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Safeguarding children: are we getting it right?
  1. Owen J Arthurs1,2,
  2. David Williams3,
  3. Alison Steele4,5
  1. 1Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  2. 2UCL Great Ormond Street Institute of Child Health NIHR Biomedical Research Centre, London, UK
  3. 3High Court Judge, Family Division, London, UK
  4. 4Paediatrics, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  5. 5Officer for Child Protection, The Royal College of Paediatrics & Child Health, London, UK
  1. Correspondence to Dr Owen J Arthurs, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; owen.arthurs{at}gosh.nhs.uk

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Safeguarding children is of paramount importance in modern society. Professionals work hard to identify potential problems in the community, and all National Health Service (NHS) workers, teachers and social workers undergo rigorous safeguarding training to detect and try to prevent child maltreatment. However, recent media coverage of two cases has highlighted the myriad challenges in this field, particularly the impact of clinical decision making in suspected physical abuse, and raises the question: are we getting it right?

The Sunday Times recently covered two court cases in which children were removed from their parents following a provisional diagnosis of maltreatment. One child had bruising and a rib fracture diagnosed by local radiologists adhering to the Royal College of Paediatrics and Child Health (RCPCH) guidelines, but an expert radiologist appearing in the family court disagreed. In a different case of a child with more than one fracture, the court decided that the fractures had been caused accidentally.1 2 The children were returned to their parents. The implication in the media articles was that a different initial diagnosis would have spared these families from distress and the court process. This raises several overlapping issues in this field, including diagnostic uncertainty, when it is appropriate to remove a child following an initial diagnosis and the court’s overarching non-medical role in safeguarding our children.

When to investigate: diagnostic uncertainty

Children’s services exist to support and protect vulnerable children, including providing children and their families with extra help. Balancing the risk/benefit to the child of …

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Footnotes

  • 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.

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

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