Local authorities urged to review policies for bruising in nonmobile infants

Local authorities and safeguarding partners are being urged to look at their practices and policies around bruising in pre-mobile infants following a Child Safeguarding Practice Review Panel (CSPR) roundtable.

The roundtable was sparked by research undertaken by the University of Central Lancashire’s Emeritus Professor Andy Bilson, who found that many local authorities were not actually following national guidelines, and were in fact often jumping to worse case scenarios when dealing with a bruise on a young child. Seven local authorities looked at in the study automatically send every referral of a child under six months old for a section 47 investigation.

The findings of the CSPR panel, which were published earlier this week, said it did not support blanket policies that require section 47 enquiries or other interventions without an initial appraisal of the circumstances of the presentation.

The panel also said that the guidance should be clarified to define clearly what is meant by a child not being independently mobile, saying this should specifically recognise a child who is unable to move independently through crawling, cruising or bottom shuffling. Particular attention should be given to the risks in those children who are unable to roll over, the guidance said.

Commenting on the findings, Professor Bilson said professionals should recognise that bruises in pre-mobile infants should be a cause to consider abuse: but there are many causes of accidental bruises that are not abuse or neglect.

He said that while it’s true that accidental bruises in pre-mobile infants are less common than in more mobile children, the only longitudinal study found that over a quarter (27%) of pre-mobile children had an accidental bruise over a period of seven weeks and that one in nine (10.9%) infants who can roll had a bruise on a single observation. So they’re more common than many policies suggest.

Research reviewing the policies in 148 of 152 English local authorities found that seven local authorities (Bedford Borough, Central Bedfordshire, Luton, North Lincolnshire, Sunderland, Kingston upon Thames, Richmond) appeared to require all pre-mobile children with a bruise to be investigated under section 47 of the 1989 Children Act. This would usually involve police and social workers visiting, often your baby would have two full skeletal surveys and, even if the investigation found no abuse, a permanent record of child abuse investigation needing to be declared if applying for jobs in the caring professions.

In another 28 local authorities, the policy assumes that any bruise pre-mobile child is sufficient to indicate that a child is suffering or likely to suffer significant harm. This means all referrals of bruises automatically lead to a strategy discussion – without carrying out a social work assessment as required by national guidance.

23 local authorities’ policies directly contradicted research evidence on the causes of accidental bruising: stating, for example - “Infants do not bruise themselves by lying on a dummy or banging themselves with rattles and other infant toys or by flopping forwards and banging their heads against their parents' faces.” Research has disproved this – children can and do bruise in these scenarios.

Professor Andy Bilson, Emeritus Professor at the University of Central Lancashire (School of Social Work, Care and Community), said the review body is “absolutely right” to ask for procedures to be reassessed.

“Through careful research, I reviewed 148 local authorities’ policies and found a quarter appeared not to follow statutory national guidance and many had misinterpreted the evidence and risk misleading staff. Rather than providing useful guidance, these policies are only making their difficult jobs even harder - by potentially exaggerating the likelihood that bruises on young babies are non-accidental.

“While clearly a careful balance needs to be struck, by following such guidance, babies with accidental bruises are ending up in the child protection system without grounds, taking away vital resources and making it harder to see the minority of cases where a bruise indicates a child is at actual risk of harm. Well-meaning interventions may well be harming the very children these policies aim to protect.”