The Report of the Royal College of Paediatrics and Child Health, (2001) suggests triggers that may raise concerns with health professionals, including:
- Reported symptoms which do not correlate with any recognisable disease (or with a disease known to be present)
- Signs which do not correlate with any disease
- Signs which do not correlate with reported symptoms
- Investigations which do not correlate with signs
- Treatment for an agreed condition which does not produce the expected effect
- Repeated presentations, particularly to a variety of doctors and with a variety of problems
- Specific problems e.g. apnoea or loss of consciousness, fits, choking or collapse
- History of unexplained illnesses or deaths or multiple surgery in parents or siblings of the family
- A past history in the carer of child abuse, self harm or somatising disorder or false allegations of physical or sexual assault
- Triggers from other agencies could, for example, include concerns about reported reasons for poor school attendance.
NOTE: It is recognised that when any of the above are present, the health professional would usually be discussing the reasons with the parents; this may include querying history or specific reported symptoms. There is no reason to avoid such discussion, and normal clinical inquiries should continue. It is important to try and maintain a working relationship with the parent(s), while recognising that the parents may be expressing their own needs through somatisation in the child. For further guidance please see the above report.
Consultation (Guidance note 2)
It is essential that decisions are not made in isolation. If practitioners are in any doubt whatsoever that they could be dealing with a case of fabricated illness, then it is vital that colleagues with more specialist knowledge be consulted. This is important for:
The safe management of the case, and subsequent protection of the child
Ensuring support is available for health professionals who may be closely involved with the family.
You should always consult the Designated Doctor for Child Protection at BGH via BGH switchboard or the On Call Consultant Paediatrician via BGH switchboard
Tel: 01896 826000.
The paediatrician may subsequently have discussion with the Consultant Psychiatrist for the relevant area.
Other specialist advice may be available from:
Consultant Child and Adolescent Psychiatrist, CAMHS, Andrew Lang Unit, Tel: (01750) 23715
The Consultant Adult Psychiatrist for the relevant area (can be identified from Huntlyburn House – Tel: 01896 827152)
You may also wish to consult the Child Protection Adviser for NHS Borders: Tel: 01896 662762).
Screening for social work and police concerns (Guidance note 3)
In all cases, contact Child Protection and Reviewing Officer – Tel: 01896 662762 and give parents’ names and dates of birth. This is not a Referral. State this is an enquiry under the agreed protocol.
Child Protection and Reviewing Officer will check for existence of Social Work record. If family have moved in from another area, this may include checking with previous area. Child Protection and Reviewing Officer will also check with Police colleagues.
If record exists: Child Protection and Reviewing Officer will share information with enquirer. A discussion will identify areas of known risk and whether there are sufficient concerns to warrant an immediate Child Protection Referral (Option 3), otherwise the process will continue as per flowchart, with a joint decision being made by all involved health professionals. This may of course subsequently lead to a Child Protection Referral.