Protecting children and young people

Child protection examinations

Key points - chapter 7

  • Get consent or other legal authorisation to carry out a child protection examination.
  • Make sure the person giving consent understands the purpose of the examination, what it will involve and how the results of the examination might be used.
  • Respect a child’s or young person’s decision to refuse an examination.
  • Avoid repeated examinations of a child or young person.

Carrying out a child protection examination

61

This guidance provides advice specifically on child protection examinations. A child protection examination is carried out to look for signs that a child or young person has been abused or neglected. This is different from a clinical examination, which aims to establish what is wrong with the child or young person and what treatment may be needed. We provide guidance on getting consent for clinical examinations, investigations or treatment of children and young people in 0–18 years.

62

Before carrying out a child protection examination, you must be satisfied that you have carried out appropriate specialist training (see paragraph 71) and that it is necessary and appropriate in the circumstances. You should be clear about what it is designed to achieve and whether the outcome is likely to affect the proposed course of action. You should consider giving the child or young person the option of having another adult present during the examination (this might be a parent, or an independent chaperone, as appropriate).25 You must avoid repeated examinations as these may be harmful to the child or young person.

25

See our guidance on maintaining boundaries.

Asking for consent

63

You need consent or other legal authorisation to carry out any child protection examination, including a psychiatric or psychological assessment. You can get consent or authorisation from:

  1. a child or young person who has the maturity and understanding to make the decision26 
  2. a person with parental responsibility if the child or young person does not have the capacity to give consent (it is usually enough to have consent from one person with parental responsibility)
  3. the courts – for example, the family courts or the High Court.
26

See appendix 1 to this guidance for advice on assessing capacity.

64

You must be satisfied that the person giving consent understands the purpose of the examination and what it will involve. This includes whether photographs or other images will be taken and how the results of the examination might be used – for example, as evidence in court.27 28 You must explain to the person that they have the right to refuse consent, and what may happen if they do this. You must record the discussion in the child or young person’s medical record.

27

Covert recordings (recordings made without the patient’s knowledge or consent) can only be made in exceptional circumstances. For advice and information, see our guidance Making and using visual and audio recordings of patients and Safeguarding children and young people: roles and competences for health care staff.

28

Also see guidelines on HIV testing of children who have parents with confirmed or suspected HIV infection

65

If the police or another agency tells you that a person with parental responsibility has given consent, you should check that the person has been given the information described in paragraph 64.

66

You must keep to the terms of the consent. For example, if someone has given consent for images to be taken for forensic purposes, you should not use the images for other purposes – such as education or training – unless you get separate consent to do this.

67

Advice on testing children and young people for a serious communicable disease is set out in paragraphs 12–16 of our guidance Confidentiality: disclosing information about serious communicable diseases. 28  30  

12

You should explain to patients who have serious communicable diseases how they can protect others from infection, including from sexually transmitted diseases. This includes the practical measures they can take to avoid transmission, and the importance of informing people with whom they have sexual contact about the risk of sexual transmission of serious communicable diseases.

13

You may disclose information to a person who has close contact with a patient who has a serious communicable  disease if you have reason to think that:

  1. the person is at risk of infection that is likely to result in serious harm
  2. the patient has not informed them and cannot be persuaded to do so.
14

If you believe that an adult who is at risk of infection lacks capacity to understand this information, and is at risk of serious harm, you must give relevant information promptly to an appropriate responsible person or authority, unless it is not of overall benefit to the patient to do so (see paragraphs 55 - 56 of Confidentiality).

15

You should tell the patient before you disclose the information if it is practicable and safe to do so. When you are tracing and notifying people, you should not disclose the identity  of the patient, if practicable. You must be prepared to justify a decision to disclose personal information without consent.8 

16

Most patients with a serious communicable disease who are parents of, or care for, children will do all they can to protect the children from the risk of infection or the effects of the disease. You should make sure the patient understands the information and advice you give them, which you should tailor to their needs. You should do all you reasonably can to support them in caring for themselves and in protecting their children.

28

Also see guidelines on HIV testing of children who have parents with confirmed or suspected HIV infection

30

See Ministry of Justice Civil Procedure Rules London, The Stationery Office, rule 35.3, Ministry of Justice Criminal Procedure Rules London, The Stationery Office, rule 33.2, Act of Adjournal (Criminal Procedure Rules) 1996, Criminal Justice (Evidence) (Northern Ireland) Order 2004, Ministry of Justice Family Procedure Rules London, The Stationery Office, rule 25.3, Children’s Hearings (Scotland) Rules 1996

When consent is not given

68

If a child or young person who has the capacity to consent refuses a child protection examination, you should discuss with them their views and concerns about the examination or what might happen afterwards. But you must respect their decision, even if this may affect the quality of forensic evidence available. Children and young people who are given the information and support they need, and allowed to make decisions for themselves, may later change their decision.

