Safeguarding sits in the professionalism domain of the ST1 paediatrics interview and appears in most of them, either as a scenario or as the follow up to a clinical one. It is scored on structure and safety: the child's welfare is paramount, you gather information without accusing, you involve the right people early, and you know the frameworks. This guide covers the scenarios and the structure.
The scenarios that recur
- A two year old has bruises of different ages and the parents' account does not fit.
- Parents refuse a blood transfusion for their child on religious grounds.
- A fifteen year old wants contraception and does not want her parents told.
- A parent wants to take their child home against advice.
- A child discloses something at the bedside that worries you.
- A mother with a baby appears to have been drinking.
The structure that scores
- The child first. Is the child safe right now? Does the child need treatment? If a transfusion is urgent or a bruised toddler needs assessment, that comes before anything else.
- Gather information without accusing. Take a careful history of how the injury happened, from each parent if possible, and examine fully. Document what you see in detail, including a body map. Do not confront the parents with your suspicion; your role is to notice and record, not to investigate.
- Involve the senior and the safeguarding team early. The registrar, the consultant, the named nurse or doctor for safeguarding. Say who they are and that you would speak to them before the family leaves.
- Know the frameworks and the next steps. The local safeguarding procedures, the referral to children's social care, the skeletal survey and the other investigations a safeguarding assessment involves, and the fact that the child may need to be kept in hospital while it happens.
- Communicate with the parents honestly. Tell them that the injuries need to be looked into, that this is routine when the explanation does not fit, and what will happen next. Do not lie about why.
- Document everything and hand over clearly.
The transfusion refusal
Parents with a sincere religious objection refuse a transfusion their child needs. The child's interests come first. Explore the refusal, explain the risks plainly, offer alternatives where they exist, involve the consultant and the hospital's legal team early, and know that where the transfusion is life saving and the parents still refuse, the hospital can apply to the court. In a genuine emergency the doctors act to save the child's life and justify it afterwards. Say all of this calmly and with respect for the parents, who are not acting from malice.
The pregnant or contraception seeking teenager
Gillick competence and the Fraser guidelines are the frameworks. Assess whether she understands the advice, cannot be persuaded to involve her parents, is likely to continue the relationship, would suffer harm without the treatment, and whether it is in her best interests. Explain confidentiality and its limits. Encourage a trusted adult. Involve safeguarding if there is any concern about the age or nature of the relationship, coercion or exploitation. Say that you would discuss it with a senior.
The parent who wants to leave against advice
Assess capacity to consent for the child, find out why they want to go, address what you can, explain the risks, involve the senior, and if the child is at risk and the parents still insist, know that the hospital can act to protect the child, including through an emergency protection order. Most of these resolve with listening and a senior conversation; say that first.
The colleague who may be impaired
Patient safety first: the colleague must not care for children tonight. Say so kindly, keep them out of the clinical area, tell the consultant, and support the colleague afterwards. The neonatal unit cover is arranged by the senior, not by you.
What the assessors score
The child kept safe throughout, information gathered without confrontation, early involvement of the right people, accurate knowledge of the frameworks, honest communication with the parents, and documentation. The common failures are confronting the parents, discharging the child, and not knowing who the safeguarding team are.
Practising
Talk each scenario through aloud with the next step ready for "and if they still refuse?", "and if the consultant is not available?", "and what would you say to the mother?". The follow ups are where the marks sit.