- Whilst under the age of informed consent, it is up to those with parental responsibility to act on their behalf to ensure that the children are recipients of these services.
- In circumstances where children are denied these services by their parents/carers, health professionals, including General Practitioners must consider that it is their professional responsibility and duty to act on the child’s behalf.
- It is advised that professionals take into account each individual child’s circumstances and the likely implications of the failure to receive appropriate services.
NOTE: Babies and very young children are particular vulnerable.
- Professionals should take steps to ensure that parents are able to make informed choices and be flexible in negotiating alternative means of offering services.
- Where services would normally be accessed in a clinic, a surgery or school, consideration should be given to home visits as an alternative means of offering services. Children who are persistently missing from school or who have been excluded may require home visits to facilitate uptake of services.
NOTE: In circumstances where you have concerns about a child and you cannot gain access to the child during home visits, refer to “No Access” Guidance.
If parents / carers continue to fail to engage and there are concerns that the child’s health and development may be significantly impaired as a result of this, referral should be to the Locality Team in which the child lives.
Refusal of prescribed treatment
Where parents, the child or others refuse, withdraw or actively withhold commonly available foods or fluids, or fail to co-operate with prescribed medical or therapeutic treatment such that a child suffers, or is likely to suffer significant harm, or neglect, a Referral should be made immediately to the Locality Team in which the child lives under the Child Protection Procedures.
Attempts may be made to justify the above neglect on some basis, for example
- The religion of the child/parent/carer
- Cultural expectations
- Disability of the child including learning difficulties
- These attempts may be misguidedly believed to be in the child’s best interests
- Such information and reasons do not change the legal duties of all agencies to protect the child’s best interests, and this may result in the NHS or SBC01721 taking legal advice.
For further information refer to Inter-Agency Procedures under the category of physical neglect.
Refusal or withdrawl from routine health services:
In circumstances where children are repeatedly denied access to routine health services designed to promote their health and development, health professionals must ensure when communicating with parents/carers that they give sufficient information about the importance of the services to their child, outlining alternative means of provision and enabling them to make informed choices.
It is important for professionals to demonstrate that they are seeking opportunities to work in partnership with parents in order to achieve good outcomes for the child.
Legally it is important to have written evidence to prove that you have attempted to gain co-operation with parents/carers in the routine delivery of services. The following information should be documented:
- The number of contacts / appointments not attended, including the dates and times (e.g. home visits, clinic / hospital appointments, phone calls).
- Information provided to parents / carers.
Consider referral to ICS and / or Meeting Around the Child to discuss issues and possible solutions to engaging and supporting family. If the whereabouts of the family are unknown, refer to the ‘Missing Family Guidance’ pages in the Child Protection Procedures.