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Okay, Hopefully that has worked. Apologies for the delay. Just having some slight technical issues. Um, I'm very pleased to better introduce you all to are brand new pediatric Siris here on mind. Oblique. Uh, my name is James, and I'm joined this evening by Dr Helen Armstrong, who is a consultant pediatrician on the session. That we have a plan for you is practical safeguarding. It's, uh, so just a little bit about myself to start with. Um so I am an f Y one doctor in hematology. It's stuck Mandeville. But I have quite a lot of experience previously working with Children both in the mainstream and special educational needs sectors on. So I worked in the Children's home, a special school specializing in epilepsy. Um, but also we looked after a lot of Children had difficult home circumstances, very challenging behavior on I said, a lot of safeguarding work there. I've also done support groups for young people with autism spectrum disorder. Um, and throughout my kind of childcare career of looking up the Children between the ages of three and 12, working about 10 years of sports coaching every year I have to go in various safeguarding courses. Um, so I become very, very familiar with it. Um, the last thing I want to highlight from that kind of many resume, um, would be I'm part of safeguarding team at my hospital state man who so each week on me with one of the senior pediatricians and safeguarding those on this it's not alive. That's a slight issue. Oh, well, it is. I've been corrected that we are, I believe, like, so apologies for that. Let me carry on and see what we between myself, pediatrician, some of the nurses, one of the safeguarding later nurses. We go through all the recent cases that have been flagged up by the junior doctors. Um and generally kind of discuss, Do we have any extra concerns that we need to raise it and kind of what sort of mistakes have been made, unfortunately by the juniors in their documentation or tackling of some of these cases. So just a little bit more about hopefully what we're going to try and put on for you guys. So over the next 12 weeks, and we're gonna have 12 different sessions. But my guest speakers that are somewhat experts in their field, ranging from consultant pediatricians for advanced nurse care practitioners to fellow F one F twos that have a real passion for a certain area. Um, this particular week, we are focusing on safeguarding on what you actually need to do as a junior doctor. I'm sure all of you have trust inductions or safeguarding lectures at medical school. But at least in my experience, I have found talking to my colleagues. A lot of people aren't actually that confident in what to do when they're working with Children, whether that's in the pediatric emergency department or out on the Ward's. But before we get started, I just wanted to just put a trigger warning out there. This presentation doesn't have any distressing images on know really kind of hover stories on, but I know it's definitely a challenging subject for me to talk about for my own work. Previously, um, and whatever backgrounds themselves might have, you might find this quite difficult talk to go through, so just take it at your own pace, obviously, is a livestream. If we were here if you were here in personal, so you're you're more than welcome to kind of take five minutes out and have a break. Okay, so just kind of take it easy. Okay. So what? Actually, are we hoping that you guys conducive? You're a medical student watching this, um, as a general rule, if you know you're probably your exams on, you get a pediatric history particularly. We want you to show that, actually, with the questions you're asking, you're aware of all the different potential safeguarding issues, and you're kind of ruling them out. Um, I spoke to Dr Astra before we started, and she said, Actually, if you come down to kind of for pediatric emergency department, we want you to recognize that there might be a safe guarding issue while you're taking your history and then immediately escalate to one of the seniors who can take over from you because it's really important we want we want to keep Children. So if you want, keep young people say, um and actually is something has to be handled very carefully. So why having a kind of an awareness of all these issues? Hopefully, that is something you will be able to contribute to. Now your phones F two. So actually be kind of working with Children on a daily basis. We want you to go to do a thorough assessment of Children on understand kind of what you need to go looking for to properly assess safeguarding concerns. Pick up on things, little cues in your history or your examination that are actually of concern. Document. Document it Really Well, I cannot stress enough if you don't document something. You know this from all of your jobs. If you didn't document, it didn't happen. But we're safeguarding. There's kind of there's a legal side to it on. This does get kind of transferred to your social services, the police. Your documentation is so important us to be able to interpret what is going on with that young person. And the big, big thing that we're gonna come back to again again throughout the tour is that we want you to escalate to your seniors and have a really low threshold. But discussing any concerns, not just the safeguarding, but page is a wonderful, wonderful specialty because everyone is so supportive. It is senior lead on. The only time they're really going to get upset with you is for not coming to them for help. They want to hold your hand. They want you to take you for and they want you to make sure this is done properly on. Actually, if it's a difficult case particularly going quite happy to take over, would you agree with that assessment? Doctor Armstrong? I would absolutely agree with that. I think I, as David said, I've only ever been upset when people haven't told me, know when they have. Yeah, people have made some of the main reasons I want to get into a swell as all those lovely things I've done in the past. Okay, so why? Why, exactly is safeguarding important? And so we thought we could kick the series off with soap on it because it isn't born because Olden are incredibly run a ball. If you look at the happy little chapter we've got on the slide here, he can't tell you what's been going on at home. He can't tell you if someone's been hurting him. If something, everyone has been meeting his needs. That's one of the biggest things that he will not be to tell you what is going on. So you, as a pediatrician or is a junior doctor of the medical student have to be switched on of picking up the sign that something is something is a Ms and that goes well put Children learning disabilities or mental health issues that again may not be in a communicate some of those issues to you. Okay. Furthermore, with Children, they are easily led astray. Um, so I used to work in care. You start with mainstream Children. Big part of my job is convincing the child to do something they don't want to do. But let's get up to school. It may be having a shower at the end of the day. It may be, you know, eating with a knife and fork. I had a million and one tricks, and I would persuade them to do something that initially they did not want to do. And that is exactly, unfortunately, same thing that can happen to show it may lead astray on That means they engage in thing that they shouldn't be. And that's kind of where abuse continually easily happen. On a lot of actually, they are very dependent on the adults around them on they, you know, they do trust adults, and that is fantastic in some regards again. It makes an incredibly vulnerable um, you, as a junior doctor may actually be one of the only professionals that have sufficient access to identify some of these issues. So in the last couple of years, we've had coated, which means Children school less. They're going to less out our school clubs, less sports clubs with you think that having less contact with the normal specials pick up these issues. But on top of that, as a doctor, we get to be super nosy. We get to ask all the questions that we want. We get to really delve into what's going on in that child's life. And on top of that, we we could get to examine all different parts of the body in a way that your school teacher does. No. Which means that we're in a very privileged position. Also have a big responsibility to be the ones to pick up this stuff. Um, and as a doctor, I'm sure you're already aware you have a duty. Care to your patients. You have legal responsibility back for some of the reporting within safeguarding, but we're gonna touch on that bit later. Okay? So okra thing on the treatment of vulnerability s. So we're just gonna go to a couple of fact or a few factors, um that you just need to have in the back of your head. If these things are present. It makes the young personal the trial more susceptible to abuse or neglect. So if you look at one of their family circumstances, things like a low so socioeconomic status if the parents don't engage with healthcare, so they they're not really listening to you when you're trying to tell them how many is that kids asked her. That's not a good sign that they're taking a good