What to do if you're worried about a child
The most important thing to remember if you are faced with a child who may have been abused is that you do not need to manage this on your own. It is also important to remember that your first duty is to the child and that you have the responsibility for dealing with any injury or dental needs. No child should be left untreated or in pain because of underlying concerns about abuse.
The Department of Health poster, ‘What To Do If You’re Worried A Child Is Being Abused: a flow chart for referral’ (see below)26 summarised how you should proceed. This forms the basis for our summary flow chart,
Child Protection and the Dental Team: flow chart for action.
Reproduced with permission of the Department of Health
Colleagues to consult
The first stage if you have any concerns should always be to discuss this with an appropriate colleague or someone else you can trust. This may be an experienced dentist, a senior dental nurse, a paediatrician, child protection nurse or a social worker (see
Finding your local contacts). In the salaried primary dental care services close working relationships often exist with health visitors and school nurses, some of whom are highly experienced in child protection and may be a source of helpful advice. All local hospital and community health services should have Named nurses and doctors to provide advice and support for all issues related to safeguarding.
Advice on whom to consult and what to do
if you are worried about domestic abuse or parental mental health issues has already been given.
Making a referral
If, having discussed it with an appropriate colleague, you remain concerned, then you should make a referral to your local children's services (formerly social services). You should already have identified where and how to contact your children's services team (see Finding your local contacts). Referrals should be made by telephone, so that you can directly discuss your concerns, and should be followed up in writing within 48 hours. There is often a locally agreed referral proforma, check with your local children’s services office. Your referral should clearly document the facts of the case and include an explicit statement of why you are concerned (using a proforma will prompt you for relevant case details. The telephone discussion should be clearly recorded, documenting what was said, what decisions were made and an unambiguous action plan.
'I used to think it wasn’t my business to interfere – but now I see that my phone call could be the first link in the chain to put the family in touch with the support they need’
A dental therapist, speaking after a child protection training session
Informing the child and parents
It is good practice to explain your concerns to the child and parents, inform them of your intention to refer and seek their consent. Research shows that being open and honest from the start results in better outcomes for children. There are certain exceptions and reasonable judgement must be made in each case.
There are some exceptions. Usually you should not discuss your concerns with the parents in the following circumstances:
where discussion might put the child at greater risk;
where discussion would impede a police investigation or social work enquiry;
where sexual abuse by a family member, or organised or multiple abuse is suspected;
where fabricated or induced illness is suspected (see specific guidance); 53
where parents or carers are being violent or abusive, and discussion would place you or others at risk;
where it is not possible to contact parents or carers without causing undue delay in making the referral
‘I know I did the right thing in referring him, but what was so difficult was the feeling that I’d gone behind their backs and didn’t discuss it with the family first. I think things have changed for the better now you’re advised to explain your concerns to the parents first. Of course it wouldn’t be easy, but I’m convinced that’s the best way to do it’
A dentist reflecting on a child protection referral she had made some years ago
Remember it is important to consider issues for the parent that may impact on their ability to provide safe and adequate care for their child. Mental health, general health, misuse of substances and domestic abuse will all affect the child.
Child Protection and the Dental Team: flow chart for action provides a concise summary of the action you should take. Other suggestions to help your team prepare to respond to concerns about the welfare of a child are discussed in the section on
Further detailed guidance can be obtained from your ‘LSCB Procedures’. If not already supplied to your practice, a copy of this informative document should be available from your local children's services department or online (see
Finding your local contacts).