Master CPS - Paediatrics
for MSRA

Core Concepts

Child Protection & Safeguarding (CPS) in paediatrics focuses on protecting children from harm and promoting their welfare. It is a legal and ethical duty for all healthcare professionals. Child maltreatment encompasses physical abuse, sexual abuse, emotional abuse, and neglect. Professionals must understand their responsibilities, recognise signs of harm, and know the referral pathways. The child's welfare is paramount. Risk factors include child vulnerability, parental mental health, substance abuse, domestic violence, and poverty. Understanding the local multi-agency safeguarding hub (MASH) process is key.

Clinical Presentation

• Physical Abuse: Unexplained bruises, fractures (especially <1 year, spiral, metaphyseal, posterior rib), burns (glove & stocking, clear demarcation), head injuries (subdural haemorrhage, retinal haemorrhages), multiple injuries of varying ages, injuries inconsistent with history or developmental stage.
• Sexual Abuse: Genital/anal injury, STIs, UTIs, painful urination/defecation, sudden behavioural changes (withdrawal, aggression, sexualised play), disclosure.
• Emotional Abuse: Severe behavioural problems, anxiety, depression, low self-esteem, developmental delay, 'failure to thrive' without organic cause, psychosomatic complaints.
• Neglect: Malnutrition, poor hygiene, poor growth, recurrent preventable illness, dental neglect, lack of supervision, inadequate clothing, missed appointments, unsafe living conditions.
• Fabricated or Induced Illness (FII) / Münchausen by Proxy: Recurrent unexplained illness, discrepancies in history/findings, parent overly involved/knowledgeable, symptoms only present with parent, parent seeking unnecessary procedures/investigations.

Diagnosis (Gold Standard)

Diagnosis is a process involving meticulous data collection and multi-agency collaboration, rather than a single test. It typically involves a detailed history (from child if appropriate, parents/carers separately), comprehensive head-to-toe physical examination (documenting all findings, including photographs if appropriate and consent/legal basis exists), and targeted investigations (e.g., skeletal survey for <2 years with suspected physical abuse, neuroimaging for head injury, blood tests for clotting disorders). The 'gold standard' is a robust multi-agency assessment through the Local Authority Children's Services (Social Care), often involving paediatricians, police, and other specialists, leading to a conclusion of whether significant harm is occurring or is likely to occur.

Management (First Line)

The immediate priority is to ensure the child's safety. If there is immediate danger, emergency protection measures (e.g., hospital admission, police involvement) may be necessary. The first-line management for suspected child maltreatment is a mandatory referral to Local Authority Children's Services (Social Care) via the MASH, following local safeguarding policies, when there is reasonable cause to suspect a child is suffering or is likely to suffer significant harm. Healthcare professionals must maintain meticulous, objective, and factual documentation of all findings, conversations, and actions. Communication with families must be sensitive and non-accusatory, maintaining professional boundaries. Relevant information should be shared with other agencies (Social Care, Police) following safeguarding information-sharing principles.

Exam Red Flags