Safeguarding / Non-Accidental Injury

Safeguarding concerns must be raised whenever a child's safety or welfare may be at risk. Every doctor has a duty to act. The threshold for referral is concern — you do not need proof. Key principles: document objectively, do not confront…

Working Together to Safeguard Children 2023

The pathway

1 · Recognise features of NAI

Bruising in non-mobile children
Unusual distribution of injuries
Inconsistent/changing history
Delayed presentation
Child's behaviour or affect
Multiple A&E attendances

2 · Do not confront

Do not challenge parents/carers about your concerns during the consultation. This may increase risk to the child and compromise investigations.

3 · Examine and document

Full examination, document injuries objectively with body maps (shape, colour, size, location). Photography with consent if possible. Note exact words used by child and carers.

4 · Consult safeguarding lead

All trusts have a Named Nurse and Named Doctor for Safeguarding. Consult them. If unavailable, refer directly to children's social care (local authority).

5 · Section 47 referral

If child is at immediate risk of significant harm — telephone referral to children's social care for Section 47 enquiry. Child may need to remain in hospital for safety.

6 · Multi-agency working

Police
Health
Social care

Child Protection Case Conference may be required. Ensure complete documentation in medical notes — these may be legal documents.

When to escalate

Immediate risk to child — admit to ward, notify safeguarding lead and children's social care urgently,Suspected abusive head trauma (retinal haemorrhages, subdural) — neurosurgery + ophthalmology + PICU,Suspected sexual abuse — do not examine internally, refer to SARC (Sexual Assault Referral Centre),Child attempting to leave with parent against medical advice — consider Section 47, legal advice

Reference: Working Together to Safeguard Children 2023 / RCPCH Safeguarding Children Guidance

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