care of the young person in front of you. Similarly, if they previously stuff abuse themselves, if they have mental health issues, substance abuse, domestic abuse, these things will increase the likelihood Children are probably suffering abuse. But that is absolutely not to say if you look at some of this list, you know your apparent yourself. Well, maybe it's one or two of these things on. We're not trying to say that this means that you are going to abuse Children. It just means in the back of your head. These are factors that statistically make it more likely. Okay? And when you look at the child different ages, different sexes will predispose Children. Two different types of abuse. Um, and that's something you will get a kind of a feel for the more you work with young people, important for the cases you're involved in. If they had previous abuse previous trauma, their kids and care if they've got learning disabilities like we said before, where they can't can't tell you things or they can't process things in the same way that a child age would, um he's full increase of vulnerability. Is there anything that you wanted to add? 20 of that. Okay, arms from, Um, no, I think that's all really relevant. I think. As James said, this is not about judgment. This is just about being aware that these things suddenly all the case, one of my favorite families probably takes away these boxes, and they're absolutely wonderful parents. But suddenly we know statistically that these things do you make it more likely. Okay, so now one of the big topics were move onto his assessment. So this is a QR code that links to a paddle. It also gonna posts. Um, let's hopefully alongside the video. Um, and what I'd like you guys to do is go in and have a think about some of the questions that you would like to ask in history with any any child that comes into pediatrics and that helps you identify safeguarded concerns. What other things? That kind of we, you know, we're really concerned about what questions you gonna ask Every single consultation. What we're gonna ask about teenagers specifically what we're gonna ask about primary school age Children. You know how we gonna approach how we're gonna phrase the questions on? You know, I think I've always well on the padlock, but I'm different headings. You can post your ideas underneath. Um, similar. Active. I did the different types of abuse and neglect. Um, so again, you can think about the different the different areas that you want to approach kind of investigate. So if you have a quick go up that but you should get a scan it with your phone and on the event I have not been links. I will see if I can quickly add that to the video as well. Okay, look, I'm not going to take you through the things that would come up with, um, so in every single consultation, we want to be asking 100. Is there any social sevens? And But when I ask, it's of every pair of that Clark, one of their Children's in the emergency department make it a routine question. Um, we've just kind of discussed the full Oh, you know, these are one of the things that make it more likely. Also mean when we escalate to social services or police, they know that they can go and look someone up if you know they have had previous contacts. Um, we also want to think about who else is at home. Um, that's important because, you know, brothers, sisters, for example, they may be having issues themselves, and that's gonna have an effect on our child. A young person, also Mom or Dad are bringing in kind of partners or friends. You know, they're abusing alcohol if they're abusing drugs, that again puts the child a bigger risk. I just want to jump in and add that when you thinking about who's at home. If you're worried about safeguarding and the child you got with you. You also need to consider that there's that potential risk to those Children still at home on who will be looking after them. If you are initiating safeguarding proceedings with the child with Absolutely, and that is that is really important. Um, and also, if you know when we're kind of, uh I'm sorry, who is with them is what I was thinking there. So if you think about his gun, who has turned up Simone's department? Um, if we're gonna recess kind of the relationship between child in this person, we need to know who they are. You know, it's very different. How you gonna act with your mom or your dad? Your pee teacher. The brought you in half. We're through the school day on what's appropriate with each is going to change. It was gonna be very different. Um, we just want to think about the timing of the presentation. Is it? You know, is it reasonable that they've waited four days before coming to talk to you about something? If it's not, that is kind of one of the things that might be typically often thinking. Okay, well, maybe this is a collect maybe there are other needs that are being that here. Um, we can also ask about, you know, how is school going? How are things at home? Um, I'm short, but from from three kids and not very good liars, Um, generally, you get quiet up front, you get a pretty good sense of what's going on because I mean rolling their eyes are saying at school, Is going to boring is very different, you know, dreading going in every day, having panic attacks and crying because they're being bullied or that being hurt when they're at school. The other thing it's worth asking just around school is that if you're thinking about neglect, rather than say something really obvious, like a physical abuse, it's quite difficult to prove that. But some of the quantity of things you can assess are school absences. There was in Have they been absent one day a week for every week for the last six weeks, etcetera. And that's really helpful. Absolutely. That's that's a really good point. Um, and similarly, you know, how often are they coming into hospital? What's been going on if they're coming in for the same thing again and again, you know, kids are accident prone. But if this is the fourth time you've fallen down the stairs, you know, Are you being program appropriately supervised? Is there kind of a danger in the home that the hell it is? It needs to go out and see looking for patterns, eyes really, really important. I'm gonna touch in this little later. But the teenagers, we're gonna be thinking about relationships, drugs, alcohol, um, suicidal ideation or mental health issues. Although I know we are now seeing a lot more about primary school. These Children, um, but definitely is something to have in the back of your mind with teenagers. Um, if we think about how we want to let leave, this is It's similar to a little history's you're going to be doing anyway. So patient focused or child lead were appropriate. What we said when we were looking at kind of the baby that probably can't speak yet. They're not gonna be leaving the consultation, but absolutely. Get your 78 year old to kind of tell you a bit about what's going on in their own words. That is really, really key, and you'll get a lot more useful information that way. Um, we want to ask myself questions. We definitely don't want to be kind of taking a trial down in one particular direction and getting them to kind of agree to things that may or may not be happening because then we're kind of putting words in their mouth. Um, I find a really helpful question if you're struggling with apron questions, and safeguarding is after you've said so tell me what happened. And I think things like and then what happened next? Because that way you could leave them through the history, but without leading them. So that's that. Now that's a really nice temp. It's a really good way of just you're moving it along. But leaving it entirely up some kind of way where you go with, um, be non judgmental is that, you know, it's kind of quite casual. It's quite routine. Yes, you're taking it seriously, you know, having a laugh about it. But you're not going over the top, being shocked or kind of reacting and being overly emotional. But you may be feeling like that inside with some of these things. Um, but if you think about someone kind of divulging the information to you. You do You need to feel the person that you're divulging to is isn't judging you And that this is, you know, something They do date today. Um, Okay, so we have another chase and another handle it. We should be posted in the group. Just double check. Do that. Um, So what When you think about is what you want to know about this case you got a 14 year old girl that comes in, um, a parent. So? So every child would tells, you know, she's been very tearful where it was drawn at home of irritable about something. She doesn't even go into school. Grades are all going pretty downhill. The teachers and sandwiches. Not quite the same kid she was before. Um, and all this seems to have started not long after seeing a new boyfriend. Um, and the parents just growing, say, really worried about mental help. Um, So I think about, you know, what is it that you want to know? It's a job down. A few ideas. I'm just gonna check your MRI. Sure. Doing what it's supposed to isn't see women ish access that not much is coming through, but with that kind of gonna discuss it anyway. Okay, so this guy's gonna focus around relationships and this This can go with weight and for primary school aged normal the way the teenagers on actually again. If you work with adults vulnerable, I don't. You need to be thinking about similar sorts of things there, Um, so thinking about the age of the partner in relation to the young person in front of you. So while many of you will know in the UK, for example, the age of consent brought sexual intercourse is 16. That doesn't mean to 15 year olds that are having a sexual relationship are breaking the law because it's an appropriate, appropriate age relationship. We would counsel them so that they understand it for things like contraception. Um, you know, protecting yourself from sexually transmitted diseases. Um, you do start to worry when there's a slightly larger age gap. So if our 14 year old is seeing a 17 year old in 18 year old, it may not be quite so appropriate, and you kind of need to assess that on the case by case basis. That being said, anyone under the age of 13 cannot on any circumstances consent any sexual activity. Even that's with another 13 year old with a 12 year old. Doesn't matter. They are too young. It is illegal. You need to report to immediately and escalate it soon as possible. Ask your concern. Ask your registrar. Probably they would want to take over. That's the case if you're not really sure because you think we're okay there. 