The below resources have been created by trainees and supervisor, as well as children and young people, about the Safeguarding domain in the Progress+ curriculum domain.
What children and young people say
Doctors need to know that sometimes children's hearts are broken and we are not always happy
We asked CYP what they think keeps them safe and the told us:
- Having trusted adults to talk to
- Having safe places to go to spend time with friends
- Not being judged by services or staff for having a social worker
See more in our CYP flyer below
How to use this in your everyday practice
Dr Will Christian and Dr Lucy Bott for Safeguarding at UHBW Trust, explore how safeguarding practice develops throughout the RCPCH Progress+ curriculum. Using case-based examples, they illustrate how trainees progress from recognising and escalating concerns to coordinating care and leading multi-agency responses.
Progression means moving from identifying and escalating to leading and coordinating.
Case studies
- Patient presenting to acute paediatrics with incidental finding of obesity
Setting: General paediatric on-call
How did the opportunity arise? You are the paediatric ST4 working the night shift at a busy district general hospital. Your FY2 (foundation year) colleague has just seen a six week old with difficulty breathing. During the examination she notices a bruise on the cheek and asks your advice on further management.
What happened? As the senior clinician on duty you need to recognise that this finding may well represent non-accidental injury, especially in a non-mobile infant. You need to speak to the parents yourself to ask about the bruise, examine the child fully and document your findings on body maps.
You need to liaise with children’s social care, the safeguarding named nurse and doctor and admit the child for further investigation and speak to the family about the plan. You should also phone and speak to the consultant on call so they are aware of this child and can offer advice on any other immediate management.
How did this support your development? This situation is not uncommon in paediatrics and can often feel daunting. Being up front with families about the management plan and the reasons further investigations are required can help foster good relationships with them.
This is a situation that demands a multi-professional approach as the observations of all staff looking after this child will be very important. It is also important to make the time to discuss the case with your FY2 and given them a chance to debrief as this may be the first time they have been in this situation.
Any practical tips? Utilise your hospital’s safeguarding team (named nurse and doctor for child safeguarding) who have vast experience in these kinds of situations and will be able to offer you advice and support.
Make sure you document your findings clearly during or immediately after your consultation, including using body maps. You may have to write a statement and it is much easier with detailed contemporaneous notes.
- Patient under court order
Setting: Neonatal on-call
How did the opportunity arise? You are the paediatric ST6 working the night shift on the neonatal unit at a busy district general hospital. A baby on the unit is due to be taken in to foster care the following day following a court order. The child’s birth mother manages to get into the unit and starts shouting at the nurses that she wants to see her baby and take him home.
What happened? As the senior clinician on duty you need to recognise that this represents a serious safeguarding issue. The immediate concern is the safety of the child and your colleagues and you should phone the hospital security team. In the meantime, you should talk to the mother, ideally away from the cot space.
This is clearly a very stressful situation for her and it is important to try and understand what she is thinking. Once she has calmed down, it may be that she is able to spend some time with the baby but this will depend on visiting rights and must be done in conjunction with your senior nursing colleagues. When appropriate, you should let the consultant on call and social services know, too.
How did this support your development? Parents get angry, especially in a situation like this. The safety and wellbeing of the child must be your main concern. Efforts to understand where this mother is coming from are likely to result in her calming down, at least a bit. You need to exercise your professional judgement, in conjunction with nursing colleagues, about whether the mother can spend some time with her baby. Clear written documentation is essential so that teams on duty after you have an idea of what has happened.
Any practical tips? It is really helpful to have an overview of the visiting arrangements for all babies on the unit when you take handover. The nursing staff will usually have documentation too but in situations like this it is useful to know who is allowed to visit the baby and when.
Neonatal units all have some kind of quiet room and difficult conversations are almost always best had in one of these. This is a very emotive situation for the mother and it may be easier and more appropriate for other families to speak to her there.
Special thanks and acknowledgement to Dr Hannah Jacob and to all those who contributed in providing the content for this safeguarding domain.