The Legal bits
Consent
Young people aged 16 & 17 are presumed in law to have capacity to consent for themselves. Younger children who fully understand what is involved in a proposed procedure may also give consent (although their parents would ideally be involved). In all other cases someone with parental responsibility must give consent on the child’s behalf. In an emergency a doctor may go ahead and treat a child without consent if it is in the child’s best interests to do so.
- Adults (>18yrs) are assumed to HAVE mental capacity until proven otherwise.
- Children (<16yrs) are assumed to LACK mental capacity until proven otherwise.
- Young people (16 & 17yr olds) are ASSUMED to have capacity to consent but CANNOT refuse treatment.
Young people aged 16 & 17 are presumed in law to have capacity to consent for themselves. Younger children who fully understand what is involved in a proposed procedure may also give consent (although their parents would ideally be involved). In all other cases someone with parental responsibility must give consent on the child’s behalf. In an emergency a doctor may go ahead and treat a child without consent if it is in the child’s best interests to do so.
Parental Responsibility
Parental responsibility refers to the rights & responsibilities that most parents have in respect of their children. It includes the right to consent to medical treatment on behalf of the child & the disclosure of information held by healthcare professionals about the child.
Doctors are not compelled to uphold the wishes of those with parental responsibility if they believe that they are contrary to the best interests of the child. However, if you find yourself in this situation you must discuss immediately with the senior doctor on duty.
So who has parental responsibility?
The father may acquire parental responsibility:
How do other people acquire parental responsibility?
In a consultation with a child, ALWAYS establish the NAME & RELATIONSHIP of those accompanying the child & document this.
Parental responsibility refers to the rights & responsibilities that most parents have in respect of their children. It includes the right to consent to medical treatment on behalf of the child & the disclosure of information held by healthcare professionals about the child.
Doctors are not compelled to uphold the wishes of those with parental responsibility if they believe that they are contrary to the best interests of the child. However, if you find yourself in this situation you must discuss immediately with the senior doctor on duty.
So who has parental responsibility?
- The child’s mother
- The father if he is married to the mother at the time of insemination or at the time of the child’s birth
- The father if he is named on the child’s birth certificate (after 01/12/2013).
The father may acquire parental responsibility:
- If he marries the mother
- By a written agreement with the mother
- By a court order
- If the father is appointed the child’s guardian following the mother’s death
How do other people acquire parental responsibility?
- Adoption (original parents cease to have parental responsibility).
- Guardian - parents with parental responsibility may appoint a guardian to acquire parental responsibility after their death (without involving a court).
- A residence order - when a child is effectively given to the care of another.
- A local authority named in a care order (parents do not lose parental responsibility).
- An applicant may be granted an emergency protection order but only has parental responsibility for the duration of the care order.
In a consultation with a child, ALWAYS establish the NAME & RELATIONSHIP of those accompanying the child & document this.
Safeguarding Children
You NEED to complete Level 3 Child Protection Training during your CT3 year. This is a one day course. For dates email: plh-tr.safeguarding@nhs.net
Definition
Child abuse or maltreatment consist of anything which individuals, institutions or processes do, or fail to do, which directly or indirectly harms children or damages their prospects of safe or healthy development into adulthood.
ED Management
There are cases where there are direct concerns about the safety of a child. Children may make an allegation themselves or they may be brought in by a parents or other concerned individual such as a teacher or the police. However, many cases of child abuse present as an accidental injury but suspicion is aroused for some reason whilst the child is in the department. You must continually keep the possibility of abuse in mind when seeing children. Additionally, it is also important to remember that we may have concerns about a child in whom the parent or carer is our patient and the child is not actually in the department.
Consult HAS for any alerts on the system; those who have a current protection plan in place should be identified. Children’s social care will have a current list of all children who have a child protection plan in place. The list is updated on a weekly basis. If a child who is subject to a child protection plan presents to the department you MUST notify children’s social care of the attendance immediately even if you have no concerns about the actual attendance. Nursing staff are also a useful source of information regarding concerning behaviour within the department.