14. The boyfriend 16 is their power and balance there. Is it a bit odds again? Ask you, seeing your they will be able to help you explore it fully. Did you have something you wanted to trip in on that? Yeah, I would absolutely agree with that. I I still remember the case when I was Nestea eight of a young lady that came in with update pain everyone thought was appendicitis. That turned out to be P i. D. Because she had been in a relationship with an older boy who he was only about 18 and she was 13 and 14. Took a lot of I'm picking. My consultant helped me do it, and I was quite a senior register and so I would always rather know about this early doors. And if you're worried, just ask. Absolutely. Yeah, I know. I cannot emphasize that strongly in a um so in addition to that, you know, if you think about you know, when you were young, when you were trialed a teenager, how big pear pressure is when you know your first kind of relationships and stuff the ability to lead each other Australian things like drugs, alcohol or advise is really big. That is definitely something you need to be enquiring about, particularly you've seen a significant behavior change. Um, but no, only that is there is their pressure coming from one side, the other Is there any black male? Is it, you know, is the reason that the behavior has changed actually is because one side or both sides have unrealistically expectations of what relationship needs. It's really hard to teach that stuff out, but it is important to kind of, you know, delve deeper. And if that means you have to see the young person you know without their parents for 10 minutes and see if they'll open up that way, that is definitely something you can kind of try to sit tight. Um, I talked. It would be no Amy for safeguarding, but in clinical well, I always a pin it, like kind of saying, Would you like Teo have a chat with just me and maybe one of the necessary few minutes? Some some young people say no. Some say yes on burtin Currie these kind of circumstances. If you wanted to ask about sex and boyfriends, I usually say something along the lines of, So I've got a few, probably slightly embarrassing questions. Dress key. Would you like your parents to step out or you're happy for them to stay on? Actually, some some young people are so open with their parents that they really don't mind this day in while you ask them about sexual relationships. Some of them are obviously much more kg and would like their parents to step out. I know which of those two I I definitely went into when I was a teenager, and maybe it's an adult, but yeah, but I've always been amazed, actually, how open relationships are with some families, and it is really nice to say, um, but on top of that, we do need to be also thinking about, you know, is there any kind of domestic violence but kind of physical violence between a couple? Um, also a big thing that's coming out. You know, more recently, explicit image sharing. Um, so the idea that you know, they would be sending images back before then they have a falling out or one of them shows it with their friends, and it goes around the school so as well as with the kind of legal issues around child pornography. Um, it can be used for things like black male bullying. Um, and it's really a treatment. I had a massive effect on someone's mental health. Um, and as well as thinking of the age, if there is kind of sexual activity and appropriateness, we do need to think about their cognitive abilities. Um, so, yes, they may be the same age. Actually, one of them even has a slight learning disability. But as the mental age of a 12 year old, a 10 year old or some other sort of vulnerability that does need to be taken into account, Um, and again kind of your your seniors or you're more experiences? No. All the ones that you want to be running this stuff by on. And then if we just kind of go back to the case, that's the parents worried about the mental health. Of course, we need to screen away the usual mental health issues that we would with our adult patients with the stuff that you kind of, you know, the way that we risk assess the way that we, you know, try and bend down exactly how it's affecting their day to day life. Really, really important. You can still use your many your mini mental status test. Um, and as you would an adult, but just tailor it to the child. Okay. Okay. So now we think about our assessment or are examination, um, so general principles throughout the history You want to be observing that a lot you can pick up without know, formally examining a child when they're in with you. You know, how are they playing? How they interact with mom or dad? Or like I said, that PT to the brought them in in the middle of the day? Is it kind of respectful of that? You know, they playing up because they were in the new environment? Well, do they seem, you know, frightened or on edge, or they're always looking for someone else. The answer. And that's something that you can pick up actually, just while you're taking your history ongoing, make up a big kind of part, holding pressure that you get the other thing that you may be raised. A little bit of a red flag. TV is kind of the polar opposite of that. When a child a very friendly and kind of once hugs in attention from nurses or doctors because that's often a sign that they're not getting it at home, which actually brings us down to one of the kind of concerning findings down here so inappropriate behavior. So if you've got kind of a a younger child, it's actually, you know, talking about things that are quite sexual it with, um, a drug use so alcohol of it. And it's not appropriate for their age That does again. Raise questions are is less and sexual abuse there. Are they being exposed to things that they shouldn't be, Um, and actually, unfortunately, a lot of Children that have been sexually abused we'll kind of start experimenting sexually with their peers and acting in a way that really isn't appropriate. And that can be used a silly as you're going up to a stranger and hugging them, stroking that leg. That's if they're three and they're upset. It's not odd, necessarily. You know, old it can really be. And it's again, it's a judgment. If you work with lots of Children, you may have a sense. But again, escalate to your seniors or you're more experience nursing thing, um, fully exposed babies. Um, again, they can't tell you what's been going on. Do you want to see head to toe? You want to look for rashes, little bruises, cuts all those things that again they might give you the diagnosis for the medical problem. But also they're going to expose a lot of safeguarding issues with bruising or if there's been any kind of trauma there. Um, enlisting. The parent parent will hope if Procrit Um, I'm sure by now most of us at some point that's a GP practice. Have the look in someone's mouth or is that's about two years old. Doesn't trust you because you're a stranger. Getting to sit with Mama that's a lap will help you with distracting or even your appropriate holding their head. That can be really helpful. Obviously, if we previously been quite concerned about the way they're interacting with Mom or Dad, we may. We may 100 you know, consider not know, enlisting help and that way. But for most kids with appropriate relationship having you know their parent helping, I was going to make them more comfortable, more cooperative and make your examination more thoroughly. Use it for you. You will need a chaperone. Um, do you get one on? Make sure you write in your notes who it is. Um, it is important on it's important legally. And it protects you, not just a child on your person. They The any point I wanted to after that is make it be a separate, and that can stay there for the whole time. Because sometimes your nursing what HCA colleagues will try and bob I/O. That is not what you need. And I often prefer to take one of the junior doctors