As a safeguarding practitioner for your organisation, your role is essential in supporting children and families who may be navigating challenging and distressing experiences. The following guidance has been developed to ensure all agencies and professionals involved in safeguarding are working in alignment. Please support your team in implementing this pathway with sensitivity, clarity, and compassion.
If a practitioner is concerned a child may have suffered abuse contact Children’s Social work Services (CSWS) Duty and Advice team.
Child protection medical request in hours (Monday to Friday 9am to 5pm):
Following a strategy discussion, if a Child Protection Medical is required, the Social Worker should make the request by contacting the Community Paediatric Department on 0113 8432001. This should be done in a timely and sensitive manner, ensuring the child’s safety, emotional wellbeing/concerned-about-a-child, and dignity remain central throughout the process.
If, no same-day appointment is available and the Social Worker believes the Child Protection Medical is urgent, they should promptly contact the Community Paediatrician using the number provided to ensure the child’s needs are prioritised in a sensitive and timely manner.
If the situation is not urgent, the Social Worker should arrange the earliest suitable appointment, taking into consideration the child’s emotional wellbeing and ensuring the process is handled in a calm, supportive, and trauma-informed way.
Child protection medical request out of hours (5pm to 9am, weekends and bank holidays)
The Social Worker should contact the ‘On Call’ Consultant Paediatrician at Leeds General Infirmary (LGI) on 0113 2432799 to discuss the urgent need for a Child Protection Medical out of hours.
If a child discloses sexual abuse or has other presentations indicative of sexual abuse, please refer to Appendix 2: SARC Pathway for appropriate guidance.
Consent must be obtained before proceeding with a Child Protection Medical. This should come from a parent or carer with parental responsibility, or from the child themselves if they are assessed to be Gillick Competent. When seeking consent, professionals should be mindful that the parent or carer may be a potential source of harm. In such cases, a further discussion must be held with Children’s Social Work Services (CSWS) to determine the safest course of action.
If consent is not provided, the medical examination cannot proceed unless authorisation is granted by the Court of Protection. See Consent for Child Protection Medical / Medical Treatment for further advice.
When is a child protection medical necessary?
A Child Protection Medical should always be considered essential when there has been a disclosure or there is a concern about any form of abuse or neglect involving a child.
In addition to safeguarding the child’s health and wellbeing, key considerations include:
- Securing any necessary forensic evidence
- Obtaining accurate medical documentation to support assessment and care
In situations involving severe neglect, physical injury, or recent (acute) penetrative sexual abuse, the medical assessment should take place on the same day as the referral, provided this aligns with and supports the child's emotional and physical welfare. All decisions should be made with the child’s safety, dignity, and psychological needs at the forefront.
Only a an appropriately trained senior paediatrician or other suitably qualified specialist, (not a general practitioner (GP) is permitted to carry out a physical examination for the purpose of a Child Protection Medical. Other professionals involved should carefully document any visible marks or injuries using a body map, along with detailed written observations in their records, avoiding unnecessary examination or questioning of the child.
Strategy Discussions must include, in consultation with a paediatrician where possible, careful consideration of the need for and timing of a Child Protection Medical. These discussions should also explore whether any other children in the household may require medical assessment, always keeping the safety and wellbeing of all children at the forefront.
If a paediatrician is not present during the Strategy Discussion, and a decision is made to proceed with a Child Protection Medical, the Social Worker must contact the Community Paediatric Department or the on-call Paediatric Consultant at Leeds General Infirmary (LGI) to ensure the appropriate arrangements are made promptly and sensitively.
If abuse is identified within the hospital setting, for example, in the Emergency Department, Children’s Social Care should be contacted immediately via the Duty and Advice team.
In some situations, a Child Protection Medical may be carried out by the general paediatric team at Leeds General Infirmary (LGI) before a strategy meeting has taken place. In such cases, the allocated Consultant Paediatrician will clearly explain the concerns prompting the medical assessment, its purpose, and how the findings may support decision-making and communication with other safeguarding agencies.
The Paediatrician will seek informed consent from the parent or carer with parental responsibility prior to the examination. Where appropriate, and if the child is deemed Gillick Competent, the child’s own consent will also be sought.
However, wherever possible, it is considered best practice for a strategy discussion to occur before a Child Protection Medical takes place, to ensure a coordinated, child-centred, and trauma-informed response.
When is a child protection medical necessary?
A Child Protection Medical should always be considered essential when there has been a disclosure or there is a concern about any form of abuse or neglect involving a child.
In addition to safeguarding the child’s health and wellbeing, key considerations include:
- Securing any necessary forensic evidence
- Obtaining accurate medical documentation to support assessment and care
In situations involving severe neglect, physical injury, or recent (acute) penetrative sexual abuse, the medical assessment should take place on the same day as the referral, provided this aligns with and supports the child's emotional and physical welfare. All decisions should be made with the child’s safety, dignity, and psychological needs at the forefront.
Only a an appropriately trained senior paediatrician or other suitably qualified specialist, (not a general practitioner (GP) is permitted to carry out a physical examination for the purpose of a Child Protection Medical. Other professionals involved should carefully document any visible marks or injuries using a body map, along with detailed written observations in their records, avoiding unnecessary examination or questioning of the child.
