Safeguarding Children & Young People (Child Protection)

SJT Textbook: Safeguarding Children & Young People (Child Protection)

Safeguarding Children MSRA

This guide covers the high-stakes domain of Safeguarding Children 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

Safeguarding children is about protecting children and young people from abuse, neglect, and exploitation, and promoting their welfare. In England, practice is framed by the Children Act 1989 and Working Together to Safeguard Children (2023). Health professionals are statutory partners and must act when there is reasonable cause to suspect significant harm, not just when there is proof.

Section 17 (Child in Need) supports children whose health or development is likely to be impaired without services. Section 47 (Child Protection) requires enquiries when a child is suffering, or likely to suffer, significant harm. Clinicians identify concerns, see and hear the child, share information lawfully on a need-to-know basis, and refer promptly to Children’s Social Care (often via MASH).

In the MSRA SJT, top-scoring options prioritise safety and early referral, avoid promising secrecy, use secure and proportionate information-sharing, and keep objective, detailed records including verbatim accounts, body maps where appropriate, and clear plans.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Treat immediate medical needs and assess current safety, including whether the child can safely return home today.
2. See and hear the child or young person alone where safe, explaining that you cannot keep secrets if they are at risk.
3. Discuss concerns promptly with your safeguarding lead or Named Doctor/Nurse and refer to Children’s Social Care (MASH) when s.17 or s.47 thresholds are likely met.
4. Share the minimum necessary information with appropriate agencies via secure channels, recording what you shared, with whom, and why.
5. Record findings objectively, including verbatim quotes, who was present, timing of events, and injuries using body maps according to local policy.
6. Participate in multi-agency processes such as strategy discussions, child protection medicals, and child protection conferences.
7. Consider LADO referral where allegations concern staff or volunteers working with children, in addition to Children’s Social Care.
8. Safety-net and plan follow-up, including explicit triggers for urgent re-review if new information or injuries appear.

Low-scoring options usually delay action while seeking certainty, promise secrecy, discuss concerns in front of alleged abusers, or share information in insecure and unprofessional ways. High scorers act on risk, share minimally and securely, and use formal safeguarding pathways.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I would like to speak with you on your own for a few minutes so I can understand how things are for you.”
* “I am going to speak with our safeguarding team now and make a referral to Children’s Social Care today.”
* “I will write down your exact words and explain what will happen next, including who will talk with you.”
* “Because I am worried you might be at risk of harm, I have to share this information, but we will do it in a careful and respectful way.”
* “As this concerns someone who works with children, I will also refer to the Local Authority Designated Officer.”

Check safety • Hear child alone • Information share (minimum, secure) • Lead consult (safeguarding) • Document verbatim • Section 47 test • Act on strategy plan • Family support under s.17 • Escalate and review

📋 QUICK FAQ

Can I share information without consent to protect a child?
Yes. Data protection law allows and expects information sharing to safeguard children. Share the minimum necessary, on a need-to-know basis, using secure channels, and record your rationale.

Does Gillick competence stop me from referring to safeguarding?
No. Even a Gillick-competent young person cannot consent to abuse. Competence does not override your duty to protect them from significant harm; you must explain limits of confidentiality and refer.

Is bruising in a pre-mobile infant always abuse?
Not always, but it is rare and treated as a red flag. It should trigger urgent paediatric assessment and safeguarding consideration, often including a child protection medical and referral to Children’s Social Care.

Should I do a detailed forensic interview myself?
No. You should listen, avoid leading questions, record what the child says in their own words, and then allow trained paediatric and police teams to conduct formal interviews and forensic examinations.

What is LADO and when do I involve them?
The Local Authority Designated Officer (LADO) oversees allegations about individuals who work with children. You should involve LADO whenever there is an allegation or concern about a member of staff, volunteer, or professional in contact with children.

Do I need proof before making a child protection referral?
No. You act on reasonable cause to suspect significant harm. Waiting for proof can leave the child at ongoing risk and is a common exam trap.

