BNSSG Remedy has multi-Agency Guidance for injuries in non-mobile babies, please consider this and specific guidance for OOH IUC clinicians.
Multi-Agency Guidance for Injuries in NON-MOBILE Babies 2023 can be located on Remedy.
Presentation – is this a non-mobile baby?
All injuries or concerning presentations in non-mobile babies should prompt use of this pathway. This includes a history of trauma where there is no visible injury.
Mobile baby = babies who can crawl/ pull to stand/ cruise/ toddling
Non Mobile = babies who cannot do the above.
- Babies who roll are classed as non-mobile.
- Use clinical judgement for babies who can sit independently but who cannot crawl, depending on the plausibility and severity of any injury.
Raising concerns for those who do not meet specific NMBI criteria
Regardless as to whether the baby is non mobile / or not, or has a visible injury, or not, please still address any safeguarding concerns by considering face to face assessment and making a safeguarding referral.
Gather Background information
- EMIS - Review problem list for safeguarding concerns, alerts in blue banner, Household concerns: Health Visitor notes/ DNA’s to GP/ Parental risk
- Connecting Care Social Care alerts – red banner, Hospital attendances especially to ED with injuries
- CLEO -CP-IS (Child protection information sharing system) box (national safeguarding info for children), Summary Care box, Special patient notes
Make the call
- Record the narrative as it is presented - It is not our role to determine causality in primary care
- Ask ‘who else lives at home' Check if any partners are birth parents.
- Who was present at the time of injury? When did they present?
- Explain because of the age of the child, you will need to run checks with the Local Authority and need the names and DOBs of all those in the household and who have caring contact with the baby.
Please text this BNSSG Leaflet via free text message in Cleo, to carers to explain the NBMI pathway process. It can also be found on this Remedy Page.
Arranging F2F Appointment & Contacting Social Services
A base F2F appointment should be considered standard in ALL cases of injuries to non-mobile babies including those with a history of trauma without visible injury. IF a professional judgement is made that this is not required, please discuss with the Clinical Co-ordinator or (if no Clinical Coordinator on shift), another clinical colleague, and document reasoning for this.
Please indicate on the first line of your CLEO notes 'NMBI concern's so that this is clear for the ops team and F2F clinician.
If concerns about significant injuries; please refer directly to BCH ED call through 0117 342 8666, asking to speak to a senior clinician. For such cases, arrange a time frame for attendance, and follow up the case to ensure the patient has attended as planned.
All other injuries can be assessed by the IUC e.g. bruises, minor head injuries. The aim is to avoid sending these babies to ED, which may not best meet their needs.
Contact Social Services - required for all NMBI injuries or non-mobile baby concerns
- Ring Emergency Duty Team (EDT) and ask for ‘Checks to be run for the Non-Mobile Pathway’. 01454 615165 (if in-hours refer to Remedy for Local Authority numbers)
- If sending the baby to ED please still make a Social Care referral yourself. Discussing with EDT is still helpful in first instance in the IUC period.
- Please note requesting the checks do not replace the requirement to make a separate safeguarding referral.
It is recommended that the triaging clinician contacts social services, but it may be the F2F clinician.
Community Paediatrician (triaging clinician to consider)
- This is either completed by the triaging clinician in advance of a F2F, or the F2F clinician once they have seen the baby.
- As triaging clinician, it may be helpful to call the community paediatrician at the time of the triage. For example: a mother reporting bleeding from baby’s mouth, as F2F clinician it is helpful to get paediatric advice as to causes of this and what to examine for before seeing the baby.
- In more straightforward cases it may be a better use of time that the clinician who has seen the baby calls and has the conversation in one sitting.
- Ring UHBW/BRI switchboard for all BNSSG on 0117 923 0000 and ask for the Community Paediatrician on call.
- Explain the narrative given to you, nature of the injuries and explain that the baby will be seen at base and that the base clinician will also ring to update them. Provide any information given to you from Social Care.
Assessment at Base:
- Retake the history and document as presented to you. This will help highlight any inconsistencies.
- Document clearly who has brought the child to the assessment, name, date of birth and relationship. And, document anyone else who has regular caring responsibility for the baby.
- Make a global assessment of the child, including clothing, interaction with parent and describe any lesions in detail. Please undress the baby fully to examine the whole body.
- Please document clearly any observed marks or concerns. There is no expectation to do a body map or a detailed safeguarding medical in primary care.
- If there are any safeguarding concerns at all please make a safeguarding referral.
- If an injury is identified, or safeguarding concerns remain, ring the Community Paediatrician or Bristol Children's ED (with baby and carer out of the room), to update and decide if a further Safeguarding Medical is required and to make a plan. Community Paediatricians will arrange to see the child within 24 hours if required.
- Discharge baby home if there are no immediate safety concerns at your F2F assessment, or flagged by social care.
- Make a clear safety netting plan.
Closing the Case:
- Please remember to tick the Safeguarding Concerns box (even if no social services referral made)
- Please tick that you have made a Referral to social care if you have
- Triggering of the Non-Mobile Baby Pathway should be reported via PLS (Practice Liaison Service). Please tick the box for a manual handover by the ops team to the usual GP.
- If you have referred the child directly to ED, check on Connecting Care under Timeline, to see if they have arrived at BCH. Or handover to the operations team to ensure this has happened.
Debrief:
Safeguarding cases can be complex and challenging for clinicians.
Please consider speaking to the Clinical Co-ordinator if you need to debrief immediately or contact the Brisdoc Safeguarding Team: Renuka Suriyaarachchi by emailing renuka.suriyaarachchi@nhs.net
If you would like your case documentation reviewed, please contact the Clinical Guardian Team on brisdoc.guardian@nhs.net
Bruising in non-mobile children
Please download the following PDF for more guidance on - Bruising in Non Mobile Infants
USEFUL TOOLS FROM SECONDARY CARE TO IDENTIFY RISKS