Strategy Discussions must include, in consultation with a paediatrician where possible, careful consideration of the need for and timing of a Child Protection Medical. These discussions should also explore whether any other children in the household may require medical assessment, always keeping the safety and wellbeing of all children at the forefront.
If a paediatrician is not present during the Strategy Discussion, and a decision is made to proceed with a Child Protection Medical, the Social Worker must contact the Community Paediatric Department or the on-call Paediatric Consultant at Leeds General Infirmary (LGI) to ensure the appropriate arrangements are made promptly and sensitively.
If abuse is identified within the hospital setting, for example, in the Emergency Department, Children’s Social Care should be contacted immediately via the Duty and Advice team.
In some situations, a Child Protection Medical may be carried out by the general paediatric team at Leeds General Infirmary (LGI) before a strategy meeting has taken place. In such cases, the allocated Consultant Paediatrician will clearly explain the concerns prompting the medical assessment, its purpose, and how the findings may support decision-making and communication with other safeguarding agencies.
The Paediatrician will seek informed consent from the parent or carer with parental responsibility prior to the examination. Where appropriate, and if the child is deemed Gillick Competent, the child’s own consent will also be sought.
However, wherever possible, it is considered best practice for a strategy discussion to occur before a Child Protection Medical takes place, to ensure a coordinated, child-centred, and trauma-informed response.
What is the purpose of a Child Protection Medical?
The purpose of a Child Protection Medical is to provide a thorough and sensitive assessment of the child’s health and wellbeing, while also supporting the safeguarding process. Key aims include:
- Diagnosing the cause and mechanism of any injury or harm, and initiating appropriate treatment where needed
- Carefully documenting all findings in a clear and objective manner
- Providing a medical report that includes an informed opinion on the likely cause of any injury or harm observed or disclosed
- Assessing the child’s overall physical, emotional, and developmental health in a holistic and compassionate way
- Planning and undertaking any necessary medical investigations to support diagnosis and care
- Offering clear explanations and responding to any questions or concerns the child and their parent/carer may have, in a supportive and age-appropriate manner
- Arranging follow-up care and reviews as needed, including attention to any emerging physical or psychological symptoms
The leaflet: What happens when your child needs a child protection medical examination - Leeds Teaching Hospitals NHS Trust should be shared with the child’s parent or carer, and their understanding of the content and process should be clearly documented in the child’s records.
While the child may not be assessed in a hospital setting, the leaflet outlines some of the investigations that might take place if hospital-based assessment is required, helping families understand what to expect. The aim is to support parents and carers with clear, compassionate information and to reduce anxiety during what may be a distressing time.
Consent for Child Protection Medical / medical treatment
The following individuals or bodies may provide consent for a Child Protection Medical to take place:
- A young person aged 16 or over, who can legally consent for themselves
- A child under 16 who is deemed by a doctor to have sufficient understanding and maturity to make their own decisions, known as being “Gillick Competent”
- Any person with Parental Responsibility for the child
- The local authority when the child is subject to a Care Order, although parents or carers should still be informed when possible
- The local authority when the child is accommodated and the parent or carers have either abandoned the child or are unable, due to physical or mental incapacity, to provide consent
- The High Court when the child is a Ward of Court
A Court, through a direction attached to an Emergency Protection Order, Interim Care Order, or Child Assessment Order when a child is involved in ongoing Court proceedings, legal advice should be sought regarding obtaining the Court’s permission to carry out a Child Protection Medical.
As a general principle, it is good practice to seek the permission of the parent or carer for children under 16 before proceeding with any Child Protection Medical or other medical treatment, even if the child is assessed as having the capacity and understanding to consent independently (Gillick Competent).
If seeking parental or carer permission is not possible or appropriate, the reasons for this decision must be clearly documented in the child’s records to ensure transparency and accountability.
When a child is Looked After and a parent or carer has given general consent for medical treatment, legal advice should be sought to clarify whether this consent extends specifically to a Child Protection Medical. It is important to remember that the parent or carer retains full parental responsibility for the child.
If the local authority shares Parental Responsibility, their consent must also be obtained before proceeding with the Child Protection Medical.
In cases where a child has been assessed as having the capacity to make decisions but chooses to refuse the Child Protection Medical, this decision may be overridden by a court order to ensure the child’s safety and wellbeing.
In emergency situations where a child requires urgent medical treatment and there is not enough time to obtain parental consent:
- The medical practitioner may proceed without consent if it is necessary to protect the child’s life or prevent serious deterioration in their health; and/or
- The medical practitioner may determine that the child is of sufficient age and understanding to give their own consent, in line with Gillick Competence
In such cases, parents or carers must be informed as soon as possible, and the decision-making process must be clearly and contemporaneously recorded in the child’s medical and social care records.
In non-emergency situations where parental consent is not obtained, the Social Worker and their manager must seek legal advice before proceeding.
Doctors should refer to the General Medical Council’s guidance, 'Protecting Children and Young People – The Responsibilities of All Doctors' (GMC, updated 2024), for further clarity on decision-making and consent.