📚 GMC ANCHOR POINTS

* Protect children and young people by acting quickly on concerns about abuse or neglect (GMC: Protecting children and young people).
* Disclose information when necessary to protect patients or the public, even without consent (GMC: Confidentiality).
* Treat children and families with respect and sensitivity, listening to their concerns and experiences.
* Work collaboratively with other agencies, including social care, police, and education, to safeguard children.
* Keep clear, accurate, and contemporaneous records of concerns, decisions, referrals, and outcomes.
* Escalate concerns if you believe that a child is not being adequately protected by local systems.

💡 MINI PRACTICE SCENARIO

A 3-year-old attends the emergency department with a spiral fracture of the humerus. The parent reports that the child “fell off the sofa”, but the mechanism and the child’s developmental stage seem inconsistent. There have been two previous attendances in the last month with minor injuries.

Best action: Treat the fracture, take a careful history, document verbatim, discuss urgently with your safeguarding lead and paediatrics, and refer the child to Children’s Social Care for consideration of a section 47 enquiry, sharing the minimum necessary information and recording your rationale.
Why: There is reasonable cause to suspect significant harm due to the injury pattern, inconsistent history, and repeated attendances; early multi-agency child protection action is required, not watchful waiting.

🎯 KEY TAKEAWAYS

✓ Safeguarding relies on reasonable suspicion of significant harm, not proof.
✓ See and hear the child alone where safe, and never promise to keep secrets.
✓ Refer early to Children’s Social Care (MASH) and involve the safeguarding lead.
✓ Share information minimally, securely, and lawfully, recording the basis for sharing.
✓ Document objectively with verbatim quotes, body maps, and a clear plan.
✓ Use section 17 for Child in Need and section 47 for Child Protection enquiries.
✓ Involve LADO when allegations concern staff or volunteers who work with children.

🔗 RELATED TOPICS

* → Adult Safeguarding (Care Act and Domestic Abuse)
* → Information Sharing and Confidentiality in Safeguarding
* → Gillick Competence and Fraser Guidelines
* → Domestic Abuse and Impact on Children
* → Professional Boundaries and Positions of Trust
* → Documentation and Record Keeping in Safeguarding

📖 FULL PRACTICE QUESTIONS

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

A 4-month-old, who is not yet rolling, is brought to the GP with a small bruise on the cheek. The carer says the baby “bumped the toy bar”. There is a two-day delay in presentation. The baby is otherwise well. You check the history and cannot find a clear accidental mechanism that fits the developmental stage.

Options:
A. Reassure the carer that bruises are common, advise observation at home, and arrange routine follow-up in two weeks.
B. Arrange a same-day paediatric child protection medical, inform your safeguarding lead, and refer to Children’s Social Care (MASH), documenting the history and examination with a body map.
C. Ask the carer to send you photos by personal messaging app and keep them on your personal phone for reference.
D. Wait to see if any further bruises appear before making a referral.
E. Document the bruise briefly as “NAD” to avoid upsetting the family.
F. Call paediatrics for advice but do not document the conversation to keep things informal.
G. Discuss your concerns in front of the carer and suggest they may be harming the child, without any referral.
H. Take a careful, non-judgemental history, examine the child fully, document verbatim quotes, and seek immediate advice from paediatrics and the safeguarding lead.

Example SJT — Rank 5 (best → worst)

A 15-year-old attends a sexual health clinic and discloses that they are in a sexual relationship with a teacher at their school. They appear Gillick-competent, deny coercion, and beg you not to tell anyone. They are physically well.

Options:
A. Explain that you cannot keep this secret, ensure immediate safety, inform the safeguarding lead, make an urgent referral to Children’s Social Care, request a strategy discussion with police, refer to LADO, and document verbatim.
B. Respect their confidentiality because they appear competent, offer STI screening only, and make no referral.
C. Tell them you will wait to see if the relationship continues before deciding whether to refer.
D. Try to speak to the teacher confidentially to hear “their side of the story” before making a decision.
E. Post anonymised details in a staff messaging group asking colleagues what to do.