![A boy's hand thrust forward towards the camera](https://www.york.gov.uk/site/dist/images/cyscp/york-cyscp-banner-1800.webp)
Jenny is an infant who attended Hospital presenting with symptoms of possible febrile convulsion (fits). However, after further medical investigation, clinical staff became concerned for Jenny as she had reduced movement in the left side of her body. A CT scan was completed which showed a subdural hematoma (bleed on the brain) and subsequent ophthalmology tests revealed bilateral retinal haemorrhages. The medical view was that these injuries were highly suspicious of non-accidental injury.
Neither mother nor mother’s partner could offer an explanation for the injuries that Jenny had sustained and were subsequently arrested.
Due to the significant injuries Jenny sustained, this case was referred to the National Panel by the local authority, and the CYSCP instigated the Rapid Review Process which explored the following themes to identify areas of good practice and learning:
Jenny has a loving wider family network who she enjoys spending time with. At the time of the Rapid Review, it was understood that Jenny lived with her mum and her half-brother. Jenny has had limited contact with her father due to the relationship breakdown between her parents. Her half-brother has had no contact with his father due to domestic abuse perpetrated by his father to their mother. Jenny’s mother had been in a new relationship since Jenny was 3 months old. Her new partner worked shifts and on his days off he would spend his time with Jenny, her mother and half-brother.
If Jenny were able to speak to communicate her needs and feelings, the reviewers hypothesised that Jenny would say that, in order to feel safe and loved, she needs to live in a warm and secure home environment surrounded by people who love and care for her and prioritise her needs.
During her time on the Children’s Ward, staff who cared for Jenny shared that ‘she enjoys cuddles, having a story read to her, interacting with the nurses and her carers and being visited by people who love and care for her’. Jenny responds to warm and engaging voices with smiles and is reaching for toys and trying to stand with support. Jenny is a happy, smiley and sociable little girl’.
The following areas of good practice were identified as part of the Rapid Review process:
The following multi-agency learning points were identified as part of the Rapid Review Process:
The CYSCP to seek assurance from all agencies that fathers/partners names including date of birth and addresses are recorded within agencies records particularly in relation to domestic abuse enquiries.
NHS Foundation Trust to review their documentation standards in relation to this specific case, the current Trust requirements and whether there are any training needs within the Emergency Department or more widely within Paediatric settings regarding documentation standards.
The Trust to also consider incorporating the learning from this case into future teaching sessions to highlight the importance of detailed documentation of injuries to children, and the significance of assessing and documenting a child’s developmental stage in order to inform any safeguarding assessment in relation to injuries to non-independently mobile children.
Healthy Child Service to consider the viability of reviewing all attendances under 1 year of age to better target advice and support at the mandated 1-year review.
NHS Foundation Trust and Ambulance Service will undertake a deep case file review on the management of the incident with a focus on safeguarding and injuries to under 1's. Any learning from these case file reviews will be shared within the individual organisations and across the City of York Safeguarding Children Partnership.
Primary Care to ensure they consider the risks of stopping/continuing anti-depressant medication in pregnancy and to be aware of where they can access guidance regarding this i.e. perinatal team.
Primary Care to consider follow up/review requirements for a patient started on anti-depressants in line with NICE guidance and taking into account individual risk factors.