This applies to all children/young people under 16 years old and those 16-18 years who are considered vulnerable, engaging in sexual activity. Getting this right is immensely challenging, as it is impossible to cover all variables influencing decision making within this guidance, further more you need to carefully weight the often conlicting needs of the child. (Involve seniors early if you have any doubts)

There is additional guidance available from the GMC and BMA, however the Scottish government has formulated some great advice Getting it right for every child (GIRFEC)

Social Services referral – ALWAYS

There are certain circumstances when you should always escalate your concerns to social services:

• Under 13 years old OR too immature to consent/understand
• Coercion; force, threat, bribery, payment, drugs, alcohol
• Involved in pornography OR prostitution
• Significant age difference (>3yrs, is a rule of thumb but this will vary case-by-case )
• Position of power/trust
• Known to police/child protection agencies as having abusive relationships with children.

In any of these situations you should:

• Patient – Where possible inform the child/young person of what is happening and your concerns
• Social Services – Refer case to Duty social worker
• Paediatrics – Inform Child protection lead or paediatric consultant on-call
• Documentation – Record decisions and names of those involved
• Police – Generally social services will contact police if needed, however in exceptional circumstances you may need to contact the police.
• Rape/sexual assault guidance

If you are considering NOT sharing this information with social services: You must discuss the case with either the child protection lead or paediatric consultant on-call and document this conversation.

Paediatric liaison

If you have assessed that the relationship is not abusive or exploitative. However, you have concerns that the patient may be at risk due to their behaviour, use of alcohol/drugs, or environment.

• Patient – Where possible inform the child/young person of what is happening and your concerns
• Confidentiality – Maintain patient confidentiality (i.e. information kept within NHS)
• Support – sign posting to sexual health services, alcohol services
• Refer – Complete “Paediatric Liaison Form”

Support Only

If you have assessed that the relationship is consensual teenage sexual activity with no concerns about abuse or exploitation.

• Confidentiality – Maintain patient confidentiality
• Support – Sign posting to sexual health services,
• Parent/Guardian – You should encourage the patient to inform parents/guardians  the BMA advice is below

“If children under 16 are competent to understand what is involved in the proposed treatment, the health professional should, unless there are convincing reasons to the contrary, for instance abuse is suspected, respect the patient’s wishes if they do not want their parents or guardians to know. However, every reasonable effort must be made to persuade the child to involve their parents or guardians, and explore then reasons if the patient is unwilling to do so, particularly for important or life-changing decisions.” the BMA

 

Thanks to Dr. Rouke our child protection lead for her help