These are guidelines for health practitioners to follow whenever they are presented with a sick or injured child, "providing..
.. a summary of the clinical features associated with maltreatment (alerting features) that may be observed when a child presents to healthcare professionals. Its purpose is to raise awareness and help healthcare professionals who are not specialists in child protection to identify children who may be being maltreated.
So far, so reasonable - just in case a 'health care professional' can't recognise a suspicious set of bruises and/or cigarette burns, starvation symptoms or a child in fear and trembling at the sight of its parents. You might think.
Of course, the things I just listed would need attending to in the proper way and I think it's a good idea that government (or one of its quangos, whatever..) provides guidance to explain the correct procedure in such eventualities. It's only common sense, you might think.
But this is not what these guidelines are actually about. Of course not. Nothing could be so simple and straightforward in 21st Century England, could it? 'Healthcare practitioners' in this day and age apparently need to be looking for far more than a suspicious set of bruises and/or cigarette burns, starvation symptoms or a child in fear and trembling at the sight of its parents. They must now be the lifestyle police, trained and measured by their ability to, for example:
Consider child maltreatment if there is an unusual pattern of presentation to and contact with healthcare providers, or there are frequent presentations or reports of injuries.
So your child had better not be frequently ill, or injured. You know, when I was a child - thirty odd years or so ago now (halcyon days) - there were some children whose health was just never good. No reason, per se: it just happened that way, life being naturally a bit messy and all, but the thing was that nobody raised an eyebrow. Such variations were just accepted. Some people had a lot of time off school. Some were often at the doctors, others never went. I don't think either was a problem: certainly not cause for official concern. And injuries? Well, children are children, aren't they? Most of them like to take risks and play rough at some time or another and when I was young we were allowed to, which did us no end of good.
And yes, there probably were, from time to time,
unusual pattern[s] of presentation to and contact with healthcare providers, or .. frequent presentations or reports of injuries,
- but so what? In those days, it was called "living", and most families quite cheerfully indulged in it with impunity.
Not so any more: "Unusual pattern[s] of presentation" etc, blah blah, are just the tip of the iceberg.
For home educators, this will leap, blaring, off the screen:
5.8 Inappropriately explained poor school attendance
Consider child maltreatment if a child has poor school attendance that the parents or carers know about that has no justification on health, including mental health, grounds and formally approved home education is not being provided.
So, just in case that's not quite clear... if you take your child for any kind of medical attention and you are exercising your current legal right to home educate him or her without being registered and 'formally approved' by your local authority, you will now be suspected of mistreating your child!
This needs to be urgently revised and at least made to reflect the current legal situation, because it will bring in de facto compulsory registration without any need for the Badman report [opens pdf] or the Select Committee inquiry announced this week.
Besides that, these NICE guidelines [opens pdf] go on to instruct practitioners to:
Consider neglect if a child’s clothing or footwear is consistently inappropriate (for example, for the weather or the child’s size).
Instances of inadequate clothing that have a suitable explanation (for example, a sudden change in the weather, slippers worn because they were closest to hand when leaving the house in a rush) would not be alerting features for possible neglect.
I wonder whether the parent-or-carer has to provide documented proof of leaving the house in a rush, before the aforementioned slippers are deemed to be appropriate footwear?
Honestly. My two year-old goes to the supermarket with us to sit in a trolley seat in slippers quite regularly, just because she prefers them to her proper shoes. Who could possibly be offended by this? What harm could it possibly do, to her or to anyone else? How could it possibly suggest that we're mistreating her? On the contrary, it demonstrates that we take her preferences seriously, and allow her to have some control over her own life, what she wears and what she does. Hmm. Therein lies the problem?
• child seen at times of the day when it is unlikely that they would have had an opportunity to become dirty or smelly (for example, an early morning visit)
But in the case of home educators, we're sometimes out doing activities until bedtime. I know late morning or lunchtime baths are a regular occurrence around here. Until now, there was no law that said a bath had to take place in the early evening, before bed. Are health visitors going to be checking the clock, then checking a child's fingernails on home visits? It beggars belief. Since when was a dirty child a mistreated child anyway? In my experience, the ones who are spotlessly clean all the time are perhaps the ones to be more worried about.
Achieving a balance between an awareness of risk and allowing children freedom to learn by experience can be difficult. However, if parents or carers persistently fail to anticipate dangers and to take precautions to protect their child from harm it may constitute neglect.
Consider neglect if the explanation for an injury (for example, a burn, sunburn or an ingestion of a harmful substance) suggests a lack of appropriate supervision.
