Why is this document important?
Pharmacists have a professional, legal and moral duty to protect children from abuse or neglect and to work with other organisations and authorities to safeguard children.
What this document does not cover
This is not intended to be comprehensive guidance on child protection legislation and does not include statistical data.
- Identify and recognise signs of abuse or neglect
- Act on signs of abuse or neglect
Possible signs of child abuse or neglect
It is important to remember firstly that these lists of signs are not exhaustive, and that a series of 'minor' factors could also indicate child abuse or neglect.
Also the presence of one or more of these signs may not necessarily indicate child abuse or neglect.
- Injuries which are unusual or unexplained
- Injuries in inaccessible places e.g. neck, armpit, behind ears, soles of feet
- Bite marks, scalds, fingertip bruising, fractures
- Age of injuries inconsistent with account given by adult
- Injuries blamed on siblings
- Repeated injury.
- Failure to thrive – poor growth and weight
- Poor hygiene, dirty and unkempt
- Inappropriate food or drink (e.g. non-foodstuffs, soiled foodstuffs, alcohol etc).
- Evidence of self-harm/self-mutilation
- Behavioural problems e.g. aggression, hyperactivity, nervousness, social withdrawal
- Inappropriate verbal abuse
- Fear of adults or a certain adult.
(See also section on sexual activity in children below)
- Indication of sexually transmitted disease
- Evidence of sexual activity or relationship that is inappropriate to the child’s age or competence.
- Delays seeking medical treatment or advice and/or reluctant to allow treatment
- Detachment from the child
- Lacks concern at the severity or extent of injury
- Is reluctant to give information
- Aggressive towards child or children.
What to do if child abuse is suspected
You should follow local child protection procedures where these are available if not the outline process below may be useful.
Where you consider the nature of the child abuse to be an emergency then the police should be contacted.
Otherwise make a decision on next steps such referring to local social services where appropriate or taking further advice. You should feel comfortable with sharing concerns and suspicions of abuse, even where these are not proven facts with social services.
You should not attempt to investigate suspicions or allegations of abuse directly.
Sources of advice
- Named child protection professional within your organisation, PCT, or Health Board. The named individual and their contact number
- Child’s general practitioner
- Peers or senior colleagues
- NSPCC Helpline 0808 800 5000
- Referring to social services: local social services name(s) and number
- Referring to police: details of local police child protection officer. name and number
If referral is by telephone, then confirm the referral in writing within 48 hours using standard local referral forms where these exist. An acknowledgement should be received within one working day of receipt and if this is not received within three working days then social services should be contacted again.
Make appropriate records of concerns and suspicions decisions taken and reasons whether or not further action was taken on a particular occasion.
Sexual activity in children
Children under the age of 13 are legally too young to consent to any sexual activity. Instances should be treated seriously with a presumption that the case should be reported to social services, unless there are exceptional circumstances backed by documented reasons for not sharing information.
Sexual activity with children under the age of 16 is also an offence but may be consensual. The law is not intended to prosecute mutually agreed sexual activity between young people of a similar age, unless it involves abuse or exploitation.
You can provide contraception (e.g. on prescription or under PGD) or sexual health advice to a child under 16 and the general duty of patient confidentiality applies, so consent should be sought whenever possible prior to disclosing patient information. This duty is not absolute and information may be shared if you judge on a case-by-case basis that sharing is in the child’s best interest (e.g. to prevent harm to the child or where the child’s welfare overrides the need to keep information confidential).
Remember that it is possible to seek advice from experts without disclosing identifiable details of a child and breaking patient confidentiality – and that where there is a decision to share information, this should be proportionate.