Child Safeguarding (Signs, Referral, Documentation)

SJT Textbook: Child Safeguarding (Signs, Referral, Documentation)

Child Safeguarding MSRA

This guide covers the high-stakes domain of Child Safeguarding MSRA scenarios. In the Professional Dilemmas paper, you are tested on your ability to act on “Reasonable Suspicion” rather than definitive proof. The exam penalises hesitation; if you suspect a child is at risk, the threshold to act has been met.

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🎯 THE CORE PRINCIPLE

Child safeguarding is about recognising signs of abuse, neglect, and exploitation, recording them clearly, and referring promptly so that multi-agency systems can protect the child. Working Together to Safeguard Children (2023) stresses that professionals must be child-centred, think family-wide, and share information appropriately to safeguard children.

Clinicians do not need proof; they act when there is reasonable cause to suspect significant harm (section 47 Children Act 1989) or when a child and family need support (section 17 Child in Need). Frontline staff should document verbatim disclosures, injuries, patterns of concern, and their clinical reasoning, then refer to Children’s Social Care via the local “front door” or MASH.

In the MSRA SJT, high-scoring options believe disclosures, avoid promising secrecy, create high-quality records (quotes, body maps, times), and make same-day referrals. They share the minimum necessary information without consent when required to safeguard the child, and they do not manage significant concerns in isolation.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Assess immediate safety and treat urgent medical needs while considering whether it is safe for the child to go home.
2. Listen carefully and, where safe, see or hear the child alone, explaining that you may need to share information to keep them safe.
3. Record verbatim quotes in quotation marks, document who is present, timings, observed injuries, and distinguish clearly between facts and opinion.
4. Use body maps and diagrams (according to local policy) to document any injuries accurately and contemporaneously.
5. Refer the same day to Children’s Social Care/MASH when section 17 or section 47 thresholds are likely met, after discussion with the safeguarding lead or senior clinician.
6. Share the minimum necessary information via secure, approved channels, recording the lawful safeguarding basis and rationale if consent is refused or unsafe to seek.
7. Escalate complex patterns (for example, perplexing presentations or possible fabricated or induced illness) according to RCPCH guidance, involving paediatrics and safeguarding teams early.
8. Arrange follow-up and safety-netting, making explicit what should trigger urgent re-presentation or re-contact.

Trap answers typically delay referral, minimise concerns, offer secrecy, or avoid lawful information-sharing and robust records. Strong answers protect the child, document clearly, and refer through formal pathways.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I am going to write down your exact words and then speak to our safeguarding team today.”
* “I will make a same-day referral to Children’s Social Care and share only the information that is necessary to keep you safe.”
* “Because I am worried about your safety, I can share this information even if your parent does not agree; I will record why I am doing this.”
* “I will use a body map to record these marks accurately and note when and how they were found.”

Police if immediate danger • Refer same day (s.17/s.47) • Observe and document carefully • Talk to safeguarding lead • Evidence share (lawful, minimal, secure) • Child-centred planning • Team up via MASH

📋 QUICK FAQ

Do I need consent to share information for child safeguarding?
No. You do not need consent to share information when it is necessary to safeguard a child. You should share the minimum necessary on a need-to-know basis, use secure channels, and record your lawful basis and reasoning.

Where should I refer concerns about a child?
You should refer to your local Children’s Social Care “front door” or MASH, in line with local Safeguarding Children Partnership procedures. You should usually also inform your safeguarding lead or Named Doctor/Nurse.

How should I document a disclosure?
Record the child’s words in quotation marks, note who was present, timings, non-verbal behaviour, observed injuries (with body maps), and your actions or referrals. Distinguish clearly between factual observations and professional opinion.

Should I ask lots of detailed questions to clarify the story?
No. Avoid leading or repeated questioning. Allow the child to speak freely, ask open and clarifying questions only as needed, and then let specialist paediatric and police teams undertake formal interviews and examinations.

What about perplexing presentations or suspected fabricated or induced illness?
Follow RCPCH guidance on PP/FII. Escalate early to senior paediatricians and safeguarding teams, maintain careful, objective records, avoid direct accusations, and use multi-agency processes to assess risk.

