Child Safeguarding for GPs: Your Survival Guide
Protecting children while protecting yourself - no cape required, just clinical curiosity
Date Updated: January 2026
📋 Executive Summary: What You'll Master Today
Because safeguarding is everyone's responsibility, but knowing what to do is your superpower
🎯 Curriculum Rationale
Safeguarding is not a separate topic but a lens applied to every consultation. GPs often identify risk indirectly via adult consultations, chronic disease management, and pregnancy care. Examiner focus is on recognition, judgement, escalation, and documentation - not specialist detail.
✅ What This Page Covers:
- Professional curiosity & consultation framework
- Safeguarding in adult consultations
- Legal frameworks & professional responsibilities
- Recognition of abuse & vulnerability indicators
- Specific scenarios (FGM, Modern Slavery, PREVENT)
- Child Not Brought (CNB) to appointments
- Multi-agency working & referral pathways
- Assessment methods & learning opportunities
⚡ Quick Facts at a Glance:
📥 Downloads
path: SAFEGUARDING CHILDREN
- adolescent safeguarding.ppt
- child abuse - what to do.pdf
- child abuse facts in a nutshell.doc
- child abuse on 2 sides of a4.doc
- child protection (2).doc
- child protection - quick guide to child maltreatment.pdf
- child protection - what do to.pdf
- child protection in primary care.ppt
- child protection scenarios.docx
- child safeguarding - particular areas of general practice.docx
- child safeguarding - practitioner learning events.docx
- dash risk checklist - for young people.pdf
- professional curiosity for safeguarding.pdf
- safeguarding children resource cards - seqo.pdf
- safeguarding framework - what all gp practices should provide.docx
- safeguarding training - children - 2019.pptx
- virginity testing.pdf
- voice of the child.pdf
Data-Gathering & Consultation Framework
Professional Curiosity Without Accusation
How to ask the right questions without making families feel accused or defensive
✅ Good Approaches
- "Tell me about home life" - open, non-threatening
- "Who helps you with the children?" - explores support
- "How are things at home?" - general wellbeing check
- "What's a typical day like?" - reveals family dynamics
- "Any worries about the children?" - parent-led concerns
❌ Avoid These Approaches
- "Are you abusing your child?" - direct accusation
- "Why didn't you bring them sooner?" - blame-focused
- "That's not normal" - judgmental language
- "You should have..." - criticism
- Leading questions that suggest answers
Always Consider: "Who Lives at Home?"
This simple question opens the door to understanding family dynamics and potential risks.
Ask About:
- Household members: Who lives there, ages, relationships
- Living arrangements: How long at address, stability
- Support networks: Extended family, friends, services
- Daily routines: Childcare, supervision, activities
- Other adults: Partners, lodgers, frequent visitors
Key Questions:
- "Who lives at home with you?"
- "Tell me about the children's ages"
- "Who helps with childcare?"
- "Any other adults in the house?"
- "How long have you lived there?"
- "What's the sleeping arrangements?"
Assess:
- Mental health: Depression, anxiety, psychosis
- Substance use: Alcohol, drugs (prescribed/illicit)
- Domestic violence: Current or historical
- Coping mechanisms: Stress management, support seeking
- Parenting capacity: Meeting children's needs
Questions to Ask:
- "How are you coping with everything?"
- "Any stress or worries at home?"
- "How's your mood been?"
- "Any relationship difficulties?"
- "What support do you have?"
- "How do you manage when things get tough?"
School Engagement:
- Attendance: Regular, punctual, patterns
- Behaviour: Changes, concerns from teachers
- Academic progress: Learning difficulties, support needs
- Social interaction: Friends, isolation, bullying
- Communication: Parent-school relationship
Development Questions:
- "How are things going at school?"
- "Any concerns from teachers?"
- "How's their behaviour at home?"
- "Any changes you've noticed?"
- "Who picks them up from school?"
- "Do they talk about school friends?"
