1. Vulnerability of a non-ambulatory infant JAN HARRISON & DR S K SETHI DESIGNATED PROFESSIONALS SAFEGUARDING Leicester City LSCB May 2016

2. In the past, advice to frontline professionals was that referral to Children’s Services should be made if bruising in babies was not plausibly explained. However, in light of the increasing evidence base and learning from case reviews, advice to frontline professionals has changed and is necessarily directive

3. recognising that professional judgment and responsibility have to be exercised at all times Err on the side of safety by requiring that all pre- mobile babies with bruising where there is no obvious medical cause be referred to Children’s Social Care and for a senior paediatric opinion

4. Homicide figures the under ones are seven times more likely to be killed than older children in England and Wales (NSPCC, March 2013: ww.nspcc.org.uk/Inform/research/statistics/child_homicide_statistics_wda48747.htm l ) ww.nspcc.org.uk/Inform/research/statistics/child_homicide_statistics_wda48747.htm l

5. Finger tip bruises

6. Sometimes a child can sustain life threatening injuries without showing any or little evidence of external injury

7. Bruises Sugar N, Taylor JA, Feldman KY. Bruises in infants and toddlers: those who don’t cruise rarely bruise. Arch Ped Adol Med. 1999;153(4):399-403 Sugar N, Taylor JA, Feldman KY. Bruises in infants and toddlers: those who don’t cruise rarely bruise. Arch Ped Adol Med. 1999;153(4):399-403 – Landmark study of 1000 children less than 36 months old well child care visits at clinic – Bruises on pre-cruisers rare – Bruises on the hands and buttocks were not observed at any age 16

8. Mongolian Blue Spot

9. Check the records HV Midwife

10. Mongolian Blue Spot Check the records HV Midwife

11. Mongolian Blue Spot They are present at birth occur in more than 90% of children of Mongoloid race ( e.g. East Asians, Polynesians, Indonesians, Micronesians). They occur less frequently in other races. 10% of Caucasians Mixed -.. ? 40 to 50%

12. SCR Messages

13. 1 INFORMATION SHARING Key factor in many serious case reviews – Failure to – record information – share information – understand the significance of the information shared or not shared – to take apporopriate action

14. Substance Misuse - including Drugs and Alcohol

15. Domestic Abuse

16. Parental Mental Illness

17. The GMC Guidelines (2012:11) clearly state ‘ if you are not sure about whether a child or young person is at risk or how best to act on your concerns, ask a named or designated professionals or a lead clinician or if not available, an experienced colleague for advice’. Threshold for referral is“ Suspicion” not Evidence of abuse 17

19. ▪ If you disagree with a decision made by staff from health or other agencies: ▪ Ask why decision has been made ▪ Record conversation in records ▪ Seek advice from child protection staff ▪ Don’t be put off by role or status of other person ▪ PROMOTE a culture of challenge Challenging Decisions

20. Importance of THE MOMENT Mindful Consequences Your action is the ONLY HOPE

21. Any questions?

22. Action planning What is your action as a result of today’s session?