with me. I will happily take with me on F Y m S t because they will stay with you the whole time. Okay? Yeah, that's the lately um, quick pen and moving on to things that are gonna worry us are concerning findings on any injury. It all really, if it doesn't match the history that you've just taken. So you've been a really thorough history, and you found out what's been going on, but the bruising pound that you're seeing all the cuts of the broken arm, it doesn't really add up with the story that you just being told. Um, but any trauma in a non ambulatory child? So that was a child that is not walking any bruise on? We were talking about this before, weren't you? Got cramps from any kind of burn. Any skulled, You're going to refer that immediately and it may be And it it does happen that, you know, Mom was playing with the little one on the floor and kind of slipped over and they bang their head. It happens. It makes sense. They might have a little bump. You still need to refer her. Um, and it is because they are especially vulnerable. One ambulatory Children. But also, if you're not walking, there were only so many ways that you can kind of hurt yourself in that in that regard, and I know it seems crazy, but it is actually a legal requirement that we, as the pediatric team, discussed this with an M D. T. So that means even if we agree with you completely, that this is accidental. I still have to speak to Social Cat and tell them that that is the case. So it's really, really important. And there's nonambulatory Children. You refer them straight up to pee. Okay, so then the other thing with if you look at the diagram over on one side of the slide here, it's a certain injury patterns or locations. So Children they run around, they do silly things. They trip over. So skin, these bruised elbows, it it happens. It's not necessary, something that's gonna immediately concern you. But there are certain areas of the body that you're gonna immediately worry about anything around the kind of growing or genital area. Yes, Sometimes someone will fall down and kind of, you know, split legs over something, and that is a story that adds up. But we do need to make sure that we are really investigating it, documenting it. Um, you may have heard of the triangle of safety. So that's coming from the air down around the tip of the shoulder. It's an area that you can't really accidentally fall onto. Um, so if you're getting injuries in this area, it kind of it's strongly implies that something is hitting you rather than you tripping over and banging yourself on something, um, again, issues around the eyes, the abdomen, the chest, Any bilateral issues. Cheeks definitely is again. When we fall over onto the floor, there's no areas that were likely to hit. And, you know, I've got bruises on both of my shoulders. Unless I'm, you know, insider, I don't have been rolling down a hill. It's unlikely I'm gonna be. There's not many mechanisms of injury that can cause these, so we need to ask more questions, and we need to be really thinking hard. How has this happened? Could have been No, no, um, there any other ones that you wanted to pick out strong there, I would say Be cautious about thighs and especially in ER, but sometimes outer is well, depending on what the mechanism is bottoms like, say, if you go, it's more market about movie fallen on Atari fair game, but actually, but, um, it's a fairly padded on. They don't bruise that easily and spine. So although that's a bony prominence, it's really hard to get a bruise on your spine. Absolutely, yes, they're all good good areas kind of look out for, um but similarly, if if you if you've documented it, discuss it with someone There were people that will have seen hundreds and hundreds of these injuries, and I have a really good idea. So in my previous work, we did lots of weight with epilepsy s. So we saw lots of lots of bruises from that side. We also work with very challenging behavior, a lot of restraint. So again, I know what a finger bruise looks like. I wouldn't expect the brand new F 12. Well, I would say sometimes it's Yeah, always rely on your colleagues is the Even as a consultant, you've never seen everything. Nobody has, and we peer review each other on each other's cases on the reason why you have a safe guarding lead and say that you can discuss And if you're ever concerned as a consultant, when somebody's refers me, t you go and discuss it with another consultant? Yeah, absolutely. No. It's a very, very opener. Kind of team environment, I guess. A boat. Okay, so moving on to another case. So So what? When you just kind of have a thinking your head. Either write that you stick it on the paddle it or even on a piece of paper in front of your really commit to answer here. Are you concerned about this case? We've got 42 week old boy. Um and this is what has been documented in their notes by the junior doctor that's been sued them that they fell at home. They immediately cried. They played normally throughout the afternoon. There wasn't any vomiting. And they've got some bruising on the head and their arms. A little bit of swelling, you know, they were quite good. They look to the trust guidelines and saw that CT head wasn't indicated. They just charge him some safety netting and a head injury. And Bisley So is this something immediately that makes us go? Were very, very worried about this or no, I'm sure this was fine Again. I'll see if I can see it on the problem. That's for for younger. Are you concerned if you feel it, But yes. No. And then things we want to know a bit more about Oh, yes. Oh, a good answer here from some of this is not too concerned. Want to know how long between the accident in the presentation? A very good question. Um, so the the purpose of what prevented here is each week in the safeguarding meeting that I go to, we see logos and loads of doctors, knows that Look exactly like this on BR. Having that indeed especially to say, are we concerned about this? Um and it's not that we think that all these good questions that are coming in haven't been asked. We actually trust most of the junior doctors to ask the right questions that have the difficult conversations. But if it hasn't been written down, it didn't. It didn't happen this far as we're concerned, and we can't really assess whether or no, you know, they felt What what exactly does that mean? So now this is a much more detailed thing that will still map to this case. But for you to make your appointments, ambulatory, they're walking around. They're fully walking and they're up. They're going. They can get more injuries in someone. That's not they were seeing with their father. That was appropriate interactions. So we've always got that in the back of the head. Kind of are they appropriately interacted? The parents brought them in. Um, and this is a key bit here. We've got a description that hopefully you kind of just a swell a psych an You can picture this in the in your head you go. The young kids walking around the trip on a toy they fall for They put their arms out to catch themselves. Um, as they fall, they hit a plastic table. They bumped her head, but the weight goes on the elbows. They hit their floor. Mom saw this happen. Um, so that's probably why we have such a good description on the injury occurred at 12 o'clock. So from the person that was asking, you know, how long did it take him to come in? They came in two hours later, so they played normally for a bit. You know, Mom and dad got their coats together. They they might have had so out, child, get someone else, but the bruising on the head, in the arms. We've measured it. We said It's a two centimeter bruise and it's on the right side of the forehead. There's redness on the elbows, see body map. So we've done some of the paperwork where they've actually drawn on a picture of her body. This is where the injuries are. So you're reviewing this. Know exactly what injuries were talking about? As you can see that you can imagine how that trial that's fallen. I'm actually, yeah, I could see them bumping their head. I could see them having some redness on the elbows. It makes sense. They assess is, well, the child's behavior. They seem quite content, but a bit shy between 42 week, or they're just starting to get stranger anxiety. So it's very normal for them to be hiding behind Mom or Dad Is Dad in this case, it's brought them in a way. We discussed it with Dr X or imaginary peed specialist. It's not for registrar. That's what that's where I just on the pump is because for everything safeguarding now, it might very slightly from trust to trust they please check in your interest. But for a lot of trust in West Yorkshire, it goes straight to the consultant. Well, interesting to know I'll have to track your stuck mandible with the, uh, the exact way it works. But whoever you do discuss it with document who they are on what their rollers cause you know, I discussed it with the other one is not the same discussion of what you're consoling or discussed it with a C a. While Valuable is not. It's not the same level of review on the front of him, ever. It is no safe. Got it. And that's something I like to write the end of pretty much any history that I've taken for a pediatric child. If I'm not worried because even