If a parent or carer withholds consent, the Social Worker must escalate the case to senior management and seek advice from the local authority’s legal team. The senior Paediatrician should also be consulted regarding the best course of action. Where serious safeguarding concerns remain, legal proceedings may be required to seek court permission to undertake the necessary medical assessment or investigations.
Arranging the Child Protection Medical
See Appendix 1. When a child protection medical is required, careful consideration must be given to both the specialist paediatric expertise and the forensic aspects necessary for gathering evidence in a manner that is sensitive and supportive to the child.
These medical assessments should only be carried out by appropriately trained professionals, including Consultant Paediatricians, Forensic Medical Examiners, or experienced paediatric doctors (ST4 and above) who meet the standards outlined by the Royal College of Paediatrics and Child Health (RCPCH) for child protection medicals.
To minimise distress, every effort should be made to ensure that the child undergoes only one medical examination wherever possible. This helps reduce the potential for traumatisation and supports the child's emotional wellbeing.
It is important to think carefully about who accompanies the child to the medical assessment. Ideally, the person alleged to have caused harm should not be present. While this may not be possible in every circumstance, the child’s safety, comfort, and emotional needs must remain the priority.
If there are concerns that the child may have experienced sexual abuse, please refer to Appendix 2: SARC Pathway, which outlines the appropriate steps to ensure a safe, trauma-informed, and child-centred response.
Recording of Child Protection Medical
After completing a child protection medical, the examining doctor will provide a clear verbal summary of their initial findings to the allocated social worker and, where appropriate, the police officer involved in the case. A brief written opinion will be shared by the Community Paediatric team, with a full written report to follow within four working days.
To support effective communication and coordinated care, the social worker should ensure that the doctor is provided with the name and contact details of any police officer involved in the case.
In situations where multiple child protection medicals are requested for children within the same family over a short period, it is important to hold a multi-agency discussion. This should involve Health professionals, the Children’s Social Work Service, and the Police to ensure a shared understanding of concerns.
The sharing of the report’s findings with the child and/or their parent or carer should be considered carefully. Decisions about what information is shared, and how must be made collaboratively between Children’s Social Care and the Police, prioritising the child’s emotional wellbeing, safety, and best interests.
All child protection medical reports should be completed in line with the RCPCH guidance: Good Practice Service Delivery Standards for the Management of Children Referred for Child Protection Medical Assessments (RCPCH, 2020). These standards support high-quality, child-focused care that is consistent, evidence-based, and delivered with compassion.
If criminal or family court proceedings are initiated, the paediatrician’s written report may be submitted and shared as part of the court evidence. The paediatrician may also be asked to attend court hearings to support their findings.
When a joint child protection medical assessment has been carried out, the healthcare professionals involved should collaborate to decide who will prepare the report for Children’s Social Work Services (CSWS). If there are differences in clinical opinions or interpretations, each clinician should provide a full report. In such cases, it is usually appropriate to seek an additional, independent medical opinion to ensure clarity and support the best interests of the child.
If criminal or family court proceedings are initiated, the paediatrician’s written report may be submitted and shared as part of the court evidence. The paediatrician may also be asked to attend court hearings to support their findings.
When a joint child protection medical assessment has been carried out, the healthcare professionals involved should collaborate to decide who will prepare the report for Children’s Social Work Services (CSWS). If there are differences in clinical opinions or interpretations, each clinician should provide a full report. In such cases, it is usually appropriate to seek an additional, independent medical opinion to ensure clarity and support the best interests of the child.
For more detailed guidance, please refer to Guidance on Paediatric Forensic Examinations in relation to possible child sexual abuse (September 2004), published by the Royal College of Paediatrics and Child Health and the Association of Forensic Physicians.
Appendix 1
It is identified that a Child/ Children needs a Child Protection (CP) medical either Monday - Friday during office hours or weekends and out of hours:
All CP Medicals are carried out during OFFICE HOURS ONLY (approximately 9am to 5pm)
All CP medicals, in medically stable children, take place at St Georges Centre, (SGC) LS10 4UZ. Mon to Fri afternoons by Community Paediatricians.
Please contact: 0113 843 2001 (in office hours) to arrange a CP medical.
Out of hours please ring Social Care 0113 535 0600 to discuss a place of safety, they will request a medical the next day.
For hospital staff. Please discuss all cases from the emergency department with the acute paediatric consultant on call for advice/support and document.
Exceptions:
Out of hours: High risk situations such as non-mobile babies with injuries will be admitted.
If there are signs of injury e.g. on a Friday evening that may fade. If a child is likely to die or if the police request an out of hours medical. Acute Paediatricians can be contacted on 0113 2432799 to discuss the child’s attendance at the Leeds General Infirmary.
Appointment within 24 hours
- Physical Injury
- Neglect or emotional abuse where protection from harm is required urgently
Siblings associated with an acute Physical Injury - should aim for next working day following index child
Appointments within 10 working days
All other referrals are triaged by the on-call Senior Paediatrician, and the timing of the medical is decided depending on the concerns and urgency of other referrals.
Appendix 2
SARC Referral Pathway
