Medicine

Patient information for Translation

Radiological tests as part of safeguarding investigations in children

This leaflet is for those with parental responsibility of children who may need X-rays and scans when there are concerns about the child’s welfare as part of a safeguarding investigation

Why are these tests needed?

Children are often brought to hospital after an injury. In the majority of children, the cause is clearly explained, and the child is discharged. Some injuries may resemble injuries that occur in children following deliberate harm, and this may require the child to be admitted to hospital for further investigations. This can be a difficult and sensitive time for anyone involved in looking after the child.

It is the responsibility of all NHS staff (and everyone) to protect children from harm and ensure they are safe. This is known as safeguarding children. NHS staff are expected to raise concerns if they believe a child may have been harmed, is at risk of harm or their health and welfare may be at risk. The child’s wellbeing and safety comes first, and staff raising these concerns have a duty of care to do so to try and rule out deliberate harm.

If concerns are raised they need to be investigated fully. The process will be explained to you by the paediatric team looking after your child. As well as your child’s medical team, other agencies may be involved, such as children’s social care and the police. This is to gather information and ensure the child is discharged when appropriate to a safe environment.

It may be necessary to perform a CT (computer tomography) or MRI (magnetic resonance imaging) scan (or both) of the brain and a series of X-rays called a skeletal survey, to rule out any injuries in the child. This is especially important in younger children when they cannot tell us what has happened.

What is a skeletal survey?

This is two sets of X-rays that take place about two weeks apart, to detect any broken bones or abnormalities in the bones such as very thin bones that may have contributed to any injuries.

Where is a skeletal survey performed?

At the X-ray department. A nurse or other healthcare professional will accompany you and your child to help and support you.

What is the procedure and what is your role?

The skeletal survey is a two-stage process. The first stage will be undertaken when your child is in hospital. This involves taking about 30 separate X-rays images of the whole body. This will take about an hour to perform. Your child will need to be still for these images. We suggest you bring some toys or comforters to help distract your child. Staff present will help you hold your child safely and try to minimise any distress. Rarely, your child will need to be sedated to obtain the X-rays, and this will be explained to you by the paediatric team.

You will need to wear a protective apron to minimise your exposure to X-rays when you hold your child. If you are, or could be, pregnant, you must tell the radiographer - you will not be allowed in the room when X-rays are being taken.

When does the second stage of the skeletal survey happen?

The second part of the second skeletal survey happens 11-14 days after the first set of X-rays, unless the paediatric team tell you this is not required. This is because some recent injuries may not be visible on the initial X-rays and will only be seen later. Only with two complete sets of X-rays is the skeletal survey complete and we can be sure that there are no bony injuries in your child.

Usually, your child will have been discharged at this point. Following the first set of X-rays you will be given a time and date and reporting instructions for the second set of X-rays and the procedure is the same. In the second skeletal survey, usually fewer X-rays are taken compared to the first.

What if I cannot attend the second skeletal survey?

Please contact the paediatric team via hospital switchboard if you cannot bring or accompany your child for the second skeletal survey. They will inform the X-ray department and rearrange this with you. If your child is not bought to the second skeletal survey without explanation, you will be contacted so we can understand why you haven’t attended. Non-compliance may be escalated to other agencies involved such as children’s social care.

What is a CT Head scan?

This is a scan performed in a specialised CT machine that gives detailed images of the brain and skull.

Why is CT head needed?

To rule out any bleeding in the brain and give more detailed views of skull fractures. They are routine scans performed when there are any safeguarding concerns to help rule out significant injuries to the brain and skull.

What is the procedure with a CT scan?

Having a CT scan requires your child to stay still in the CT machine for around 10 minutes. Sometimes your child will need sedation to stay still, and the paediatric team will explain this to you.

You will be allowed to accompany your child to the scanner in most cases. You will need to wear a protective apron to minimise your exposure to radiation when in the CT scanner room. If you are, or could be, pregnant, you must tell the radiographer, and you will not be allowed in the room when the scan is taking place.

What is an MRI head scan?

It is performed in an MRI machine which looks like a CT scanner, but more like a tunnel. The MRI provides even more detailed images of the brain and skull compared to CT, and may be needed when more detailed images are necessary.

What is the procedure with an MRI scan?

Having an MRI requires your child to stay completely still in the MRI machine for around 1 hour. This is often difficult for young children, and they will therefore often need a general anaesthetic. If this is needed an anaesthetist will come and review your child and explain the anaesthetic procedure. You will also need to sign a consent form before the scan.

