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Abstract
Objectives To determine any change in referral patterns and outcomes in children (0–18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years.
Design Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown.
Setting Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children.
Participants Children aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018–2020.
Main outcome measures Numbers of referrals, source of disclosure and outcomes from CPME.
Results There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns.
Conclusions School closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.
- child protection
- community child health
- non-accidental injury
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Footnotes
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Contributors JG conceived the idea, the protocol was designed by JG, GD, JT, JA and IA. The data extraction tool was piloted, revised then used for data extraction by JG, GD,HC, JA, IA, ET, EEHT, CM and EB. The data analysis was undertaken by JG, NH and MP. Drafts of the paper were written by JG, GD, NH and JT with all authors contributing. Information for the paper came from the clinical records for each child. JG is guarantor of the article. All authors approved the final manuscript.
Funding JG is funded by West Midlands Clinical Research Network (NIHR) as a Clinical Trials Scholar. MP is supported by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The University of Birmingham provided the Article Processing Charge.
Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The University of Birmingham funded the article processing charge.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study involved clinicians analysing routinely collected patient data, from patients within their own clinical service, it therefore does not require HRA ethical approval. The study was approved by the Research and Innovation Department in Birmingham Community Healthcare Trust.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. Data are drawn from clinical child protection reports of individual children and cannot be shared. The disaggregated and anonymised abstraction files may be shared at reasonable request from the first author.