if I haven't done a great job of describing all this, at least tell someone else that read my notes. James's thought about there could be some safeguarding issues. He's are some questions about it. And if I did on balance, there wasn't an issue that he wants to bring forward or delve into further. And that's quite a reassuring thing to see written down, similar going back to the lake equally, it could be something much more, much more worrying. So I'm sure many of you will come across the idea of cruising. So where they could they're starting to walk. Probably have to hold on to either a toy. So for so they're not they're not fully ambulatory at this point to this boy about at home. But he stepped on a wet floor and he fell backwards. So it came. The legs came out with, um any went backwards. Injury was at seven. AM yesterday. Played normally. Drop the whole afternoon. Excuse me, but presented the next morning, so that is a little bit suspicious. What you know, and sometimes is a good reason why they couldn't bring the trial to the hospital in that time. But if you're particularly worried about the types of injuries, if it's a severe injury, you would expect them to drop everything and bring them straight away. Okay, so we're thinking so we've got some bruising on the head and arms that can easily be a lacerations. The forehead. The Bruce left here, bruises on the showed under the arms could be described some bruising on the arms and they appear in different stages of healing, which I didn't happen At the same time, this kid has been in the walls and it's been getting lots of different bruising, and that is something that will be really concerned about. But you can see rather, you know, again, this is a slightly artificial exaggeration, but you can see how that does fit into the description bruising on head and my arms. So we want you to be really, really specific when you document this True. I just did it at the bottom. You know, the child is quiet, withdrawn. Another sign that we're gonna be a bit concerned about because they're No, they're not playing that quite, you know, timid on D. But you can imagine if they have, you know, being hurt in a way that's scary. Quite use. If you're gonna be a quiet, they are gonna kind of They had it there for, like, the surroundings. Okay, so that brings us on. The documentation on documentation is really important. Like that. I attend a meeting every week. When we talk about documentation. It sounds to really I know. But like, I'm actually going through and seeing what people have written down what they considered it is very important because a lot of the the actual concerning cases they will be escalates the police. They will get social services, um, and the notes that you take only in form these other specialists that may be used in a court of law. Now you're registrars your consultants level four level. By safeguarding training, they will get training on how to write statements about important stuff. But that does not mean that they will not also pick up your notes on have those right out in court. So you haven't done a good job. It could mean that, actually, you know, they don't get a prosecution or, you know things can't be justified up in place, and that's, you know, that's letting the child down, and it's really something that we want to avoid. So generally you want to think you know who came in with a child. Um, not just because of the relationship there, if you know if they deteriorate suddenly and you need consent to rush into surgery. The fact that you haven't asked you this adult is and it's actually the next door neighbor or the, you know, the drug, every teacher, whoever is this brought them in. They may know actually be the person that can consent this. And if no one's bothered to ask you, they are You're not going to realize that in Tell him. Um, this is a very minor thing, but it is definitely a lot better of mine. So Children don't DNA or do not attend clinic. They're not brought. They're not the ones choosing not to come in, not to get medical treatment. He's a reflection on those looking after them. Not a reflection on the child. Were you about to jump in with something? Okay, Yeah. I think we may have said it before when we talked about history taking. But when it comes to documentation, it is really key and safeguarding case is that for both the adults You speak to you on what the, um, for the Children that you write down the bait and what they say 80. So I know that a lot of the time in our notes when we're taking a normal history, we kind of paraphrasing what they've said, and that's fine. But been safeguarding Sorry is critical that what the parent or what the child says is written down because that is very important. Legally. No, absolutely. It's really important to get that word for word that has a total different the way that you might have afraid that compare. Um, it's changed the meaning. Hands. We talked about body mass already. They should be available in your trust. If not drawn. Doesn't have to be pretty. Just stick something that tells me is the next doctor coming along? Where That injury Waas to look up when they previously come in. Okay, They had a bruise a week. You go up here. So when I see a bruise up here I go. Okay, That looks like it. Like, you know, slightly. He'll bruits. We're talking about breezes that we know that you cannot age bruises. There's no evidence he can. But we do know that if you've got bruises of different colors and different ages, that makes us worry more. No, absolutely. Um, we talked about think most of these bits and pieces One thing running for the paperwork. So, you know, when we're doing our, um, multi density referrals or information sharing? Who is gonna do that? Paperwork. The answer is probably you. Um, if you're the responsible person document that has that way. If it hasn't been done, it hasn't materialized. We can trace up the right people. Um, and we are going to be, you know, some details into the interaction, the behavior, the appearance, You know, they you know, they don't have to be following the latest fashions, but if they closed the tattered, you know, does that make sense? You know, it's after school and they've got grass stains on their shirt, and the trials is in the summer. You know what? They've probably been playing football. If it's, you know, the first appointment of the day at 9 a.m. Why are they covered in March? My favorite weather I ever learned from one of our safeguarding needs with grubby like the child looks grubby. And because that way you're not saying that they look, um, that that could just completely covered in debt. And then my other top tip I only picked up when I had a case where it mattered with nails and not just the nails of the child, the nails of the parents, because I had a child that what I had a child that looked like they were covered in little half moons all over their their back and on my consultant. When I went to discuss that said to me, Well, how long with the moms nails? And I was like, I don't know, say weirdly, think about some things that you might know usually think about. Well, definitely those sorts of observations. And then yet stick it in the note to make sure the next person can interpret that. Okay, so then we have another case. So this one is. You know, you've been working one of the pediatric wards for a couple weeks. One of the patients, they say, you know, do you mind, Doctor James, however chapter are rolled around. So I go back. I said, you know, you know what's going on. They say they've got something really important to tell me, but I have to promise to keep it a secret. So how should I respond to that? So I have a little think commit to what you would actually say to this young person. You know, you're a little bit worried about them. Seen you necessarily. I'll keep a secret. Or is it? You know there's something else that you might want to be saying I'm not saying Okay, so this is this case was all about disclosures. So we're thinking kind of do's and don'ts absolutely have a chance of them privately if they're more comfortable. But you need to explain to them who you might have to tell. So if they disclosed of abuse or they tell you that, you know, there, the little brother is at home and you know they're being hurt by their parents or something. You have a legal duty to report that. But if you just promise to them that you're going to keep a secret on, then you have to go back on that. You're gonna betray that trust on no, only you know, we don't like to break promises, but for a child that may stick with them for a really long time, they may never make another disclosure again. They may never trust another healthcare professional, another adult again, so you cannot promise that you will keep it a secret ran. But do reassure them that you're not going to just, you know, go back to the nurses station of the doctors doctors and tell everyone that's not something we're gonna do? We're gonna tell the people that need to know we're gonna update them on kind of what we're doing if it's appropriate. So you know, your three year old doesn't need to know what I told the safeguarding. Leading they sent some emails that that's not important, but you're 17 year old might want to know exactly who