How to Provide Safe Personal Care in Early Years Settings

Taken to the extreme, safeguarding can actually end up being detrimental to children’s wellbeing, explains Natalie Thompson…

Safeguarding is defined by the government as “protecting children from maltreatment; preventing impairment of children’s health or development; ensuring that children grow up in circumstances consistent with the provision of safe and effective care; and taking action to enable all children to have the best outcomes”. There is an undisputed need at present to reassess how we care for children in response to historical allegations of sexual abuse, which have highlighted society’s failure to protect the most vulnerable, but extreme safeguarding can actually be detrimental to children’s safety.

Eagerness to protect ourselves from allegations may mean we overlook the reason why safeguarding exists and lead us to forget that the child should be at the centre of any safeguarding approach.

Intimate care

One area in which safeguarding can be taken to the extreme is personal or intimate care. Through my work with ERIC, the children’s bowel and bladder charity, I’ve heard first hand from parents whose child’s school is no longer willing to change them when they’ve had a wetting or soiling accident – regardless of any underlying condition or disability. This is often because the school has introduced a new policy that two members of staff must be present for intimate care and there aren’t enough staff to carry out this duty. Schools invariably say this policy change is ‘because of safeguarding’.

In December, I received a call from a distraught mum whose son’s school had been very good at caring for her son, who has chronic constipation and additional needs, but had recently introduced a two-person intimate care policy. The school was no longer able to help change her son when he soils because one of the teaching assistants didn’t want to assist with intimate care. The school has a duty to respect the wishes of its employees, but this shouldn’t stop it from upholding its duty to safeguard the health and wellbeing of the child. In my opinion, leaving a child in soiled clothing until their parent arrives is maltreatment: the opposite of why safeguarding exists.

A colleague recently recounted a conversation she’d had with a school that had a two-person policy. Staff would grab any passing member of staff in order to change a child. Whilst aiming to uphold their safeguarding duties, the child was effectively being taught that it is okay for any adult to help with their intimate care. The potential repercussions are frightening.

Of course schools must ensure that children who need help with intimate care aren’t at risk of abuse, but they also have a duty to support those with medical needs, including bowel and bladder difficulties. Support should be delivered in a child-centred way, taking into consideration the individual needs of the child.

In practice

In order to strike a balance between protecting staff and maintaining the privacy, dignity and security of the child, schools need to carefully consider how many members of staff should be present for intimate care. The number of staff required will depend on each child’s situation and their unique needs.

Some intimate care procedures may require two members of staff for health and safety reasons, such as manual handling. Whatever number of staff are required, their names and roles should be stated in the child’s healthcare plan.

The only requirements in law with regard to staffing levels for intimate care are that the member of staff helping the child must notify another member of staff when they are going alone to assist a pupil, and must ensure another member of staff is in the vicinity and visible or audible. To further protect the privacy and dignity of the child, staff should notify others discreetly that they are taking the child for personal care.

If a situation arises that causes concern to staff helping with personal care, they should call the second member of staff if necessary and report and record the incident. Any concerns about the way in which the child is behaving during the care procedure or any comments they’ve made should be recorded and discussed with senior staff immediately.

Eric are the experts in children’s bowel and bladder issues, and have been delivering training for health and education professionals for over 20 years. To find out how they can help your school or setting, visit eric.org.uk/paediatric-continence-training