How many times have we seen this scenario? The answer came back, quite often, especially in the supermarket. So what do you do when it happens in the practice?
Answer, write it down. The father is being emotionally abusive so make a verbatim note of what has been said and include the fact that you felt uncomfortable. Ask other people in the team what they saw and heard, ask them what they felt about it.
It is important to be nice to the child; and to ask yourself – is this a one-off? Is the father having a terrible day? Always consider such situations in context, if there’s a chance ask Mike if he’s okay. Keep a note of his answers – but, be aware of the bigger picture. It may be time to take action, what do you do now?
You have concerns
Dr Fertleman gets ready to "cross the threshold"
What words should you use if you need to confront a parent?
If the child has suspicious bruising or injuries:
“I am concerned about the injury and we need to address this.”
If you are taking your concerns further:
“I am worried about the child. I have informed Social Care and we need to talk about this.”
Or: “Social Care is the statutory agency that deals with situations like this. We will work together to sort this out.”
Never use euphemisms; a concerned adult is duty-bound to protect a child they believe to be at risk and should step forward. The only time not to do so is if you fear the parent might kill the child as a result. That would be the time to contact the police or Social care services and outline your fears. However, this would be rare, so we need to think about how to present your concerns to the parent.
It is acceptable to use words like “I am duty-bound to raise my concerns”.
Say, “We don’t know how this happened and we need to work together to resolve this situation.” Or, “I have concerns and I am duty-bound to work with other agencies to find out what is happening.” If you tell the parent you will be referring your concerns to Social Care and they say no, that is a major red flag.
The Child in Need programme is there to support vulnerable people. They are working with 1.4 million people under the NHS, and 1.6 million people in Social Care. They must be doing something right.
There are also positive factors to consider: good housing, child in school, parents don’t abuse alcohol and enjoy a good financial status, and the family is supportive. In such a stable situation abuse is unlikely – but not impossible. What might trigger your concerns? What would make you step over that threshold and take action?
Even in the most secure seeming family there might be abuse in all the ways we have listed in these two articles. If you have worries talk to other people about them, find out what your team members think. A sense of collective discomfort about something you’ve all seen means reaching that threshold and taking action. It is our duty of care as adults; we must never turn a blind eye to a child we believe might be the victim of abuse.
To read Safeguarding children: Part one, click HERE.
Dr Fertleman is a consultant paediatrician. She has been a consultant at the Whittington Hospital and an honorary Senior Lecturer at University College London Medical School since 2005. Caroline has a special interest in medical education. She is the UCL Medical School site sub-dean and honorary senior lecturer at the UCL Institute of Child Health. She is also honorary consultant paediatrician at Great Ormond Street Hospital.