is being involved, who might come down to see them. Like I said, I don't make promises. Don't ask needing questions. Let them say in their own words, document in their own words on if they give you a bit, but they don't want to tell you anymore. That's fine. Leave it there like taking it their pace. It's not easy for these Children to make these disclosures and the fact that they trust you enough to come to you and say This is amazing and it's a real privilege to receive a disclosure. It's upsetting. It's horrible because obviously the views has happened. But the fact that they trust you is really important, and you want to just maintain that relationship the same thing that James saying is tree of when you're examining a child, particularly if you have to examine genitalia, especially on a younger child, kind of the 234 year olds. If they were uncomfortable, the worst thing you can do is push them to do it all at once. It is better to do it over two or three sessions if needed, then to force them and completely break that relationship. Absolutely, absolutely. And the relationships of really key and these that these early kind of years experience is stable for so long. So it is important the way that we do treat them. Um, so the phrase is that the way that I used to phrase it, but but young, mainstream Children and some of the Children I still work with the teenagers, but with mental age is that were quite young. Is that you know, if you tell me something, absolutely, you can stay between me and you. But if you tell me something where I worry that someone might be in danger, I'm gonna have to tell someone so they can help that person. And I had kids, his youngest three, that understand that, you know, they tell me that someone's in danger. I'm going to get them some help on by, Used to work with a 17 year old girl. Told that grams from this earlier, Um, you know, we got him really well. She was 17, so that's six inches taller than me. Big, bushy, curly hair. But she had the mental age of a two year old, and she was absolutely lovely that she would like to, you know, come up, come up to me, you know, transferred, got a secret, tell you a secret, and I would rattle that off. But I'm gonna have to, you know, tell someone if someone is in danger, But, you know, go ahead. And the secret was normally were having sausages. The dinner on that's fine. And I would still rather every single time, I would still say, Well, you know, I know, I keep it. I keep it between us. If there is any worries that I'm gonna have to escalate it, just in case, you know, some point she could have told me something. It's significant, and I would never want to break the trust, and it's really, really important. You might feel silly doing it, but it's something you really need to get in the habit of doing if you do work with Children, young people, hes we're coming up to another case. Um, So again you can get on the paddle it And I think maybe under what do you want to know? Or any of the headings Really? Kind of what you should be doing next in this case. So during the consultation, you notice that your parents for your patients are older. Sister, sit up. 12 years old is uncomfortable sitting on a seat. You kind of squirming. Can't quite get country. She excuses itself. Use the bathroom about three times in 30 minutes. Now, from the history you've taken from the mother and you know you're taking it around your patient, you discover that they recently returned from a long holiday in Sudan. Visiting family. So kind of what would you be asked about? What you concerned about here? Why have I put this case in? I have a little thing. I'm going to grab another PSA. I'll see if I could refresh the paddle and see what sort stuff is coming. So you have ah, coming here. That has got it right on the nose. One very worried about fgn. Say what it encourages. I know we're talking about safeguarding, but obviously there's other things that could be going on here and much, much like you think about your surgical saves in every other case. I'd encourage you to do you say now, because let's be honest. Sometimes we're so good at focusing on safeguarding that we forget the obvious cause this could be a UTI. No, absolutely, absolutely. That's a really, really important point. Yeah, I don't know Year who beats that thing's easy bruise. It's kind of Yeah, absolutely. But yeah, the case we're kind of trying to make here f g m female genital mutilation. It's really important you're aware of this, Um, in this country, it is illegal. A doctor, you have a legal duty to report if you suspect the F. G M has happened or will happen and you can be prosecuted for failing to do so because the fact that you suspect that it may happen in the future or it might have happened in the past it's pretty strong that you have to then report this. Not only is it illegal ask you reported to the police on do you may sometimes have conversations. Families saying that they're planning on doing it, and there's nothing you can do to stop them. Um, if you take a shot at the country to perform it, it is illegal, and you can lose your right to stay in this country. Um, so the signs were looking out for, um for a long travel to a country of origin where F g m is common. Yes, this is kind of profiling is stereotyping. But Jim is a practice that only happens in certain communities that typically from certain areas off the world, it doesn't mean that every one that goes to Sudan is planning on, uh, some sort female genital mutilation that. But it is something that you need to consider. And you need to ask the questions. Okay, So if they have someone in the family that's already undergone it on, that is, you know, an indication that they belong to a culture where they do practice this no idea what that is. A mother wonderful technical thing that's going on there. Um, probably not the most appropriate moment. But carrying on it's a frequent urination, um, again linking into a UTI, but is a sign that ftm may have been performed. Um, similarly depression or withdrawal can happen both in a in a young girl that knows that is going to happen. They can get more anxious, worried about it. But the first listen, we that has happened, it can then again really affect them until help, um, and a reluctance be examined. Um, the other thing that I just wanted Teo chip in is especially when when James was mentioning about the your legal responsibilities is that you'd be surprised at what level live, challenging conversation you can have that remains very a civil. So I've had conversations less so. But if GM but more so about, I'm going to take my child with cerebral palsy out of the country for some crazy healing technique, Um, saying things like, Well, I don't think that's a good idea. It's not what I would recommend. I can't stop you. However, if you do decide to do that, anything goes wrong, I will call social services. So it's really a practice of being to weigh very open and honest, and you'd be surprised how often families are very receptive to the app on. Actually will at least respect your comments, even if they don't agree. Yeah. Wow, that must really good point. Yeah. Okay. So I think this may be our final case. Um, So again, just have a little think about what you want to know. Maybe you say some questions that, like, if you're watching for someone else, put it on a piece of paper, but on the paddle it. But really commit to what you're gonna be thinking about what you want to ask eso, right? We have a seven year old boy that's come in with their father. They have a past medical history of asthma. Um, they originally prescribed that salbutamol a beclomethasone on my montelukast inhaler that went halers, I should say on Sundays. Been using the blue inhaler much more frequently. Um, he's been coughing at nights. He's been having episodes of chest tightness pretty much every p a lesson. Or when he's running around playing with friends. Um and, um, examine the child. You go full respiratory exam on. Do you really get kind of a mild? We's hurt in the chest that nothing else have any real note? They kind of What things do you want to know? But what what's safe guarding thing that we're gonna be keeping in the back of our head. I don't see if it was true on a look. Okay, it's coming through. At the moment is a few more comments about the G n. How I do appreciate there is a slight delay between the stream or becoming true, but so what? What I was trying to get out here is yes. You know, your most of your history is going to be focused on the asthma and the fact that this young chap, his his asthma, is no longer well controlled on three inhalers. So how are we gonna address that? So what, you want to know more about the symptoms? The time in severity? Um, I would assume buying now, Whether your kind of late into your medical school career or you are junior doctor, you can take a pretty good after the history. So I'm not going to tell you how to do that. But things that I would want you to probably the ask about, or the very least, have in the back of your head. Um, how many hospital attendants is? Is this child having how frequently are they coming in, particularly for their asthma? Um, and that's gonna lose on medication, compliance and technique. And so even in