Background Have coronavirus restrictions resulted in missed child protection concerns.

Objectives To evaluate the:

1. impact of coronavirus, and the public health measures taken to address it, on child protection referrals.

2. effect on child protection referrals following the re-opening of educational services.

Methods A retrospective review of patient notes was carried out for all safeguarding medicals to a tertiary dedicated UK children’s hospital between:

• April and June 2020 (peak lockdown)

• April and June 2019

• September to November 2020 (as schools and childcare settings re-opened to all children)

Data was entered into an Excel spreadsheet and quantitative analysis undertaken.

Results

• The total numbers of safeguarding referrals were similar across all 3 time periods.

• Physical abuse was the most common category for referral throughout. There was a higher proportion of neglect in both 2020 data sets compared to 2019.

• Children were previously known to social care at the time of their referral in 38% of cases in 2019 compared to 60% of cases in both 2020 data sets.

• Most children were managed as outpatients: 84% in April- June 2019, 76% in April- June 2020 and 92% of September- November 2020.

• In April – June 2020 20% children required ongoing medical care or intensive care in comparison to 10% of cases in 2019.

• Abuse was confirmed or suspected in 54–55% of cases across all 3 time periods.

Conclusions Concerns about children not being referred for safeguarding medicals are not supported from this data. In contrast, other UK centres have reported their referrals dropped by a third. [i]^,[ii]

During the lockdown period more children required hospitalisation including to intensive care compared to 2019, reflecting more significant injury.

The 2020 data sets had a higher proportion of neglect cases, potentially reflecting the increased pressure coronavirus had put on already vulnerable families.[iii]

During lockdown educational settings identified safeguarding concerns in only 6% of cases, potentially explained by extensive educational closures. 15% of referrals in September- November 2020 data were identified by education, not supporting the concern of a spike in referrals as schools re-open. This has been found elsewhere also. ^[iv]

References

1. Bhopal S, et al. Who has been missed? Dramatic decrease in numbers of children seen for child protection assessments during the pandemic. Archives of Disease in Childhood Published Online First: 18 June 2020. doi: 10.1136/archdischild-2020-319783

2. Garstang J, et al. Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK. BMJ Open 2020;10:e042867.

3. www.internetmatters.org/hub/research/new-childrens-commissioners-2019-report-reveals-rates-of-childhood-vulnerability/#:~:text=New%20Children’s%20Commissioner’s%202019%20report%20reveals%20rates%20of%20childhood%20vulnerability&text=New%20report%20reveals%20that%20an,of%20a%20vulnerable%20family%20background. (accessed 23.12.2020)

4. Jentsch B, et al. Child welfare in the midst of the coronavirus pandemic—Emerging evidence from Germany. Child Abuse & Neglect 2020; 110 (2):104716