Examination & Observation Clues
Non-verbal and contextual cues that may indicate safeguarding concerns
Parent-Child Interaction:
- Lack of eye contact or warmth
- Child fearful of parent
- Inappropriate expectations
- Role reversal (child caring for parent)
- Harsh or threatening language
- Child seeking comfort from strangers
Physical Presentation:
- Hygiene and clothing condition
- Nutritional status and growth
- Developmental appropriateness
- Untreated medical/dental conditions
- Recurrent unexplained injuries
- Signs of self-harm or neglect
Behavioural Indicators:
- Frozen watchfulness
- Inappropriate maturity or regression
- Excessive compliance or defiance
- Attention-seeking behaviour
- Sexualised behaviour
- Recurrent unexplained attendances
Safeguarding in Adult Consultations
Children Often Identified Through Adult Patients
A core GP competency - safeguarding is a lens applied to every consultation, not a separate topic
Key Principle
GPs often identify risk indirectly through adult consultations, chronic disease management, and pregnancy care. Always think: "Are there children in this household who might be affected?"
High-Risk Adult Presentations:
- Substance misuse: Alcohol, drugs (prescribed or illicit)
- Domestic abuse: Victim or perpetrator
- Severe mental illness: Psychosis, severe depression
- Chaotic attendance: Frequent DNAs, crisis presentations
- Pregnancy with vulnerabilities: Young age, substance use
Questions to Always Ask:
- "Do you have children at home?"
- "Who looks after them when you're unwell?"
- "How are they coping with your difficulties?"
- "Any concerns about their safety?"
- "What support do you have?"
Parental Substance Misuse - One of the Commonest Safeguarding Triggers
Assess parental capacity to function and risk to children and young people
Parental Functioning:
- Can they meet basic needs when intoxicated?
- Ability to provide safe supervision
- Recognition of impact on children
- Willingness to engage with services
Environmental Risks:
- Storage of drugs/paraphernalia accessible to children
- Funding of habit affecting family resources
- Dangerous adults in the home
- Risk of grooming or exploitation
Domestic Abuse & Pregnancy - Dual Safeguarding Responsibility
Understanding coercion vs control and impact on children
Coercion vs Control
Impact on Children:
- Witnessing violence (emotional abuse)
- Physical injury during incidents
- Emotional and behavioural problems
- School attendance and performance issues
- Long-term trauma and attachment difficulties
Severe Mental Illness & Parenting Capacity
Assessing when mental health difficulties impact on child safety and wellbeing
High-Risk Presentations:
- Psychosis with paranoid delusions involving children
- Severe depression with suicidal ideation
- Manic episodes with poor judgment and impulsivity
- Substance-induced mental health crises
- Personality disorder with emotional dysregulation
Protective Factors:
- Insight into condition and its impact
- Good compliance with treatment
- Strong family support network
- Stable housing and financial situation
- Active engagement with mental health services
Brainy Bites: Essential Safeguarding Wisdom
Key Questions for Data Gathering
Professional curiosity: "Tell me about home life" - open questions reveal more than closed ones
Document everything: Use the child's exact words - "Mummy hits me" not "reports domestic violence"
Trust your gut: If something feels wrong, it probably is - don't ignore that nagging feeling
Think family: When you see an adult patient, always consider children in the household
Red Flags - What Not to Miss!
Injuries inconsistent with history: Bruises on babies who can't cruise, burns in unusual patterns
Delayed presentations: Serious injuries presented late without good reason
Behavioural changes: Sudden regression, sexualised behaviour, extreme fear of specific adults
Parental factors: Substance misuse, domestic violence, mental health crises, social isolation
Legal, Ethical & Professional Frameworks
Statutory Duties & Professional Responsibilities
Your legal obligations and professional duties in child safeguarding
Core Professional Duty
All healthcare professionals have a statutory duty to safeguard children and vulnerable adults. This means ensuring clinical decisions and behaviour align with established safeguarding procedures.
Clinical Practice:
- Recognise signs of abuse and neglect
- Know when and how to make referrals
- Document concerns appropriately
- Work collaboratively with other agencies
- Maintain professional boundaries
Your responsibilities include:
- Promoting child welfare
- Protecting from maltreatment
- Preventing impairment of development
- Ensuring safe and effective care
- Taking action when concerns arise
Children Act 1989 & 2004
The cornerstone of child protection law in England and Wales. Establishes the principle that the child's welfare is paramount.
