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Monday, 14 July 2014

In which no one asks if I abuse my disabled child, damn them

Smiler is what is officially known as a regular attender at A&E, and although sometimes it's been because of seizures or nosebleeds, a couple of years ago I got a bee in my bonnet because he'd been seen a number of times for what I (with my social worker / child protection head on) classed as potential non accidental injuries (NAIs), and no one seemed concerned.

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As an example, one day Smiler was playing in his room quite happily (as in, he threw all his toys and books on the floor), and later, when he was sat up at the table having tea, we noticed that he wasn't using his left hand to stop his plate from sliding around.  "Come on Smiler, hold your plate please, you're going to make a mess".  Five minutes later we were telling Smiler that he couldn't have pudding if he didn't at least try to hold the bowl, and when he wouldn't, so we realised something was going on (and fed him his pudding, cos we're not that mean).  Back in the living room I checked his left arm - shoulder fine, elbow fine (when I say fine, it's kind of a relative term - it's dislocated and the bones have fused, so he has no rotation and can't straighten it out), wrist fine, fingers looked a bit swollen but he could still move them all and there was no bruising, so we decided to leave it until the next day and check him over again.  The following day Smiler's fingers were clearly swollen and he still couldn't use his hand as usual, so of we went (after breakfast, of course) to the accident and emergency department of Bristol Children's Hospital.

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So, what did he do?
No idea.
When did it happen?
Yesterday afternoon.
Was anyone with him when it happened?
Nope.
When did you think he might have done something?
Teatime yesterday.


Now, as I said, with a professional background in Child Protection, I figured we would be raising red flags all over the place.  Parents who didn't see what happened, didn't know what he'd done or how he'd done it, didn't seek prompt help, all along with a child who was non verbal - who couldn't give any explanation or correct anything inaccurate that had been said - classic non-accidental injury circumstances.

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The other perspective I have on this is from having been the child who was being physically abused within the family home, and seen several times a year at A&E - well, sort of... Both my parents worked in the hospital - after a fight my father would drive me to the hospital, chat to whoever was on the desk, explain how I'd managed to fall down the stairs / trip over a paving slab / shut my hand in a door again, and I'd go straight through to x-ray.  I'd be plastered if there was a break, splinted for broken fingers, (often with bruised arms and or legs), given the usual advice for cracked ribs.  No follow up appointments, nothing on file, even though I was on what was then known as the Child Protection Register, recognised as being at risk of physical harm within the family home.  No one asked how I had managed to slam my hand in the car door again, or why I had a split lip along with those cracked ribs.  My parents were plausible - my mother particularly, a midwife, a sister on the labour ward, while my father gave the impression of being a slightly cowed husband, amiable, maybe a bit dim, but certainly harmless.  Confident and complete explanations were freely offered to school and anywhere else that might notice I seemed to have more than the usual number of trips and falls, and no one saw anything odd in this.

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So here I was, regularly presenting to the hospital with a child in a situation that ticked every box on a cause for concern sheet, and no one seemed concerned - this scared me, terrified me in fact.  I knew no one was hurting Smiler (who had in fact broken two fingers somehow).  I knew the reason we often didn't know how long ago he'd done something was because he has an incredible pain threshold combined with disliking hospitals and would often tell us 'fine, fine!' and use his hand (or whatever) to prove it, because he knew otherwise it meant going to the hospital, which he hates.  I knew the reason for the delay in getting him seen was because although we often suspect he may have hurt himself, but wait until the following day to give us a chance to observe him using (or avoiding using) that hand / arm / leg.  It was once suggested that we took him in each time he fell down, to get him checked over, but once we explained he falls to the ground maybe four or five times on an ordinary day, this was recognised as being untenable.  Still, I wanted ... needed even to know that these situations raised red flags, and that those red flags didn't get ignored.

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Never before have I seen a professional so utterly confused as the day a couple of months later that I asked why a social worker hadn't come and asked me if my son was being abused, and if not, why he had sustained so many injuries.

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My thinking was that I know Smiler is okay, but also that part of the reason no one was querying his injuries was that I come across as a caring, involved parent, intelligent and well versed in the potential medical implications of his condition - in other words, I was able to provide plausible explanations and appeared to be concerned with his welfare.  Exactly as my parents had.  No one is abusing Smiler, but I don't know if the same is true of the next non verbal child whose parent doesn't bring them in until the next day, and who cannot say for certain what happened to cause their injury.

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To their credit, the hospital took my concerns seriously, and reviewed Smiler's notes with a view to whether child protection concerns had been raised, or should have been raised.  Smiler (and I) were the topic of a specially convened meeting regarding child protection concerns involving disabled children, looking at whether the systems in place were robust enough, or whether the 'oh you're so good with him (I don't know if I could cope)' putting parents of children with significant additional needs on pedestal thing was blinding staff to potential abuse.  I was offered (and accepted) the opportunity to discuss this in depth with one of the department leads, who talked me through the procedures and how cases were progressed when there were any concerns.  Smiler had been flagged at one point and discussed, which made me feel better, and it was clear that the measures in place make it incredibly unlikely (never say never) that a child could slip through the cracks of the system.  I was thanked for my honesty, which seemed strange, but it was explained that they value the opportunity to check their system through, and that they had never before had a parent ask why they weren't being investigated, who wanted to talk through what had and hadn't been looked at, by whom, and why.

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I'm sure my childhood has influenced plenty of my decisions over the years, and this is, to my mind, another reaction to that time.  While I knew Smiler isn't being hurt by anybody, I don't know that about every other disabled child being seen in that department.  I struggle with the idea that a parent can run interference and prevent reasonable questions from arising in the minds of others, and I'm relieved to find that the procedures in A&E are more robust than that.  I'm glad that my questioning triggered a conversation, a reminder for staff about the possibility of a disabled child being abused.  Smiler is still a regular attender at A&E, and we still usually don't know exactly what he did, so I guess we still keep raising those red flags, but I'd still rather be asked awkward questions every single time, knowing that those same questions might also be being asked and those same discussions might be being had about someone who does need help.

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What do you think?  Have you ever felt staff in A&E or school were suspicious of your care for your child?  Do you think they should be more trusting of parents - were you offended?  
Feel free to disagree with my point of view - everyone I love does so on pretty much a daily basis after all!

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