Parents of more than one in four babies in England face suspicion of child abuse and potential investigation

23 April 2018

Academic calls for more rigorous approach to child protection policy making

New research published today, Tuesday 24 April, in the Child & Family Social Work journal reveals that child protection policies in nearly half of local authorities across England require all babies with a bruise to be referred to children’s services or investigated for signs of abuse, despite recent research showing that more than one in four (27%) babies had an accidental bruise over a seven to eight week period.

National Institute for Health and Care Excellence (NICE) guidelines and English Local Safeguarding Children Board (LSCB) policies on pre-mobile babies – those who cannot crawl or walk – provide rules for how local authority, health and education staff respond to possible abuse. This research has found major inconsistencies between the action the policies require staff to take, with many exaggerating the chances that a bruise on a baby is abusive.

A researcher at the University of Central Lancashire (UCLan) accessed LSCB policies for all 152 English local authorities through a Freedom of Information (FOI) request and, for those who did not respond, policies were accessed online between July and August 2016.

It was found that 91 local authorities had specific policies on bruising in babies who can’t crawl or walk, based on the premise that accidental bruising is very uncommon, and bruises are thus likely to be abusive. More than three quarters of them (77%) didn’t give front-line staff such as nurses, health visitors and GPs the freedom to make judgements about the causes of a bruise and required a referral to a paediatrician within 24 hours. Additionally, 66 policies required an automatic referral to Children’s Social Care.

"91 local authorities had specific policies on bruising in babies who can’t crawl or walk, based on the premise that accidental bruising is very uncommon, and bruises are thus likely to be abusive"

Further to this, five local authorities consider any bruise in a pre-mobile child to be ‘reasonable cause’ to suspect a child is suffering, or likely to suffer significant harm which means a formal child protection investigation must be undertaken. This can leave families with a record that, regardless of the outcome of the investigation, will appear alongside criminal convictions on any application to work with children. Four of these LSBCs also require a child protection investigation regardless of the parent’s explanation for the bruises or staff views on the cause.

These policies were analysed against a critical review of eight research papers on bruising in pre-mobile children. This revealed a number of limitations within the research underpinning these policies and guidelines, including significant inconsistencies in the definition of a pre-mobile baby, small sample sizes and singular observations. The most recent British research and the only study that involved several observations of children found that more than a quarter of the pre-mobile babies studied had an accidental bruise over a period of seven to eight weeks.

LSCB policies had considerable variations across the country despite being based on the same research studies. This research from UCLan calls for the implementation of standards for policy making in child protection similar to those used in public health screening to ensure their consistency and validity.

"It’s concerning to see the considerable inconsistency in these policies across the country"

Professor Andy Bilson, Lead Researcher and Associate Director of UCLan's Centre for Children and Young People's Participation, commented: “It’s concerning to see the considerable inconsistency in these policies across the country. Many policies have taken a ‘one size fits all’ approach towards the guidelines that frame assessments of bruising in babies.

“If, as recent research suggests, bruising in pre-mobile babies is ‘like the common cold’ and over a quarter of children are bruised accidentally in just a short period, then we need to be very careful before suggesting that all bruises are indicators of abuse. Unnecessary investigations not only pose further strain on the safeguarding system’s already limited time and resources, but also impact greatly on the families involved. A string of rigorous assessments and medical examinations are required when launching investigations and this can cause distress and harm families and their children.

“We need to be careful that our approach to child protection does not have unintended consequences such as discouraging parents of children who may be suffering from illnesses such as meningitis and septicaemia – which have symptoms that look like bruising – from seeking medical help because of fear of being investigated.

“This research by no means diminishes the need for vigilance and professional judgement when it comes to a case where a child has an injury. It highlights the need for policies and guidance that support a well‐informed and accurate understanding of research evidence, alongside a careful assessment of the evidence. This review shows that to achieve this we need improved standards for local child protection policy making.”

Read the full research paper here.