Section 17
Children in need - local authority duty to provide services to promote welfare and prevent significant harm
Section 47
Child protection investigations when there's reasonable suspicion of significant harm
Care Orders
Court orders placing children in local authority care when threshold criteria met
GMC Guidance: 0-18 Years
Comprehensive guidance covering children, safeguarding, capacity, and confidentiality in medical practice.
Key Principles:
- Child's best interests are paramount
- Listen to children and young people
- Respect their developing autonomy
- Work in partnership with parents/carers
- Share information appropriately
Capacity Assessment:
- Under 16: Gillick competence assessment
- 16-17: Presumed competent (rebuttable)
- Consider maturity and understanding
- Decision-specific assessment required
- Fluctuating capacity considerations
Balancing Confidentiality with Safeguarding
The ethical challenge of maintaining patient confidentiality while protecting children from harm.
Justified Disclosure:
- Child at risk of significant harm
- Serious crime has been committed
- Public interest outweighs confidentiality
- Court order requires disclosure
- Statutory duty to report (e.g., FGM)
How to Share Appropriately:
- Share only relevant information
- Use secure communication methods
- Document what was shared and why
- Inform patient where possible and safe
- Follow local information sharing protocols
Clinical Recognition & Risk Factors
Presentations of Abuse & Neglect
Recognising the signs and symptoms of different types of child abuse and neglect
Physical Abuse (Non-Accidental Injury)
Deliberately inflicted injury or knowingly not preventing injury to a child.
Bruising Patterns:
- Unusual sites: ears, neck, buttocks, back
- Grip marks and finger impressions
- Multiple bruises at different stages of healing
- Bruising in non-mobile infants
- Pattern bruising (belt marks, hand prints)
Burns & Scalds:
- Cigarette burns (circular, punched-out appearance)
- Immersion burns with clear tide marks
- Contact burns with clear outlines
- Absence of splash marks in scalds
- Burns in unusual locations
Remember TEN-4 Rule:
Bruising to Torso, Ears, or Neck in children under 4 years should raise suspicion of abuse. Any bruising in non-mobile infants is concerning.
Emotional Abuse
Persistent emotional maltreatment causing severe adverse effects on emotional development.
Direct Emotional Abuse:
- Persistent criticism, humiliation, rejection
- Threats, intimidation, isolation
- Unrealistic expectations or demands
- Corruption or exploitation
- Denial of emotional responsiveness
Indirect Emotional Abuse:
- Witnessing domestic violence
- Exposure to parental mental illness
- Substance misuse in the home
- Scapegoating within family
- Inappropriate role expectations
Sexual Abuse
Forcing or enticing a child to take part in sexual activities, including non-contact activities.
Physical Indicators:
- Genital or anal injuries, bleeding, discharge
- Sexually transmitted infections
- Pregnancy in young adolescents
- Recurrent urinary tract infections
- Difficulty walking or sitting
- Torn, stained, or bloody underwear
Behavioural Indicators:
- Age-inappropriate sexual knowledge/behaviour
- Sexualised play or language
- Regression to younger behaviours
- Fear of specific people or places
- Sleep disturbances, nightmares
- Self-harm or suicidal thoughts
Important Notes:
- Most children show no physical signs of sexual abuse
- Normal examination doesn't rule out abuse
- Disclosure may be delayed, partial, or retracted
- Believe the child - false allegations are rare
- STIs in children should always raise suspicion
Neglect - The Most Common Form of Child Abuse
Persistent failure to meet a child's basic physical and/or psychological needs. Accounts for approximately 50% of child protection plans.
Physical Neglect:
- Poor hygiene, dirty or inappropriate clothing
- Failure to thrive, malnutrition
- Untreated medical or dental problems
- Lack of adequate supervision
- Unsafe living conditions
- Frequent accidents due to lack of supervision
Emotional Neglect:
- Lack of emotional warmth or responsiveness
- Failure to provide comfort when distressed
- Ignoring child's emotional needs
- Lack of stimulation or interaction
- Failure to show affection or praise
- Not protecting from emotional harm
Common GP Scenarios with Hidden Risk:
Always ask: Is poor control due to non-adherence, chaotic parenting, or impaired supervision?