69

Sometimes a child or young person may refuse consent because they are afraid of the person who is abusing them, or because they are under pressure to refuse. If you suspect this, you should consider the risk of harm to the child or young person and discuss your concerns with your named or designated professional or lead clinician or, if they are not available, an experienced colleague. If you are concerned about the safety or welfare of the child or young person, you must follow the advice set out in paragraphs 32 – 38.

32

You must tell an appropriate agency, such as your local authority children’s services, the NSPCC or the police, promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect unless it is not in their best interests to do so (see paragraphs 39 and 40). You do not need to be certain that the child or young person is at risk of significant harm to take this step. If a child or young person is at risk of, or is suffering, abuse or neglect, the possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing your concerns with an appropriate agency might cause.

33

When telling an appropriate agency about your concerns, you should provide information about both of the following:

  1. the identities of the child or young person, their parents and any other person who may pose a risk to them
  2. the reasons for your concerns, including information about the child’s or young person’s health, and any relevant information about their parents or carers.
34

You should ask for consent before sharing confidential information unless there is a compelling reason for not doing so. For example, because:

  1. delay in sharing relevant information with an appropriate person or authority would increase the risk of harm to the child or young person
  2. asking for consent may increase the risk of harm to the child, young person, you or anyone else.
  3. you have already decided that disclosure is justified in the public interest.
35

You should ask the child or young person for consent if they have the capacity to give it. If not, you should ask a person with parental responsibility. You should also ask for consent from any adults you want to share information about. When asking for consent, you should explain why you want to share information and how it will benefit the child or young person. You should also explain all of the following:

  1. what information you will share
  2. who you will share it with
  3. how the information will be used
  4. where they can go for independent advice and support (see Sources of independent advice and support for parents and families for examples of organisations).
36

You can share confidential information without consent if it is required by law, or directed by a court, or if the benefits to a child or young person that will arise from sharing the information outweigh both the public and the individual’s interest in keeping the information confidential. You must weigh the harm that is likely to arise from not sharing the information against the possible harm, both to the person and to the overall trust between medical professionals and patients of all ages, arising from releasing that information.

37

If a child or young person with capacity, or a parent, objects to information being disclosed, you should consider their reasons,  and weigh the possible consequences of not sharing the information against the harm that sharing the information might cause. If a child or young person is at risk of, or is suffering, abuse or neglect, it will usually be in their best interests to share information with the appropriate agency.

38

If you share information without consent, you should explain why you have done so to the people the information relates to, and provide the information described in paragraph 35, unless doing this would put the child, young person or anyone else at increased risk. You should also record your decision as set out in paragraph 54.

70

If a child or young person refuses, or their parents refuse, to give their consent to a child protection examination that you believe is necessary, and you believe that the child or young person is at immediate risk of harm, you should contact the police and local authority children’s services, which may take emergency action to protect them. If you judge that the risk is not immediate, you should follow the advice set out in paragraphs 32 - 38.

32

You must tell an appropriate agency, such as your local authority children’s services, the NSPCC or the police, promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect unless it is not in their best interests to do so (see paragraphs 39 and 40). You do not need to be certain that the child or young person is at risk of significant harm to take this step. If a child or young person is at risk of, or is suffering, abuse or neglect, the possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing your concerns with an appropriate agency might cause.

33

When telling an appropriate agency about your concerns, you should provide information about both of the following:

  1. the identities of the child or young person, their parents and any other person who may pose a risk to them
  2. the reasons for your concerns, including information about the child’s or young person’s health, and any relevant information about their parents or carers.
34

You should ask for consent before sharing confidential information unless there is a compelling reason for not doing so. For example, because:

  1. delay in sharing relevant information with an appropriate person or authority would increase the risk of harm to the child or young person
  2. asking for consent may increase the risk of harm to the child, young person, you or anyone else.
  3. you have already decided that disclosure is justified in the public interest.
35

You should ask the child or young person for consent if they have the capacity to give it. If not, you should ask a person with parental responsibility. You should also ask for consent from any adults you want to share information about. When asking for consent, you should explain why you want to share information and how it will benefit the child or young person. You should also explain all of the following:

  1. what information you will share
  2. who you will share it with
  3. how the information will be used
  4. where they can go for independent advice and support (see Sources of independent advice and support for parents and families for examples of organisations).
36

You can share confidential information without consent if it is required by law, or directed by a court, or if the benefits to a child or young person that will arise from sharing the information outweigh both the public and the individual’s interest in keeping the information confidential. You must weigh the harm that is likely to arise from not sharing the information against the possible harm, both to the person and to the overall trust between medical professionals and patients of all ages, arising from releasing that information.

37

If a child or young person with capacity, or a parent, objects to information being disclosed, you should consider their reasons,  and weigh the possible consequences of not sharing the information against the harm that sharing the information might cause. If a child or young person is at risk of, or is suffering, abuse or neglect, it will usually be in their best interests to share information with the appropriate agency.

38

If you share information without consent, you should explain why you have done so to the people the information relates to, and provide the information described in paragraph 35, unless doing this would put the child, young person or anyone else at increased risk. You should also record your decision as set out in paragraph 54.