Consideration should always be given to the need for a medical examination of each child, about whom there are concerns.
Practitioners need to be aware that the purpose of a medical examination or assessment is to:
The child’s welfare is the paramount concern and the gathering of evidence must not become an additional source of abuse of the child. The need for forensic evidence should always be considered as secondary to the need for medical treatment for a child.
The doctor, to whom the request for an examination is made, must judge the timing of the examination. The following should be taken into consideration:
The assessment of the child should be carried out by a paediatrician with Level 3 competences as per Safeguarding Children and Young People: Roles and Competences for Health Care Staff.
Where a trainee carries out the assessment, they should be supervised by a consultant or senior paediatrician (RCPCH) guidance from Royal College of Paediatrics and Child Health.
Doctors undertaking the examinations must be aware of latest guidance from Royal College of Paediatrics and Child Health.
Examining doctors must be aware of the principles of informed consent and of the guidance contained in the RCPCH Child Protection Companion 2006.
Social workers and police officers undertaking s47 enquiries and criminal investigations also need to be aware of the issues of consent for the medical examination.
N.B. Examination without consent may be held in law to be an assault. It is the responsibility of the examining doctor to obtain the informed consent preferably in writing.
A child of 16 years and over can give their own consent. If they are unable to consent, for example because of a learning disability, consent may be sought from a person with parental responsibility.
Children under the age of 16 years, who are able to fully understand what is proposed and its full implications, are competent to consent (Gillick v Wisbech 1986).
However, the more serious the medical procedures proposed a correspondingly better grasp of the implications is required. Therefore, the examining doctor needs to ensure that the child fully understands the nature of the medical examination and how the information obtained might be shared with others.
If a child is not deemed to be Fraser/Gillick competent, consent from a person with parental responsibility is required. However, the child may still refuse to be examined.
For a child under 16, consent for a child protection medical examination will require the informed consent of a person with parental responsibility and of the child, preferably in writing.
Where the child is already the subject of proceedings in a court, the consent of the same Court is required. If the child is subject to a Care Order, see local arrangements as to who in the local authority can provide consent.
For the consent to be informed the doctor needs to speak directly to the person with parental responsibility and explain:
Consent should always be sought on a face-to-face basis – that is with the parent in attendance with the child. However, if the parent cannot or does not want to be present the doctor will need to decide on the action needed to obtain a valid consent.
Only in the case of a medical emergency where the child needs urgent medical attention, is consent not required.
An application for a Child Assessment Order, can be made if parents continue to refuse access to a child for the purpose of establishing basic facts about the child’s condition but concerns about the child’s safety are not so urgent as to require an Emergency Protection Order.
The Order enables the Court to direct the parents to co-operate with an assessment, the details of which will be specific, but does not allow for the removal of the child from home.
The Order does not take away the child’s own right to refuse an assessment. The parents should be informed of the legal steps that could be used.
This should include:
The report and any diagrams should be signed and dated by the doctor undertaking the examination.