- Faltering growth: Non-medical causes (neglect, emotional abuse)
- Poorly controlled asthma: Chaotic home environment, missed medications
- Frequent A&E attendance: Pattern of injuries or crisis presentations
- Recurrent infections: Poor hygiene, neglect, immunocompromise
- Dental problems: Poor oral hygiene, lack of dental care
Specific Vulnerabilities & Scenarios
Female Genital Mutilation (FGM)
Mandatory Safeguarding Knowledge:
Legal duty to report FGM in under 18s to police within 1 month
Risk Indicators:
- Family history or cultural background
- Extended family visits abroad
- Talk of "special ceremony" or "becoming a woman"
- Unexplained absence from school
- Family pressure or traditional expectations
Physical Signs:
- Difficulty with intimate examination
- Scarring or unusual genital appearance
- Recurrent UTIs or gynecological problems
- Pain during menstruation
- Complications in pregnancy/childbirth
PREVENT & Radicalisation
Government Counter-Terrorism Strategy:
PREVENT aims to safeguard vulnerable people from radicalisation
Vulnerable Groups:
- Homeless individuals
- Those with learning disabilities
- People struggling financially
- Children and young people
- Socially isolated individuals
- Those experiencing identity crises
Warning Signs:
- Social isolation and withdrawal
- Expression of extreme views
- Significant behavioural changes
- New social groups or online activity
- Rejection of previous beliefs/lifestyle
- Secretive behaviour
Modern Slavery & Trafficking
Global Crisis - Local Impact
40+ million people are slaves globally. More modern slavery victims IN THE UK are BRITISH! 1 in 4 victims are children. Countries of origin: Albania, Vietnam, UK, China & India.
High-Risk Groups:
- Mental health problems: Depression, PTSD, anxiety disorders
- Substance misuse: Alcohol and drug dependencies
- Homeless individuals: Lack of stable accommodation
- People with disabilities: Learning or physical disabilities
- Children (1 in 4 victims!): Especially those in care or missing
Additional Risk Factors:
- Financial difficulties or debt
- Social isolation and lack of support
- Immigration status issues
- History of abuse or trauma
- Language barriers
- Cultural or religious vulnerabilities
Physical Signs:
- Non-specific trauma, old untreated injuries
- Sexual trauma, STIs, late pregnancy booking
- Poor nutrition, dental hygiene
- Signs of physical abuse or restraint
- Exhaustion, malnourishment
Behavioural Signs:
- Depression, anxiety, self-harm
- Withdrawn, submissive, looks distressed
- Always accompanied by same person
- Language barriers, communication difficulties
- Fearful, especially of authorities
The Salvation Army:
- General: 0300 303 8151
- 24 hours: 0800 808 3733
- Email: mst@salvationarmy.org.uk
- Referrals: mstreferrals@salvationarmy.org.uk
Hope for Justice:
- Office hours: 0300 008 8000
- Hours: 9am-5:30pm Mon-Fri
- Out of hours: Crimestoppers 0800 555 111
- Email: help@hopeforjustice.org
Assessment & Learning Opportunities
Application and Assessment Methods
How trainees are expected to apply safeguarding knowledge in practice
🎯 Examiner Focus
Assessment focus is on recognition, judgement, escalation, and documentation - not specialist detail. Demonstrate explicit safeguarding awareness and appropriate information-sharing rationale.
Suitable Learning Experiences:
- Attending and contributing to a case conference for child safeguarding
- Documenting concerns regarding children where parents misuse substances
- Managing a consultation where safeguarding concerns arose
- Liaising with health visitors or social workers about vulnerable families
- Reflecting on a missed safeguarding opportunity
Reflection Framework:
- What safeguarding concerns were identified?
- How did you assess the level of risk?
- What actions did you take and why?
- Who did you involve and how did you communicate?
- What would you do differently next time?