In most cases, you will be allowed to accompany your child into the MRI scanning room. You do not need to wear protective clothing; however, the MRI radiographer will go through a checklist with you to check whether it is safe for you and your child to be in close contact with the MRI scanner as the scanner uses a magnet.

X-ray and head scan results

The paediatric team will be informed of any results and will inform you. Scans and X-rays are usually reported by radiologists within 24-48hrs of being taken. The test results may also be shared with any other agencies involved such as children’s social care, as well as with other members of the medical team. Test results will also be included in the hospital discharge summary which you usually receive a copy of.

Radiation

We are all exposed to natural background radiation. This is made up mostly of cosmic rays and from the ground. Every X-ray gives us a small additional dose of radiation. A skeletal survey is equivalent to a few months’ background radiation. A CT head scan is equivalent to about 18 months of background radiation. Overall, a skeletal survey and CT head gives the same radiation dose as natural background radiation from 23 transatlantic airline flights. These extra exposures to radiation slightly increase the lifetime risk of cancer; however, the increase in risk is very small.

The radiographers are experienced working with children, and will use techniques to ensure they achieve the correct X-ray/scan first time and to keep the dose of radiation used as low as possible.

What if I have further questions?

The paediatric team looking after your child will be able to answer any questions whilst you are an inpatient. For queries after discharge contact the paediatric team who were responsible for your child during their admission. The details of the lead doctor in charge of your child’s care will be on your child’s discharge summary. The paediatric secretaries can be contacted via switchboard.

How do I contact the Trust?

We aim to provide the best possible service and staff will be happy to answer any questions you may have. If you have any suggestions or comments about your visit, please either speak to a member of staff or contact the Patient Advice and Liaison Service. Patients, their carers and families are welcome to drop in to discuss their concerns. However, if they are unable to visit the office in person, they can ask a member of staff to contact them, or contact PALS directly.

You can contact the PALS service in a number of ways as advertised on their website:  

Website: www.bartshealth.nhs.uk/pals

Reference: Society and College of Radiographers and the Royal College of Radiologists. The radiological investigation of suspected physical abuse in children, revised first edition.

The Royal College of Radiologists, 2018

Large print and other languages
This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. For more information, speak to your clinical team.
 

এই তথ্যগুলো সহজে পড়া যায় অথবা বৃহৎ প্রিন্টের মত বিকল্প ফরম্যাটে পাওয়া যাবে, এবং অনুরোধে অন্য ভাষায়ও পাওয়া যেতে পারে। আরো তথ্যের জন্য আপনার ক্লিনিক্যাল টিমের সাথে কথা বলুন।

Na żądanie te informacje mogą zostać udostępnione w innych formatach, takich jak zapis większą czcionką lub łatwą do czytania, a także w innych językach. Aby uzyskać więcej informacji, porozmawiaj ze swoim zespołem specjalistów.

Macluumaadkaan waxaa loo heli karaa qaab kale, sida ugu akhrinta ugu fudud, ama far waa weyn, waxana laga yabaa in lagu heli luuqaado Kale, haddii la codsado. Wixii macluumaad dheeraad ah, kala hadal kooxda xarunta caafimaadka.

Bu bilgi, kolay okunurluk veya büyük baskılar gibi alternatif biçimlerde sunulabilir, ve talep üzerine Alternatif Dillerde sunulabilir. Daha fazla bilgi için klinik ekibinizle irtibata geçin.

یہ معلومات متبادل فارمیٹس میں دستیاب کی جا سکتی ہیں، جیسا کہ پڑھنے میں آسان یا بڑا پرنٹ  اور درخواست پر متبادل زبانوں میں بھی دستیاب ہو سکتی ہیں۔ مزید معلومات کے لیے، اپنی کلینکل ٹیم سے بات کریں'۔

Patient Advice and Liaison Service (PALS)

Please contact us if you need general information or advice about Trust services: www.bartshealth.nhs.uk/pals

Tell us what you think

Tweet us @NHSBartsHealth
Talk to us via facebook.com/bartshealth
Leave feedback on NHS Choices www.nhs.uk

Reference: BH/PIN/933

Publication date: Sep 2020

All our patient information leaflets are reviewed every three years.

©Barts Health NHS Trust

Switchboard: 020 7377 7000

www.bartshealth.nhs.uk