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Who has been missed? Dramatic decrease in numbers of children seen for child protection assessments during the pandemic
  1. Sunil Bhopal1,2,
  2. Annaliese Buckland2,
  3. Rhona McCrone3,
  4. Andrew Ian Villis4,
  5. Stephen Owens1,4
  1. 1 Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  2. 2 Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
  3. 3 South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
  4. 4 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  1. Correspondence to Dr Sunil Bhopal, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; sunil.bhopal{at}

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Infection with SARS-CoV-2 does not, thankfully, appear to be harming children in great numbers at this point of the COVID-19 pandemic.1 Concerns have however been raised that necessary social distancing and particularly ‘lockdown’ measures are having negative, often unintended, consequences for the health and well-being of babies, children and young people. These consequences have been termed ‘collateral damage’,2 and it has been argued that measures to control the COVID-19 pandemic are likely to cause a ‘secondary pandemic’ of child neglect and abuse.3 The Children’s Commissioner for England has raised concerns within government that children are at increased risk of abuse and neglect during the pandemic, while household stress is high, families are confined to the home and usual societal safety nets including social services, schools and other statutory and voluntary agencies are less able to be in regular contact with those children who are known to them.

We are paediatricians serving Newcastle upon Tyne, Sunderland, North Tyneside and Northumberland local authority areas across the North East of England (population 1.1 million), with some of the highest levels of deprivation in the UK4 and great need for child safeguarding services. We anticipated that need for these services would have increased during the pandemic but noted a decrease in inward referrals to our services, particularly following the most drastic ‘stay at home’ messaging announced by Prime Minister Boris Johnson on 23 March 2020. We therefore examined monthly referral data for children and young people (0–16 years) attending for child protection medical examination as part of a child safeguarding assessment from January to April 2020 in comparison with the same months in the last 2 years.

Our analysis showed that the 28 assessments done in March 2020 was lower than in 2018 (36 assessments) or 2019 (43 assessments). This was drastically lower in April 2020 after institution of ‘lockdown’ when there were only 13 assessments compared with 50 in April 2018 and 30 in April 2019. The total number of assessments from January to April was 152 in 2018, 156 in 2019 and 99 in 2020, a reduction of approximately one-third (table 1). Reported vast increases calls to domestic abuse and child support telephone lines, and feedback from local authorities mean that we think this number of ‘missed’ children is likely to be a worrying underestimate.

Table 1

Child Protection Medical Examinations across four local authority areas of the North East of England, by month in each of 2018, 2019, 2020

We are concerned by our findings. We think it is likely that children who are at risk of considerable harm are not being identified by services that could keep them safe. We strongly encourage paediatricians, healthcare professionals, educationalists, social workers and all those in the children’s sector to urgently consider what more can be done to ensure that we do not let down some of the most vulnerable in society.



  • Twitter @sunilbhop

  • Contributors The analysis was conceptualised by SB and SO. All authors contributed to data collection and data analysis. SB wrote the first draft, which was edited and approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.