Child Protection

It is strange how one’s life journey doesn’t always take you on expected paths…

As a junior doctor and trainee paediatrician in the early 1990s, there were two career avenues I decided I really did not want to pursue: child protection and research. So I often wonder how it is, 28 years later, that I end up retiring from a career as an academic paediatrician specialising in child protection.

I suspect it was my time in Cambodia that set the compass leading me down this route. And perhaps, even more so, returning to this country – having seen the huge needs of children and families in such an impoverished and war-torn country – and wondering where the most vulnerable children and families in our country were, and what I could possibly do to make a difference.

I may puzzle over it, but I certainly don’t regret the career choices I have made. It has been an incredibly rewarding. Looking back, there is so much I can celebrate and feel positive about.

But it has also been a hard journey and it is perhaps only recently, with the prospect of retirement looming, that I have come to appreciate just how much of a toll it has taken. There are times when I feel tired and I look forward to no longer having to take responsibility for decision making and giving advice on individual cases – knowing that my advice can have such profound impacts on the lives of individual children and their families.

 

The good

As I look back, though, there is so much I can appreciate. Like the little girl who took me by the hand and proudly showed me round her new primary school after I’d seen her for a follow up medical after the one that led to her being taken out of the awful home situation in which she was living. Or the stressed out mum who learned to praise the good she saw in her child…

I first saw this little boy as a toddler brought to my clinic with constipation and soiling. From the moment they entered the clinic room, his mother poured out a torrent of abuse, calling him a ‘little shithead’ and ‘the child from hell’. Over the following months, with appropriate treatment, his constipation gradually improved. Each time they came to clinic, I made a point of telling the little boy something positive about himself. I also, over time, started asking the mother what she liked about him. One of the last times I saw him, they both came in beaming and his mother (now calling him ‘my little angel’) prompted him to show me his latest star chart – a gold star on every day.

Or another family where a bit of joint agency detective work led to a positive outcome for everyone…

As a newly appointed consultant I was asked to see a baby girl with rib fractures discovered on a ‘routine’ chest x-ray. There were no other injuries, the girl looked healthy and thriving and both parents seemed to be devoted to her. And yet, she had serious and unexplained injuries. Further investigations, including a home visit, revealed that the family lived in a poorly maintained first floor flat. In order to reach their home, the father, who had a disabling muscle condition which left him unsteady on his feet, would climb a narrow, unlit stairway, holding his daughter under one arm, while he held onto the bannister with the other. It became apparent that at times he had stumbled and, in doing so, gripped his daughter tightly round the chest – the likely explanation for the fractures. With a multi-agency child protection plan, rehousing to somewhere more suitable, and some parent training and support, the family were able to stay together and protect their daughter from further harm.

 

The bad

Sadly, not all the cases had such good outcomes, or such readily apparent solutions. I am sure there have been times when I have missed cases of abuse, given unhelpful advice, or simply been unable to reach any clear conclusions. I know that there have been times when decisions I’ve made have resulted in children being left in abusive environments. Equally, there have been times when my advice has ended up with children being unnecessarily removed from families. That is the hard road we walk balancing child protection and family support, where far too often, we just don’t know what route to take.

And there have been other cases where the best solution has been apparent, but we just haven’t had the resources to see it through…

I was asked to assess the baby of a couple with learning difficulties. The baby had suffered sunburn after the mother had applied after-sun lotion, not realising that it wasn’t actually sun-block. The baby had signs of neglect with poor growth and developmental delay. Both parents clearly loved their child, wanted the best for him, and would never knowingly harm him. A psychologist had assessed the parents’ capacity to take on board instructions and to be able to parent their child safely. The advice of myself, the psychologist, and the social worker was that, given enough support, these parents could look after their child. However, the levels of support that would be needed to ensure the child’s safety and wellbeing, were well beyond the resources available in the local authority, and the child was placed in care.

 

And the ugly

One of the most disturbing cases I have dealt with in my career was as a young registrar, early in my training. I was called to the emergency department to see a 2 year old who had been brought in with some minor injuries. From the moment I walked into the cubicle, the young girl, sitting on the examination couch, watched me with an intent, watchful expression. Throughout my examination she didn’t react at all – neither smiling nor crying – while her father sat stony-faced on the other side of the cubicle. I concluded that her injuries were accidental in nature and didn’t need any treatment, and I sent her home with her father. What really upset me though – and has haunted me ever since – were five words written in biro on her arm: ‘I am a little bitch’.

I have often wondered what happened to that little girl. What kind of a home did I send her back to? What kind of person did she grow up to be? Did anyone else pick up on the emotional abuse she was experiencing and act where I had failed to act?

 

Child protection does have its ugly side. Fortunately they are rare, but there are parents and others who deliberately and maliciously harm their children – physically, emotionally, and sexually. In the course of my career, I have had to deal with that. It isn’t easy seeing the pain that some children have to live with. Nor is it easy seeing the pain of parents who have their children taken away from them; of families torn apart by abuse, domestic violence, addictions. Or seeing adults carrying the pain of abuse they have suffered – from parents or partners, and sometimes just not knowing how to deal with that pain, or the stresses of life that can be so overwhelming that children end up getting caught in the middle and hurt themselves.

It isn’t easy. But it is important.

Which brings me back to the good, and one of the greatest privileges I have found through working in this field: the people. The very real and ordinary families who have shared with me some of their struggles, hopes and dreams; the amazing children, so many of whom show incredible resilience, joy and love, even in the face of such devastating adversity; and the professionals – social workers, police officers, nurses, teachers, doctors and others – all dedicated and committed to helping others, passionate about making this world a better place for children.