3/3/2023 0 Comments Officetime proThey said this showed that concerns about “staff underestimating the seriousness of bruising in infants seems to have led to an exaggeration of risk in these procedures and diminution in discretion for front-line staff, with the potential for harmful over-reaction”. They also found that 18 policies said that accidental bruising was very rare and highly predictive of non-accidental injury, with 35 saying that serious case reviews had shown that staff had underestimated the seriousness of bruising, leading to more significant injuries being missed. The 35 who followed one or other route was up from 13 identified as doing so in 2016, based on analysis of 91 available policies on bruising ( Bilson, 2018).īilson and Talia found that, as in 2016, most policies required an immediate referral to children’s social care and an assessment of the bruising by a paediatrician, with the police called if parents refused for their child to be seen by a health professional. Under Working Together to Safeguard Children, strategy discussions should take place when there is reasonable cause to suspect that a child is suffering, or is likely to suffer, significant harm, and should determine whether a section 47 enquiry should take place. More councils automatically triggering child protection processesĭespite this, Bilson and Talia found that increasing numbers of councils were automatically triggering child protection processes where bruising was identified in a pre-mobile infant.Īn analysis they conducted of published policies on bruising, covering 148 of the 152 English local authorities, found seven councils automatically initiated a section 47 enquiry while a further 28 required a required a strategy discussion to be held. “This challenges the idea that bruises in general are reliable indicators of future harm,” they said. They said one of the studies considered by the RCPCH ( Kemp et al, 2015) found 27% of pre-mobile infants had a bruise over an average of 7.6 weekly observations. In a yet unpublished paper, considered by the panel, social work academic social work academic Andy Bilson and mental health researcher Alessandro Talia, challenged the RCPCH’s view that accidental bruising was rare in pre-mobile infants. The panel said this meant that incidents were, though uncommon, not unknown. The panel’s briefing cited a 2020 evidence review by the Royal College of Paediatrics and Child Health (RCPCH) that found that the rate of accidental bruising among pre-mobile infants ranged from 0 to 1.3%.īut research papers that fed into this review found that rates among infants who were not yet rolling or crawling ranged from 0.6% to 5.3%, based on a single observation of them. The panel urged councils and their safeguarding partners to review their policies to ensure they were consistent with the evidence base and national guidelines. Also, a multi-agency discussion, involving the examining health professional and considering any other information on the family, should be held to determine whether any assessment or interventions to support the family or protect the child should follow. It said children should be examined by an appropriately qualified health professional, including to check whether a medical condition could have contributed to the bruising. The panel, whose role is to review and learn from serious cases, said it did not support policies that required section 47s or other interventions “without an initial appraisal of the circumstances of the presentation”. This was despite researchers finding that accidental bruising of pre-mobile infants was not rare. The Child Safeguarding Practice Review Panel made the call in a briefing published last week, as research found increasing numbers of authorities had policies that required a section 47 enquiry or a strategy discussion to decide whether such an enquiry should take place, in these cases. Councils should stop automatically triggering child protection enquiries under section 47 of the Children Act 1989 in response to bruising in pre-mobile infants, government advisers have said.
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