Unexplained Injury Or Mark On A Child - Safeguarding Children

Safeguarding Children

Ipswich Hospital
Tel: 01473 702381

Colchester Hospital
Tel: 01206 742267

What happens now?

When a child or young person comes to hospital with an injury or mark that healthcare professionals are worried about, the child or young person will be seen by a senior paediatric doctor who will make a full assessment. This includes asking questions to find out how the injury or mark may have been sustained, fully examining the child or young person to look for any other injuries, marks or signs of illness and requesting further tests that may be necessary. This ensures that we are able to diagnose any medical conditions that may have contributed to the injury or mark and that the child or young person is safeguarded at all times.

This digital leaflet will explain more about this process and why it is necessary.

More Information

Safeguarding children is everyone’s business and we all share a responsibility for safeguarding and promoting the welfare of children and young people. Children and young people can be thought to be in need of safeguarding if there are concerns about their health and/or wellbeing or if abuse is suspected. Professionals have a statutory duty to become involved with children and young people who we feel have suffered or are likely to suffer harm without our intervention.

Safeguarding children, promoting their welfare and protecting them from harm, is everyone’s responsibility. Everyone who comes into contact with children and families has a role to play. Health services have a duty under Section 11 of the Children Act 2004 to safeguard and promote the welfare of children and protect them from harm. As an organisation we are committed to providing a high standard of service to promote the health and wellbeing of every child and young person.

A senior paediatric doctor will ask questions to gain a full history and will complete a full examination of your child to look for any further injuries, marks or signs of illness. The doctor may also request further medical investigations be carried out if necessary.

The doctor will also ask you questions about your social situation which will include who lives in the home and details of any other children and young people who may or may not reside with you. This is routine practice, so please do not be worried.

The medical staff will discuss with you any medical investigations needed. Further information about these investigations can be found in this booklet. If your child does require further medical investigations they will be admitted to the children’s ward for an inpatient stay until these have been completed.

Staff may make contact with the hospital safeguarding children team and a member of the team may come and see you and your child or young person.

Accidents in children and young people are common, but sometimes a child or young person may have an injury that causes concern to professionals. In these circumstances, professionals have a duty to ask questions and talk to other agencies, including Social Care and, in some circumstances, the police.

If professionals feel that their concerns need further investigation, a referral will be made to Social Care.

When a referral has been made to Social Care, we expect them to contact us within 24 hours to tell us how they are going to process the referral. They have a statutory duty to investigate concerns about a child’s welfare.

Whenever possible, we want to involve families in our referral to Social Care or other services. There may be times when you might not agree with our decision to make a referral. Please remember that we only have the child or young person’s best interests in mind, and we believe that we need to share information with other services.

If you do not agree with a referral, please ask the professionals to explain the reasons why they think it is necessary in a way that helps you to fully understand.

Referrals can be made without consent if professionals feel the child or young person may be at risk of significant harm.

If further medical examinations are required the medical staff will discuss this with you in detail. This may include blood tests, skeletal survey, CT head scan and an eye examination.

Further details about each of these tests are provided below.

Blood tests are performed by a pediatric phlebotomist, paediatric nurse or pediatric doctor within the Children’s Department. This is done by passing a small needle into a vein to obtain blood to fill sample tubes.

Unfortunately children can be upset by the blood taking procedure. The Paediatric team are experienced in keeping distress to a minimum.

Why are blood tests performed?
Blood tests may be performed to look for causes of bleeding and bruising (full blood count [FBC] and coagulation) and problems that may cause weakness of the bones (lack of calcium, phosphate, vitamin D). Other blood tests may be performed depending on the nature of the injury or mark.

Your doctor will inform you of the specific tests that will be required and results of these tests when they are available.

Why is my child/young person having an eye examination?

Eye examinations can reveal abnormalities or injury to the back of the eye (retina), which can give us more information about what is going on.

What will happen during the eye examination?

The examination will take place in one of the consulting rooms in the Eye Department. Your child or young person will initially be seen by an orthoptist who will perform visual acuity assessment and ask questions to help guide the examination. The orthoptist will also instil two types of eye drops to dilate the pupils in your child’s eyes to make it easier to look at the back of the eyes. The drops will take E about 30 minutes to work

The rest of the examination will be performed by a senior: ophthalmologist (eye doctor) and is performed using a head-mounted light source (indirect ophthalmoscope) and a handheld lens. Occasionally, depending on the age of the child, a speculum (a device to keep the eyelids open) and an indentor (instrument to steer the eye) may be used.
Although these tools may not look nice, they are used by experts to get the best possible views of the back of the eye. Depending on the findings, photographs or a short video may be taken. This part of the examination will take: between 10 and 30 minutes.