our adult patients say, Oh, well, you know, you you comfortable using your inhaler and they say, Yes and you go well, show me. So we really want to treat that He's using it correctly that he's being provided with inhaler. He's seven years old. If his compliance is poor, it's not really on him, is it? It been that it may be someone else in the family is using it inhaler It may be in sharing. It may be that, you know, there's no good engagement from the family with healthcare on. That's kind of what I was getting it with the home circumstances. Um, you know, And it could be, you know, he could be getting bullied at school so he doesn't use his inhaler or take it with him to be a that's, you know, for someone that age seven, sometime not being made fun of is more important to controlling their asthma, and you might think of another or what's a bit silly, but to then, like, it's the not being made fun of him fitting in. That's more important. But it's having that conversation. Or again, maybe asking one of your more experience colleagues. I have this conversation that gently kind of push them in the right direction on thinking about how school is handling the ass manner thing. But again, relationship with father. Is there any signs of four that you come across a collector? Emotional abuse? Just tea at that stage, like things I want to know. So we talk about taking a really good asthma history. I see terrible estimate. Ask for history's all the time and say the key things I want to know and you can do it in two minutes. Got it down. You want to know how many times they've been in the last year? I don't know how many times they have steroids from the GP. Have they ever needed HD or I C level care on? Does anyone smoke like medical students out there? You are probably way better it do ms than our junior doctors, and you're seeing your colleagues we forget all the time. I'm but it's so important because if nothing else, you have an opportunity to disease prevent by offering them making cessation advice. Fantastic. Yes, absolutely. Bring into a little key. Things that we need to be asking there on that is gonna be the focus of a history in real life. This is what you mean they're gonna be focused on, but we just want you to have in the back of your head ache every contact count. Always be a whether that could be other things going on. And that doesn't mean that has to be the number one priority in your head. You know, the number one thing is probably investigating. There aspart the backyard Doctor Armstrong said Okay, so I was thinking of my colleagues that junior doctors and they were saying, Actually, the thing that scares them most is talking to the parents, particularly about safeguarding issues. So what, we're gonna be telling them. So we spoke about this before. To me, Doctor, I'm strong. So it's know ideally, parents need to be informed. Absolutely. Every single time. The parents will need to be informed of the fact that you're making a safeguarding referral on day. You need to explain the process to them. Now. The time Is that how you do it kind of vary. So did you want to jump in there? My biggest bug there in life is a child coming up from an E or from a GP surgery on Be the parent. Having no idea the reason they're coming to pediatrics of safeguarding and say The one thing I would drill into all the wonderful people is if you are sending them up with a safeguarding concern on that is your main concern. You must tell them because otherwise they get to some poor sucker like me at three AM and I'm like, So do you know why you're here? And they're like, No, but I have to tell them on. They get very angry. Where is if you tell them immediately and it really open? And as I was telling James before, the way I like to phrase, it is something along the lines of. So there's several things we're thinking about here, and so let's take bruises, and so this could be a blood disorder. This could be a problem with your platelets, or it could be that someone's hurting your child. Now, I don't know who that is, and that's not my job to decide on. I know that this process is difficult, but we have things that we have to do on. We're gonna walk through it together. You know, that's a really nice, really nice. If I have a break here, I think I've seen. Are you have if you maybe on the less concerning spectrum, also just they're reasonable people. They will kind of understand where you're coming from there on diet pills, slightly less personal cause it's it's horrible being kind of accused of that sort of stuff or thinking that that might be going on. But you know what? The child safety comes first, doesn't it? Making 100 a couple 1000 parents a bit uncomfortable. I'll do it every time to make sure I don't miss the one child that really did help. The other thing that's going to really help you is you have the opportunity to use the child's name. So if you say something like, well, you brought Jessica in to see us because you were worried, were worried, too. And what we're not saying that it's you that's hard on them. But if someone is, we all need to know that on. Actually, as James said, most reasonable parents in that circumstance like, Yeah, I was worried. That is why I'm here. And they understand that there are processes that have to happen. Yeah, And the big question we want to ask ourselves is, Does improvement apparent Put the child a risk of palm? The answer is yes. You know, we'll have discussed this with our senior, and it may be that things need to be put in place before we tell them. That might be admitting the child. The hospital. It might be contacting the police. Um, you're on a one hour and a white to you're not making that call. Know you're just not You're consultant is realistically gonna be the one that decides that. But we are going to tell them, like we said, absolutely every single time. But it may be that we first a couple of things in just a kind of safety net people child say before we tell them those things the absolutely classic thing that the days of you who are aspiring pediatricians and you know I love accumulating my pediatricians is, um is in the Royal College exams. They will have a parent. He is a safe guarding case usually be a burn. The idea is that they have caused it on there. One thing that they want to do is take the child home on all you have to resolutely do. As the junior doctor in that scenario is, say that you cannot take the child off the wood. See it actually ask your seniors to help. They may even take over, or you can ask him to take over. If you feel out of your depth, there's a good chance you are. But we will have lots of helpful people around you. That is nurses. Doctor 88 is the security. Take whoever is, but you just seniors be that delicate conversations. Bring someone with you as a kind of a chaperone witness. So if there is any confusion, any kind of upset or what you know, I think it's very emotional and things were taken in the wrong way. It's good to have someone else. There was a witness, but what I would equalise a is we always would need to be learning on. So if you had the opportunity to see someone, have one of these conversations on, you are involved in the case and you want to lead it? I am more than happy with with my genius to you come in with them and just stand behind them as they're back up. Let them do a lot of talking and just jump into things. Go back because you guys actually have a lot more skills that you probably give yourself credit for and on. You know, you do so much communication teaching nowadays that you actually you're very good at your jobs, guys. And so believe in yourself. Just take someone to be your your, like, back up. No, absolutely. You take those. Take those opportunities. Now that that's wonderful. I mean, getting the opportunity to see this stuff on your lunch? Yeah, next month. Okay, so I think we're drawing towards the end. So this is like an automatic referrals. Really Important point unauthorizing repaired. Does not mean it happens without your input. You still have to do the paperwork, use left and make sure these things get really heard. So head injuries and under ones FGM. We've spoken about any trauma and then on ambulance child that has burned scolds. It can even be small bruises. You still have to make a referral. Obviously, if you get a disclosure, you will be referring it even if it's the fourth time that week that they told a junior doctor on the ward about this doesn't matter. You document it and you were her it There is no no excuse for not doing this. Um, do you want to jump in there? I was going to say that I would genuinely and rather received 10 calls over night about safeguarding where I can say to you, It's okay, Just write it down. We don't need to do anything else that Mr One Time when it's important. Absolutely, absolutely. Um, an interesting one that I came across when I worked in the Children's emergency department carpentry dog bites from unknown dog that even if it's a perfectly good story of okay, my three year old was poking the dog in the eye because they thought it was funny and eventually the dog just turn around and gave him a little nip, and it kind of just scared them. Doesn't matter. It is a safe guarding referral, and social services will send someone