Child Advocacy

Child advocacy refers to a range of individuals, professionals and advocacy organisations who speak out on the best interests of children. An individual or organisation engaging in advocacy typically seeks to protect children's rights, which may be abridged or abused in a number of areas.

The requirement to listen to the wishes and feelings of looked-after children and young people has been established in our domestic legislation for over 20 years. Advocacy is now a recognised tool to supporting children and young people having their wishes and feelings heard.

Advocacy acts as a safety net for many children and young people in care, who do not have the natural support network of family to represent them, to support them and make sure they are involved in decisions and have their rights met.

The different presentations illustrate the wide variety of ways that child protection concerns can arise in different parts of the health service and that child protection issues are often not clear cut. Deciding whether or not a child is being abused is not the responsibility of any one person but requires professionals involved with the child and/or family/carers, such as the GP, lead nurse and doctor for child protection, paediatricians, other healthcare staff, social workers, school staff and police to work together.

Physician

You are a member of the medical team on-call in a large, acute NHS hospital and have decided to admit Paula, a 35-year-old single mother with a large pleural effusion requiring drainage. The history reveals that Paula lives with her 9- and 11-year-old daughters. Paula does not appear concerned that the two girls will be in the house alone overnight and says she wasn't planning to find someone to look after the girls.

You may suspect 'emotional abuse' and 'neglect'.

You are a GP and review a 13-year-old boy in the surgery with recurrent headaches. While you are examining him he reveals that he is being bullied via text messages and on social media websites. His mother is aware of it but does not know how to help.

You may suspect 'not clear but concerning'.

Physiotherapist

You are a community physiotherapist reviewing Mohammed, aged 15, for ongoing knee pain, which he sustained playing football. Over the course of four appointments (two of which he did not attend) you establish that he rarely attends school and is part of a local gang.

You may suspect 'not clear but concerning'.

Surgeon

You are the surgeon reviewing a 4-year-old boy with abdominal pain in A&E. As you go to examine him, he makes a sexually inappropriate comment that suggests he has knowledge of anal sex. His father, who is with the boy, appears to laugh off the comment.

You may suspect 'sexual abuse'.

Nurse

You are the nurse running the cardiology clinic in December and you see that Mr Morgan is accompanied by a male child of about 5 years. The child resembles Mr Morgan and may be his grandson. The child is inappropriately dressed for the cold weather and is unkempt.

You may suspect 'not clear but concerning' and possibly 'neglect'.

Dentist

You are a dentist seeing a 4-year-old girl with very bad dental caries. You notice that she has bruising to the neck. The child’s mother is unable to explain this.

You may suspect 'physical abuse' and 'neglect'.

Anaesthetist

You are anaesthetising a 12-year-old post-pubertal girl for abdominal surgery. During the surgical preparation you notice that she has a number of opposing crescent shaped bruises to both breasts. You are concerned that these are bite marks.

You may suspect 'sexual abuse'.

Triage nurse

You are the triage nurse in A&E. Molly is a 35-year-old mother of five children and attends the Emergency Department for the fourth time over the course of 2 months. She says her injury is due to walking into a door.

You may suspect 'domestic violence'.

Midwife

You are a midwife booking in a 21-year-old primipara. You note she has several self-harm scars on the left arm and nictotine staining of the middle fingers. You ask her about any previous or current health concerns and she denies having any issues. The GP referral letter does not mention any mental health problems or substance misuse.

You may suspect 'not clear but concerning'.

The involvement of children in decision making about matters important to them not just empowers children, but also aids their development, their transition to adulthood and safeguards them against abuse and neglect. As described in the Munro Review of Child Protection [5] there is a recognition that in a 'system that has become over-bureaucratised and focused on meeting targets', we often lose focus of children’s needs and feelings.

Advocacy helps to bring that focus back. To make it happen, the central and local government must take steps to ensure that all children in care can access advocacy support if necessary, and that learning from individual advocacy cases is utilised to improve services for all children in care. This can be done through strengthening the statutory guidance, through the development of monitoring and regulatory framework, and through better-commissioning processes.

The Listen to Me report sets out detailed policy recommendations that will make sure all children in care and carer leavers are offered the support of an independent advocate when decisions are made about their lives.

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