CHILD PROTECTION: ROLES AND RESPONSIBILITIES

Abstract

Maltreatment of children has become a global problem. It occurs in the form of deliberately inflicted physical trauma, neglect, emotional and sexual abuse. In most cases children suffer from more than one type of abuse such as a physically abused child may also be neglected and emotionally deprived of love and care during the times when he/she needs it most.1 One of the unfortunate situations a paediatrician may come across is having to deal with children who have been intentionally harmed by someone closer to them such as their own parents, family members or relatives. In a minority of cases the perpetrator is not among family members. In either case, the physical, psychological and social trauma children suffer in these circumstances has a profound impact on their growth, intellectual development, cognitive abilities, behavioural maturation and academic achievements. Paediatricians act as advocates for children’s health and they have a greater responsibility in identifying child abuse and raising awareness about the scale of this problem among general public.2 However, it is also true that “safeguarding children is everybody’s business” and it is this sense of combined responsibility that makes any child protection strategy, successful. Other health professionals such as general practitioners/family physicians, emergency department doctors, dentists and those health workers who come in contact with children and their families in community and hospital also share the same responsibility of being able to recognise features of child abuse and their role in its management. This article highlights the roles and responsibilities of all those who have a duty of care towards children either directly or indirectly. Roles and Responsibilities The following group of people share the responsibility of safeguarding children, and they all need to work collectively and closely to recognise child abuse and implement effective child protection policies: Parents: The safest place for a child is his/her home. It is an instinct for parents to care for their young ones. Parents would go extra mile to protect, feed, love and nurture their children. Our personal experiences and day to day observations are witness to the fact that majority of parents would do everything in their capacity to provide the best possible home, food, clothing, comfort, and education to make children healthy and useful members of society. However, it is also a sad reality that in most confirmed child abuse cases one or both parents are found to be responsible for abuse. Fortunately, such parents are in a minority. Certain personal, social, and medical factors among abusive parents put children at high risk of abuse. Parental stress and mental health disorders may make a child prone to abuse. Alcohol and drug abuse also play an important role in breaking the family dynamics making children vulnerable and unsafe in their own home.3 Financial difficulties and social isolation may also contribute to child abuse in certain families. It is a moral, ethical and legal responsibility of other family members, society and relevant state departments to identify such parents and provide them with necessary social, financial and psychological support they deserve in order to protect the children who are looked after by such parents. People (Society): Although a child lives with his/her parents, he/she is also part of a wider society. Besides their close family members, children interact with many people around them. This interaction may be direct (with neighbours, friends, distant relatives, common public) or indirect (electronic and social media). Children learn and develop their skills by interacting with others. It is therefore a collective responsibility of each and every adult to understand their role in protecting and nurturing children in a positive manner. Any act of omission or commission by the members of a society affects children accordingly. Children who witness or experience abuse are more likely to become abusers later in life4 Strong bonds among society members, regular interactions and reaching out to each other during the times of need not only strengthens the ties among people but also helps to eliminate the relevant risk factors of child abuse such as social isolation and low family income.5 Paediatricians: By and large, Paediatricians are considered to be the most competent to spot cases of child abuse. They are expected to possess the necessary knowledge and skills to help them identify cases of child abuse and to differentiate between accidental and non-accidental injuries in children of various age groups. Their role involves interactions with children, parents, family physicians and other government agencies such as social services and police. Therefore, it is a mandatory requirement that all paediatricians of different grades go through regular training pertaining to child protection.6 It is also vitally important that the paediatricians maintain their skills by regularly attending training courses every few years. Besides identifying child abuse, paediatricians also have a legal responsibility to liaise with the relevant agencies such as children social care and police, in order to protect children from further harm and safeguarding other vulnerable children who may be at risk of abuse if a timely intervention is not made. The Royal College of Paediatrics and Child Health (RCPCH) have published a detailed document outlining the competencies required of the paediatric health professionals with regard to safeguarding children and young people.7 Professionals (other): In addition to Paediatricians, any other professionals related to healthcare or otherwise, have a duty to report suspected child abuse cases to relevant agencies. Children who experience abuse may be known to professionals in education (teachers), social care (social workers) and community health professionals (family physicians, health visitors, midwives, dentists, opticians).  Local safeguarding procedures should be followed when concerns are raised about the welfare of a child, and these must be communicated to the relevant professionals.8 Non-medical professionals such as sports coaches and nursery staff may also become aware of situations where children are felt to be either maltreated or at a potential risk of abuse. They should also take appropriate measures and follow their local children safeguarding policies. Police (& Judiciary): Police usually work in collaboration with health professionals and social services when a concern is raised about a child’s welfare. Their role in the context of child protection is to assist the judiciary in suspected child abuse cases in order to detect the offenders and protect other children who may be at risk of abuse. They are also responsible to gather relevant information, investigate the suspects and give evidence in court to bring perpetrators to justice according to the local law.9 In the light of police investigations and presented evidence the judiciary applies the appropriate law.  A robust legal punishment helps protect children by acting as a deterrent against child abuse.10 Children and young people are the most vulnerable members of a society. Parents have a responsibility to nurture and protect their children until they become independent members of the society. Other people in the society also bear a moral responsibility to protect children from harm. Paediatricians and other health workers have a professional duty to identify child abuse and report it to social services and in some cases to police. Family physicians and other community health practitioners need to work as a team and should always discuss their concerns with relevant professionals when welfare of a child is compromised.  Safeguarding children is also a job of professionals working in educational institutions. In summary, protecting children is a collective responsibility of everyone in the society and safeguarding young people is everybody’s business.