History
Consider non-accidental injury (NAI) in the following:
Examination
Consider NAI in all children but especially when you find the following:
Further Assessment & Examination
Treat any injuries requiring immediate management. If child maltreatment is suspected a wider examination & evaluation will be required but ED may not be the right place for this. Discuss the case with a senior ED doctor who will advise regarding referral to the paediatrician on call. Ensure the nurse in charge is aware of your concerns. If you suspect child abuse the child MUST NOT leave the department. If the parents do leave the ED with the child, inform Children’s social care who will consider the appropriate action e.g. police involvement and emergency protection orders.
You NEED to complete Level 3 Child Protection Training during your CT3 year. This is a one day course. For dates email: plh-tr.safeguarding@nhs.net
Definition
Child abuse or maltreatment consist of anything which individuals, institutions or processes do, or fail to do, which directly or indirectly harms children or damages their prospects of safe or healthy development into adulthood.
ED Management
There are cases where there are direct concerns about the safety of a child. Children may make an allegation themselves or they may be brought in by a parents or other concerned individual such as a teacher or the police. However, many cases of child abuse present as an accidental injury but suspicion is aroused for some reason whilst the child is in the department. You must continually keep the possibility of abuse in mind when seeing children. Additionally, it is also important to remember that we may have concerns about a child in whom the parent or carer is our patient and the child is not actually in the department.
Consult HAS for any alerts on the system; those who have a current protection plan in place should be identified. Children’s social care will have a current list of all children who have a child protection plan in place. The list is updated on a weekly basis. If a child who is subject to a child protection plan presents to the department you MUST notify children’s social care of the attendance immediately even if you have no concerns about the actual attendance. Nursing staff are also a useful source of information regarding concerning behaviour within the department.
History
Consider non-accidental injury (NAI) in the following:
- When there has been a delay between the accident happening & the parents attending for advice.
- When there is inconsistence between the story given & the injuries seen.
- When there is a changing history.
- When there are frequent attendances at the ED.
Examination
Consider NAI in all children but especially when you find the following:
- Bruising of fracture in a child <1yr of age.
- Bruising to the face, cheeks, around the mouth or ear.
- Tearing of the frenulum of the upper lip.
- Small bruises in unusual places e.g. base of neck that could have been caused by holding a child abnormally.
- Bruises of different ages.
- Evidence of older injuries.
- Injuries to the perineum.
- Failure to thrive.
Further Assessment & Examination
Treat any injuries requiring immediate management. If child maltreatment is suspected a wider examination & evaluation will be required but ED may not be the right place for this. Discuss the case with a senior ED doctor who will advise regarding referral to the paediatrician on call. Ensure the nurse in charge is aware of your concerns. If you suspect child abuse the child MUST NOT leave the department. If the parents do leave the ED with the child, inform Children’s social care who will consider the appropriate action e.g. police involvement and emergency protection orders.
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Referral protocols
If you suspect abuse you must act. Remember that abuse escalates & if you fail to act a child may suffer serious injury or die. Inform the senior ED doctor about your concern as the child will need to be referred to the on call paediatrician when the child will definitely require a physical examination & to Children’s social care when there is a concern about safety & a more detailed assessment will be required. The on call paediatrician for safeguarding children can be contacted via switchboard in hours. If out of hours discuss with the paediatric registrar on call (779 0415). You will also need to complete a safeguarding referral form. This has recently moved to an electronic form via SALUS. This system is for children up to their 18th birthday only. |
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- Click on patient summary & enter the patient’s hospital number.
- Select the patient by clicking on the blue/pink bar with the patient’s name.
- Drop down boxes will appear, hover over “data forms” safeguarding, SCMAF and click “create new”.
- Complete all boxes and save.
- A green confirmation box should appear.
- Click on PDF button & print a copy for the patient notes.
Children in care
If a child in under the care of the local authority presents to the ED the children in care team must be notified of their attendance even if you have no concerns around safeguarding for that particular episode.