📚 GMC ANCHOR POINTS

* Protect children and young people by acting quickly on concerns of abuse or neglect (GMC: Protecting children and young people).
* Share information when necessary to protect patients and the public, even without consent, using appropriate safeguards (GMC: Confidentiality).
* Keep clear, accurate, and contemporaneous records of concerns, decisions, actions, and referrals (GMC: Good medical practice – recording information).
* Work collaboratively with other professionals and agencies to safeguard children, respecting but not being overruled by organisational barriers.
* Escalate concerns if you believe a child is not being adequately protected by current plans or responses.

💡 MINI PRACTICE SCENARIO

A 10-year-old attends your surgery with their mother. You notice multiple fading bruises of varying ages on the upper arms. When briefly alone, the child quietly says, “Sometimes Mum’s boyfriend grabs me really hard.” The mother later insists the bruises are from “play fighting” and asks you not to “make a fuss”.

Best action: Thank the child, avoid detailed probing, document the disclosure in quotation marks with a body map and timings, inform your safeguarding lead, and make a same-day referral to Children’s Social Care/MASH, sharing the minimum necessary information even if the mother withholds consent.
Why: There is reasonable cause to suspect significant harm; early referral, clear documentation, and lawful information-sharing through formal safeguarding pathways protect the child.

🎯 KEY TAKEAWAYS

✓ Safeguarding acts on reasonable suspicion and risk, not definitive proof.
✓ You do not need consent to share information when safeguarding a child, but you must share minimally and securely.
✓ High-quality documentation (quotes, body maps, times, who was present) is essential to multi-agency decision-making.
✓ Same-day referral to Children’s Social Care/MASH, with involvement of the safeguarding lead, is expected where s.17/s.47 thresholds are likely met.
✓ Do not manage significant concerns in isolation or rely on “watchful waiting” when there is ongoing risk.
✓ RCPCH guidance supports careful escalation in perplexing presentations or suspected fabricated or induced illness.

🔗 RELATED TOPICS

* → Safeguarding Children and Young People (Child Protection Pathways)
* → Adult Safeguarding and Domestic Abuse (Impact on Children)
* → Information Sharing, UK GDPR, and Safeguarding
* → Gillick Competence, Fraser Guidelines, and Confidentiality Limits
* → Perplexing Presentations and Fabricated or Induced Illness (PP/FII)

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A 7-year-old attends with their father. During the examination, when the father steps outside to take a phone call, the child quietly says, “Dad’s friend hits me when he is angry. Please do not tell anyone.” You see faint bruising on the child’s upper back. When the father returns, he chats casually and says the child is “clumsy but fine”.

Options:
A. Reassure the child that you will keep this a secret so they continue to trust you, and make no record.
B. Thank the child for telling you, record their exact words in quotation marks, examine and document all injuries with a body map, inform your safeguarding lead, and make a same-day referral to Children’s Social Care/MASH.
C. Wait to see if there are further attendances before taking any action, to avoid “over-reacting”.
D. Ask the father, in front of the child, whether he or his friend are responsible for the bruises.
E. Write a very brief note such as “child says hit by friend” without quotes or details, and plan to review in a month.
F. Share the full story in a staff social messaging group to get colleagues’ opinions before deciding what to do.
G. Discuss with your safeguarding lead and call Children’s Social Care/MASH the same day, sharing the minimum necessary information even if the father might object.
H. Tell the child that you must share what they have said to help keep them safe, and explain that only professionals who need to know will be told.

Example SJT — Rank 5 (best → worst)

A 5-year-old with complex medical needs has had multiple admissions for unexplained symptoms. Parents request repeated investigations, but staff rarely observe the symptoms described. Nursing staff report concerns about possible fabricated or induced illness (FII). There is no immediate life-threatening emergency.

Options:
A. Discuss concerns with the safeguarding lead and senior paediatrician, begin a careful review of records and observations, document all concerns objectively, and make a coordinated multi-agency referral according to PP/FII guidance.
B. Ignore staff concerns because there is no proof, and continue ordering tests requested by the parents.
C. Confront the parents directly with the term “fabricated illness” in an unplanned consultation and accuse them of harming the child.
D. Keep your own private notes at home, separate from the medical record, so you can decide later whether to share them.
E. Delay recording anything until “proper evidence” is available, to avoid upsetting the parents.