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Two little boys – early primary-school age – have been playing an unsuitable game. Unfortunately, it was a really very unsuitable game and one of them has ended up with a minor injury to his foreskin. Their parents, understandably, panicked and have brought both boys to A&E. No intervention was needed for the injury, a minuscule abrasion, but of course its location has rung alarm bells. Now it’s my job, as the paediatric registrar, to sort things out.
The first thing is, or course, to see whether anything more sinister going is on. Abuse is always a possibility and, alongside leukaemia, it’s top of the list of things you really mustn’t miss. So I sit down with the boys, and reassure them that no-one’s in any trouble, but we need to ask them lots of questions. Had they seen someone else play this game? Did someone suggest it to them? Had a grown-up ever played it with them? Did they see someone do it on a video?
But no, it appears that this time the regrettable activity really did just occur to one of the kids as the perfect way to enliven a rainy Sunday evening. Children do try out some very odd things – their imaginations are proverbially fertile, and not all the directions their inspiration takes them turn out to be good ones.
Safeguarding protocol, however, makes little allowance for the eclectic fancies of young children. This incident comes near enough to ‘possible child sexual abuse’ that, after checking with my consultant, I have no choice but to alert social services and to admit both children overnight, for a senior review in the morning. The boys are thrilled – a sleepover, new toys, and heaps of adult attention. Their parents are horrified.
They’d have been even more horrified if they’d been awake at 3am that morning, when two uniformed police officers, alerted by social services, turn up at the children’s observation unit.
Only with considerable persuasion and my best ‘trust-me-I’m-a-doctor’ manner can I convince them to go away and come back when the children are awake. The next day, after an unbelievable amount of paperwork on all sides, everything is sorted out and the families are finally allowed home.
So, what did we all learn? I got to practise my awkward-consultation skills. The parents found out that the machinery of child protection, once activated, is a juggernaut which cannot easily be stopped. There are excellent reasons why safeguarding procedures are so robust, but when you’re on the receiving end they can be pretty scary. And the little boys? Well, they’ve learned that grown-ups are really, really interested in willies. I suppose they were bound to find out some time.
By the Secret Doctor. Read the blog and follow @TheSecretDr on Twitter and on Facebook
A difficult situation undoubtedly, but common sense after taking a really careful history could have avoided any contact with social work or police. I wonder too what record of this incident will remain on file to potentially cause problems for the family in future.
Anonymous: this is the world we live in. As a junior doctor she had no choice but to inform the consultant. Once the consultant gave a decision, that goes. What if one of the families decided to report this as sexual abuse and the hospital had failed to assess the case? Or one of the boys decides to try the same thing again, perhaps with a less willing friend? Do we have the time to developp a good enough knowledge of the families to be certain the boys will draw the necessary lessons from this incident? No. That is the job of social services. Common sense did prevail: no further action was taken. And yes, sadly we need t overy carefully document all that transpired. 'Who-can-we-sue' is sadly more common than Trivial Pursuit in many circles.
very relevant and true to life - every individual involved can affect the outcome and not just defensive medicinwe but defensive social work and often defensive teaching staff all run scared with children left scared by the fuss or fascinated by the attention or just plain confused. Would those parents ever raise concerns in a future incident?
The parents will be utterly terrified by this incident and will likely never seek professional help again for fear of losing their kids. This will likely have caused much more harm than good
I understand all the sensitivities but there should be a viable alternative management strategy in this situation to having to admit the 2 boys overnight.
If this situation is perceived as a viable reason to admit - couldn't the same argument be used to keep them in hospital several days if it was a Friday night or the relevant consultant was on leave etc.
Admission I suggest is more about suiting the established working practices of the numerous staff likely to be involved in this situation rather than the boys, their families and to be frank all of us as taxpayers.
The likelihood of this affecting the family in future is not insignificant. They may be afraid to seek help openly and honestly, and if they were to work in any profession requiring enhanced checks this level of referral could very easily show up indefinitely. Refer refer refer may be the message, it's someone else's job then to assess it; but this doesn't take into account the harms of referral itself.
I have read the many pertinent comments made by my colleagues. If all steps of the process have been as inclusive of every party's concerns, as it appears that they have been, and the reasons for Child Protection Guidelines being written into statutes, and the risks of not following them missing possible abuse and its potentially devastating consequences, having been well communicated and shared, with case studies, as Social Services are required to, then I anticipate that the initial horror of the parents will now be replaced by reassurance and relief that we live in a country where the voiceless and vulnerable are protected.
I have visited South East Asia and South America, and taken an interest in the health systems or lack thereof, and I am proud of our complex and appropriate system.
When it is well funded and adequately staffed by boundaried, caring and dedicated well trained professionals, who communicate clearly and with empathy the reasons for their actions, our NHS works brilliantly.
I am extremely proud to be part of the NHS. The alternative doesn't bear thinking about. Thank you for sharing and for the healthy debate that has ensued.