out to assess the dog. But if that is what happened with you know, someone's pulled on the dog's tail or just, you know, just being horrible to the dog. You know, they're not gonna put the dog down. They will do it for our assessment. It is not just that you were going to put down your dog, but if it is a known dog, whether that's in the household or family friend, you contract the stuff down. You do need to do a thorough on that can actually be the ones I have noticed the quite hard conversations with people. There's a dog on myself that I am incredibly attached to my dogs. And yeah, people can get very upset about this. Um, any unexplained injuries, that much stories, ST Eisen, Children, self harm, suicidal ideation. Or just if you're concerned, you need to be doing the referral. This is not every exhaustive list is not every single thing that you need to. You need to be referring any of these. The president, even if you know some of the like a head injury on the one. Even if the story makes sense, it still needs to be discussed. It still needs to be referred on diffuse, unsure about what you know whether or not something doesn't hurt again, Just ask. Just ask. I mean, I said it so many times a saving it, but it is very, very important. Okay, So what is it? We want you to actually do so. Make every contact count, have safeguarding in the back of your head. Um, document your concerns. Do it thoroughly. Do it well, inform a senior and discuss it with them. Onda, fill out your appropriate paperwork's. That might be a mark, which is a multi agency referral form, or MASH is what? Our mattress virus? That it was going Coventry's. That's the multi agency safeguarding hub referral. The paperwork itself is self explanatory. You just need to track it down and fill it in its They're related. You can, but it basically need to get sent up. Social services police. They involve people from the school from any other kind of contacts that they have on. It's kind of an MD tea meeting that they then discuss the child. Uh um, there's an information sharing form that we use that Stoke Mandeville. So it's a similar referral, but it's where it doesn't meet the threshold for social services input so it might be reset itself. The help with this is around just to give the parents a little bit, but by some kind of put them back on the right side track. Um, and again cans were perils, even if they're known to cams. If it's a new presentation or presentations, different department, you need to be made aware by a referral, and it is your responsibility to do is the doctor and do it straight away. Don't do it when you come in a week later, do it while it's fresh if that means someone waits for extra 20 minutes in the waiting room. So it's important. Um, but that's it. Like when you look at that list, it's It's not that scary. It's not that difficult. Most of your medical students that watching they will be, had to do this is, Well, um, sometimes when it's been really busy on the you know, I've got the medical students to do this. Now it's good a good experience, and again it just needs to be done at any speed on properly. My other topped. It would be just to add to that list, and some of you probably wait yet. Think about the phone calls that come into your unit or your would. And if you get phone calls from parents looking for advice about their child, even if it's about so So we have a 24 hour open access policy after someone's been in, and it's really important to document those discussions to we never used to on. We now have a policy where we document all of them because of either poor advice that was given or an advice that was taken in correctly by apparent and misinterpreted. So, essentially, if you got, if you're having a contact with a family, write it down. Yeah, if it's not going down, it didn't happen, and it is very important. We know exactly what what's been going on. Okay, so we've got some resources here, just places that you can learn. MAWR. There's actually some very good, nice guidance. If you look actually how to do assessments and maltreatment, things like that, they break down every possible thing that you might encounter on need to ask about the the GMC of the ones that they are, as you know, the ones that set that kind of agenda for war. Level of training we need. What do These are doctors? There is the learning out there. I'm not gonna see any more about the learning You. I'm sure you have your own opinions of it, but the Royal College has actually some really good documents on it. Um, so one of them is the safe. Getting Children and young people rolls and competencies for help gets there, which I looked through thoroughly while making this presentation. And it documents basically what your responsibilities are different levels of how your training should map. So there. And that's all kind of skills and competencies and tells you what you should be able today and then. The other thing that the Royal College House is also is what used to be the Purple Book. For those of you who are maybe went in pediatrics, which essentially gives you how to do a safeguard it medical on how to write reports, but also what used to be called of core info, which is all the and research that's been done in two safeguarding over the years. So if you ever are writing a report or helping to write a report, it's all the statistics are gonna back up. Those facts about subdurals on CT's in Children have had a head injury and nonambulatory Children on. If you see a burn, it's on. That's, um, a cheek. Why, that's not okay. All of that is on the RC PCH website, and it's accessible to all. Yeah, that's about it. Really, really useful results of definitely check out Onda. Not something that that this the Children's act, is where a lot of the legislation comes from you. If you are looking through some of the paperwork and Section 17 as a child in need of that might be a looked after child or a child that is just more vulnerable. A Section 47 meeting is about child that we suspect is either suffering or is a risk of the significant harm on a child on the ward, and you've referred them up to the likes of me on. I do assessment. I'm doing a Section 47 medical and on and social Care. We'll talk about doing a sex 1 47 investigation, and then again, the kind of the key point that we've hammered in, I think I think you get it. You're probably sick of hearing it. But asked senior colleagues, after more experience colleagues, you know that could be the band six nurse that's running the shift that evening. They have a wealth of experience ham, and you will have names. Safeguarding came within your trust, and you can absolutely rely on them. Okay, so last thing, if you do have any questions, please do stick them on the Facebook video, and we will try and answer them. Now, I know we've gone a bit over time. We had some technical issues and starting a few technical issues after we started. So I do apologize profusely for that. Um, but we really appreciate if you take five minutes and give us some feedback. If you scan this QR code, there's also a link on the event. It will take you through to the middle website where you can first survey. Once you've done that, you will get a certificate saying that you attended this on. You can use that. If you're foundation doctor, you can use that as kind of your portfolio. That's what COPD time and equally if you're a medical student, it shows interest. It shows that you've been trying to get out there and learn the important things with pediatrics. Um, we will be using that either. Improve? Uh, well, both Rather, I should say to improve our webinars as we go through the Siris, but also is really useful information for us for research on behind of looking at how people view different areas on the training that we provide. And also this particular one is how you do the mandatory safeguarding training you've probably done through your trust. So please do take five minutes to do it. Give us a detailed answers. Um also want things like I could provide, such as if you do want to see pictures of awful things but that you might not have come across and you want to see or if you do feel that you need more information on how how to do a good body map on on exactly what you need to, right? Um, let's know, because we can always do more sessions If you think that's helpful for you. Absolutely. I'm just checking the video notes. If any questions specific questions coming in now, I'm aware that we've gone on for quite some time, now, So I will be checking in on. I can always relate questions to doctor arms drunk afterwards and kind of the week that follows, um, equally the pole and stuff that feedback be able to get it again. It stays open for about a week. So if you do, What's this on Catch up with her on Facebook, But it will be uploaded to YouTube, and I think the medals well goes well. Just refresh it one more time to see if anyone that might be a lot of us this evening. So thank you very much for joining us. Um, thank you, Doctor, on an Armstrong for joining us very much. Appreciate your input. Um, I just turn off the stream and hopefully we will see you all next week. Do you check your Facebook and we'll be announcing which vehicle he's taking the talk on. What subject is on. Okay,