The ophthalmologist may inform you of the results of the examination. The paediatric consultant will inform you of the results of the eye examination when these are available.

A skeletal survey is a set of X-rays taken of the skull, chest, spine, pelvis, arms, legs, hands and feet. It involves taking about 20 small X-rays of different parts of the body, not just one big X-ray of the whole body.

It is similar to having photographs taken and will not cause any pain. An: X-ray machine directs X-rays through parts of the body being examined onto an imaging plate.

A skeletal survey is performed to look for any abnormality or injury to the bones.

The examination will take place in the main Diagnostic Imaging (X-ray) Department.

The radiographer will advise you how your child or young person needs to be positioned. To get a clear picture, it is important that your child or young person is as still as possible during the test. This means that he or she will need to be held quite firmly for a few seconds while each X-ray is taken.

The process of taking a single X-ray image will last only a few seconds, but the radiographer will need to take several X-rays in different positions and of different parts of the body. The complete examination should take approximately one hour.

Your child or young person does not need any special. preparation but it may help if they wear clothes that are loose-fitting and easy to remove. You may be asked to remove some of your child’s or young person’s clothing and any jewellery or metal, for example, poppers on vests.

Although the examination is not painful, younger children may become distressed as they will need to be held still for the test. It is a good idea to bring a feed, dummy or a toy along to help settle your child, if needed. Rarely, it is necessary to arrange for a child to be sedated during the survey.

If your child or young person is taking pain relief medication for any reason, it is better if this is working at its best during the examination.

Sometimes recent injuries are not visible initially and may: only be seen on images obtained later. A smaller number • of X-rays of the chest and limbs will need to be repeated approximately 10-14 days after the initial skeletal survey.

The process of taking the images will be very similar to the first skeletal survey and you will receive an appointment to attend the hospital for these repeat X-rays to be carried out.

A CT (computerised tomography) scan is a specialised X-ray scan using a scanner and computer equipment to make cross-sectional images of the structures within the body. A CT scan of the head is performed to look for abnormalities or injury to the brain, skull bones or soft tissue around the brain.

The examination will take place in the CT Scan Department. Your child or young person will be positioned in the scanner by the radiographers. Your child or young person will need to lie very still for a few minutes while the scan is performed.

Your child or young person may need sedation if they are unable to lie still. If this is the case, we will discuss it with you in more detail.

The radiographers will need to ensure that your child or young person is in the correct position before the scan is taken. The scan will take several minutes to perform.

Both the skeletal survey and the CT head scan are performed using X-rays which are forms of ionising radiation. The radiation dose received is kept as low as possible by using specialist equipment and highly trained staff.

Large doses of ionising radiation can be harmful and are known to be a risk factor for developing cancer. Research has looked at the risk of cancer associated with skeletal surveys and CT scans; this suggests two skeletal surveys and a CT head scan would increase the overall lifetime risk of developing cancer by less than 0.1%.

During the skeletal survey, one adult (the parent, guardian or carer of the child or young person) and a qualified member of staff (usually a nurse) will assist the radiographers in holding your child or young person still. You will be provided with a lead rubber apron (body shield) to reduce your exposure to radiation.

Female helpers must inform the radiographer if they are pregnant, or think they might be pregnant. X-ray exposure during pregnancy carries a very small risk of exposing the unborn baby to radiation, which may be harmful and therefore it is advisable for pregnant women to avoid such exposure.

Parents and carers can go to the CT Department with their child or young person and remain with him or her during preparation for the scan. During the CT scan itself you will be asked to leave the scan room and wait outside. This is to avoid unnecessary exposure to radiation.

The skeletal survey and the CT scan will be reviewed and assessed by two radiology consultants and a report will be produced. The pediatric consultant looking after your child or young person will inform you of the results when they are available.

When we have all the information from the history, examination and medical investigations, this will be discussed within a multidisciplinary meeting. This may include doctors, nurses, Social Care professionals and the police. Information will be shared between all professionals involved and a decision will be made regarding the ongoing management and safeguarding of your child or young person. You will be informed of this decision by one of the members of the multidisciplinary team.

We recognise that this situation can be stressful and we will try to support you in whatever way we can. What we ask for you to do is to work with us, providing accurate information about your child and family and cooperating with enquiries, and the services who are trying to help.

Please remember that we have a responsibility to all children who access our services and any concerns we may have are not personal to you and your family but a process that we have a duty to follow.

If you do have questions about anything you have read or any aspect of your child’s care, please do ask to talk to vour doctor, nurse or safeguarding team who will do their best to answer your queries.