871 The advent of socially distanced child protection – a study of the impact of the first UK lockdown on safeguarding referrals during the COVID-19 pandemic

BackgroundThe National Society for the Prevention of Cruelty to Children (NSPCC) estimates that over half a million children are abused in the UK each year.1 It is therefore important for healthcare professionals to recognise abuse and neglect and take the necessary steps to act against it. When the COVID-19 UK-wide lockdown commenced on 23rd March 2020, paediatricians faced unprecedented child protection challenges.ObjectivesOur objective was to assess the impact of the first lockdown on safeguarding referrals received in our Child Development Centre (CDC).MethodsWe analysed all Social Care (SC) referrals requesting Child Protection Medical Examinations (CPMEs) during lockdown and one week prior: 16th March - 1st June 2020. These were compared to all SC referrals for CPMEs during the same period the year before.Results6 CPMEs were completed in 2020 compared to 17 CPMEs in 2019 – a 65% reduction during lockdown.Referral Source 2019 2020 School 9 0 Social Worker 7 4 Hospital 1 0 Individual/Family 0 2 Total 17 6 Just over half (9/17) of the referrals in 2019 stemmed from school concerns being reported to SC. Two thirds (4/6) of the referrals in 2020 were directly from SC. Schools were closed during the first lockdown and thus, the input from this avenue was absent at our CDC. Whilst there was school provision offered to vulnerable children, attendance was low.2 School provision may not have been utilised due to shielding or parents/caregivers opting out.The main reasons for referral in both years have consistently been physical abuse and neglect.In 2020, the most common age groups to be referred were the 2–5 year olds and the 11–16 year olds (2/6 respectively), whereas in 2019, the most frequent age group referred was the 6–10 year olds (10/17).In 2020, 33% (2/6) of the referrals consisted of children with learning difficulties, compared to 23% (4/17) in 2019, highlighting the vulnerability of this group.The most common conclusion to CPMEs in 2020 was the finding of an ‘unclear injury and requiring further evidence before non-accidental injury could be ruled out’ (83%;5/6). In contrast, in 2019, the medical conclusion most commonly made in CPMEs was that ‘no injury [had been] seen but [there was] risk of significant harm based on the story’ (29%;5/17). In both cases generally, paediatricians recommended SC and/or police investigation. Other suggestions made as part of the management plan included parenting courses and health visitor follow-ups.ConclusionsThis project has demonstrated the reduction in number of child protection referrals made during lockdown, with no referrals initiated by schools. Historically, schools have been the main referrers of child protection concerns to SC. Taking into account that all children (and especially the identified vulnerable) are less visible during a lockdown, paediatricians need to adapt to meet these unique safeguarding challenges during the pandemic. Paediatricians should be constantly mindful of safeguarding risks, incorporate strong safeguarding partnerships with social workers and continue to be professionally curious when seeing children in all settings, particularly during the pandemic and most especially during lockdown.