Two incidents in my family spring to mind. In the first, I made a cup of tea and had to leave it, quite well back on the kitchen surface while I dashed to attend to my new baby in the other room. Meanwhile my toddling child must have inexplicably reached up for tea (I didn't even know he could reach that far, let alone think him likely to) and pulled it onto himself, suffering 11% burns. 19 years ago, this was seen for the pure accident that it was, and I was treated with sympathy and understanding by doctors and nursing staff. Nobody ever suggested that I was anything other than a good mother, even though I was only just 21 at the time, and had two such young children very close together in age. In fact, I'd left the tea due to good mothering, in a sense, because I was dashing to pick up the baby before he got too upset. I couldn't really have foreseen the accident, but how would I be treated if it happened now? Quite differently I think.
As recently as five years ago, I took another toddler up to the bathroom while I went to use the loo, but she grew bored of waiting for me and wandered into her teenaged sister's room next door. The next thing I knew, she was screaming, with nail varnish in her eye, that she'd mistaken for mascara and decided to play with accordingly. I washed out the nail varnish and called 999: she was being checked by an eye specialist within 20 minutes and we were home again just over an hour later with a clean bill of health and no suspicions of 'maltreatment'. This would presumably not be the case under the new guidelines.
Accidents happen. They can't all be prevented, all of the time. A good parent-or-carer makes reasonable checks for safety and takes reasonsable precautions, but people have to live - go to the loo, attend to their other children, turn their backs sometimes, for whatever reason. Maybe even trust their child to go off and play at her own request, unsupervised. It's not good to have a parent-or-carer breathing down one's neck all the time. It is good to enable a reasonable amount of risk-taking and unsupervised play to facilitate the learning process and the child's general development. Is this still to be allowed? The guidelines make no mention of it.
6.3 Ensuring access to appropriate medical care or treatment
Consider neglect if parents or carers fail to administer essential prescribed treatment for their child.
So, this outlaws alternative health philosophies, pure and simple. It also removes the traditional parental authority to make decisions about their children's medical treatment, as does the rest of 6.3:
Consider neglect if parents or carers repeatedly fail to attend essential follow-up appointments that are necessary for their child’s health and wellbeing.
Consider neglect if parents or carers persistently fail to engage with relevant child health promotion programmes which include:
• health and development reviews
Consider neglect if parents or carers have access to but persistently fail to obtain NHS treatment for their child’s dental caries (tooth decay).
Even tooth decay in milk teeth? In an older teenaged child's teeth? What if the child resists? Isn't the parent the last bastion in the defence of their child's autonomy? I've seen the health effects on very young children of surgical tooth removal, and it's not something I would unnecessarily put a child of mine through. Do I still have this choice? According to these guidelines, I don't.
I'm not even going to start on immunisation, except to say that this document renders it now de facto compulsory. I don't know if the relevant pressure and support groups are aware of this.
7.1 Emotional and behavioural states
Consider child maltreatment if a child or young person displays or is reported to display a marked change in behaviour or emotional state (see examples below) that is a departure from what would be expected for their age and developmental stage and is not explained by a known stressful situation that is not part of child maltreatment (for example, bereavement or parental separation) or medical cause. Examples include:
• recurrent nightmares containing similar themes
• extreme distress
• markedly oppositional behaviour
• withdrawal of communication
• becoming withdrawn.
Goodness me. One of my children is extremely emotional and imaginative and suffers from nightmares sometimes without any known cause: I think it's just genetic. Another is very choosy about who she speaks to and when and is quite likely, in her regal two year-oldness, to decide not to acknowledge someone's presence if and when the mood takes her. These would both be marked changes in behaviour, seen from certain perspectives, not explained by a known stressful situation that is not part of child maltreatment (for example, bereavement or parental separation) or medical cause. I do not maltreat my children - far from it. But, like Philip Pullman (whose excellent books I've just got into reading) et al., it seems that we parents are to be presumed guilty until proven innocent.
There's more, far more, but this has taken enough of my time away from my own children today. You will go and read the rest of the document if you're interested, and formulate your own views of it. Meanwhile (assuming you agree with me) what can we do? If you're an EO member I'd urge you to lobby the management there to try to get this changed, as they're listed as stakeholders. If not (and I'm not) then it might not be a bad idea to just talk to people about it. I don't know if writing to complain about things actually helps, but a groundswell of public opinion might, and this affects all parents.
(As does this, especially if the Badman recommendations are enacted. We won't even be allowed to support our children's natural resistance to the school system. There will be no leeway for anyone, anywhere. Only total and unquestioning obedience.)