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Audit of child protection procedures in an A&E department

Editor—Sidebotham and Pearce’s audit of child protection procedures in an accident and emergency department should raise general awareness that children in any such departments need special consideration.1 It should also raise specific awareness that non-accidental injury often presents to accident and emergency departments. 
 
It is interesting that the nurses seem to have been given the job of scoring the risk factors for abuse in this study and that the doctors were given the job of auditing nurse practice. All accident and emergency staff should be informed and aware of the possibility of non-accidental injury, although the checking system would be carried out more efficiently if it was the responsibility of one clearly identified individual, in this case the initial assessment nurse. 
 
The accident and emergency department at Sheffield Children’s Hospital has a system of amalgamating a child’s notes so that every previous attendance to the department can be checked at each new attendance. In accident and emergency one does not have the benefit that general practitioners have of having known the child and family over a period. Every clue to the child’s health and lifestyle is needed to put the current attendance in context. 
 
There has long been an alerting system not only for children officially on the child protection register but also for families who have caused concern to other health professionals such as paediatricians, health visitors, and general practitioners. Family problems such as alcoholism and substance abuse have an impact on children and their care. With the modern practice of working with parents and registering as few children as possible for as short a time as possible, there are many children and families who need extra assessment, care, and support when children are not officially registered. 
 
I believe that there are even broader and more subtle considerations when trying to define a child at risk. The paediatric influence in accident and emergency departments would be best served by increasing the number of accident and emergency consultants with a special interest in paediatrics or at least by having a paediatrician linked closely to each department.