- What learning needs have you identified?
SCA/RCA Examiner-Relevant Skills
What assessors are looking for in simulated consultations and role-play scenarios
Demonstration of Skills:
- Professional curiosity without accusation
- Appropriate questioning techniques
- Non-judgmental communication
- Clear explanation of concerns
- Appropriate information sharing
Typical Scenarios:
- Mother under family pressure regarding FGM
- Acute safeguarding concerns with parental alcohol misuse
- Managing uncertainty in potential abuse cases
- Explaining information-sharing decisions
- Safe escalation of concerns
AKT High-Yield Knowledge
Legal knowledge and recognition scenarios commonly tested in AKT
Children Act Framework:
- Section 17: Children in need
- Section 47: Child protection investigations
- Significant harm threshold
- Parental responsibility concepts
- Court orders and their implications
Mandatory Duties:
- FGM reporting (under 18s to police)
- Information sharing principles
- Confidentiality vs safeguarding
- Consent and capacity issues
- Professional accountability
Child Not Brought to Appointment (CNB/WNB)
A Safeguarding Concept, Not an Administrative Issue
Children do not choose to miss appointments - adults make that decision. CNB is a recognised safeguarding indicator in UK primary care.
Reframing DNAs Through a Safeguarding Lens
CNB may reflect neglect, parental incapacity, chaotic circumstances, or avoidance of professional scrutiny
Safeguarding Concerns:
- Neglect: Parent unable/unwilling to prioritise child's health
- Parental incapacity: Mental health, substance misuse
- Chaotic circumstances: Unstable housing, domestic violence
- Avoidance: Fear of professional scrutiny
- Controlling behaviour: Isolation from services
Practical Barriers:
- Transport difficulties
- Work commitments
- Childcare issues
- Language barriers
- Lack of understanding of importance
- Previous negative healthcare experiences
CNB Risk Stratification Framework
Decision-making framework for appropriate response to missed appointments
Single Missed Appointment
- Rebook and document
- Consider practical barriers
- No immediate safeguarding concern
- Monitor for future patterns
- Routine follow-up
Repeated CNB
- Review records thoroughly
- Consider cumulative risk
- Contact other services
- Document concerns clearly
- Consider early help referral
CNB + Vulnerability
- Escalate concern immediately
- Share information appropriately
- Consider safeguarding referral
- Urgent follow-up required
- Multi-agency discussion
GP Actions Following CNB
What should happen after a missed appointment
Do Not Simply Code and Close:
Every CNB requires consideration of the child's wider context and potential safeguarding implications
Immediate Review Steps:
- Review child's medical history and current needs
- Check for previous CNB patterns
- Consider family circumstances and risk factors
- Review any existing safeguarding concerns
- Check involvement of other agencies
Contact Considerations:
- Attempt to contact parent/carer
- Consider contacting Health Visitor
- Liaise with school nurse if appropriate
- Contact other involved professionals
- Consider home visit if high risk
Key Take-Home Messages for Trainees:
- "Did Not Attend" is not appropriate language for children
- CNB is a clinical and safeguarding issue, not administrative
- Patterns matter more than single events
- GPs must notice, think, act, and document
- Professional curiosity without blame is key
- Child safety always comes first
You've Got This! 💪
Remember: You don't need to be a child protection expert to provide excellent safeguarding care. You just need to know when to worry, when to act, and when to seek help.
Trust your professional instincts, document everything clearly, and never hesitate to seek advice. Every child deserves to be safe, and you're their advocate in the healthcare system.
Core Take-Home Message for Trainees:
- Safeguarding is everyone's responsibility
- You do not need proof — reasonable concern is enough
- Your role is to recognise, record, share, and escalate
- Child safety always comes first
🏗️ Building Analogy
Safeguarding children is like maintaining the structural integrity of a building. GPs must not only recognize obvious damage (acute abuse) but also identify hidden signs of structural weakness (social and parental risks, subtle clinical presentations) and coordinate swiftly with specialized engineers (Social Services, Police, Health Visitors) to prevent catastrophic failure, ensuring the child's safety is prioritized at all times.