What to do if you're worried about a child

Locate and follow your local child protection procedures [1,2,3].

Document and record key information that will assist with the initial risk assessment, safeguarding and reporting a concern. A suggested list of information to record in relation to a child protection concern is provided by National Guidance [2]

Document fully the history, including details of what happened from the child and parent/carer, details of any injury or presenting complaint, the child’s past dental history and medical history, and details of the family and its social circumstances [1,3]. 

Conduct a full dental examination of the child. Take note of the general appearance and behaviour of the child and their interaction with their parent/carer [1,2,3].

Record your observations, including details of any dental, oral or facial injuries, and record the reasons given for seemingly trivial injuries, which might, over a period of time, show a repeating pattern of injury [1,2].

Make diagrams and record observations in a way that will be understandable to colleagues so that, even if no single team member gets to know the child, a written record builds up over time [1].

Clearly state any differences between the facts and your opinion [1].

Document any changes or inconsistencies in the child’s history (including discrepancies between the child’s history and the results of the examination), delays in presentation to the practice (including non-attendance or cancelled appointments), signs of inappropriate development, and any previous concerns for the child’s (or their siblings) well-being [1,3]

Talk to the child, letting them volunteer information, and record their responses. (Do not ask leading questions) [1,2,3].

If the child requests that information is kept a secret, do not promise to do this, but explain that you might have to share the information and that you will tell the child who will be informed and when [1,2].

Be aware that, although injuries to children should be regarded with suspicion, a diagnosis of child physical abuse is never made on the basis of one sign because various diseases can be mistaken for physical abuse, and injuries can be caused by other means (e.g. playground fighting) [1].

Do not intervene on your own. Share your concerns with someone you can trust (e.g. a senior, experienced colleague within the practice, child protection team, a social worker, child protection nurse or child protection doctor). (Your local child protection procedures should name a designated person with whom to discuss initial concerns.) [1,2,3]

If you still have concerns, explain your concerns to the child and the parent/carer and your intention to make a referral to your local services, and seek consent to share information. [1,3]

On the rare occasion that talking to the parent/carer is likely to put the child at greater risk of harm (e.g. child sex abuse or fabricated or induced illness) or is likely to impede a police investigation or social work enquiry or, if consent to share information relevant to the concern is withheld, discuss this with your defence organisation or senior colleagues before proceeding [1].

If required, refer the child to a medical practitioner for physical examination [1].