Safeguarding Tongue Tie Solutions

SAFEGUARDING POLICY

Tongue Tie Solutions

POLICY STATEMENT ON SAFEGUARDING CHILDREN

This organisation recognises that all children have a right to protection from abuse. Tongue Tie Solutions takes seriously its responsibility to protect and safeguard the welfare of children and babies. We will:

Respond swiftly and appropriately to all suspicions or allegations of abuse, and provide parents and children with the opportunity to voice their concerns
Have a system for dealing with concerns about possible abuse
Maintain good links with statutory child care authorities.

THE POLICY

Tongue Tie Solutions recognises that many children and young people today are the victims of neglect, and physical, sexual and emotional abuse. Accordingly, Tongue Tie Solutions has adopted the policy contained in this document. The policy sets out agreed guidelines relating to responding to allegations of abuse, including those made against staff. Tongue Tie Solutions recognises the need to build constructive links with the child care agencies. These guidelines will be kept under review and be supported by appropriate training.

The policy applies to all staff who act on behalf of Tongue Tie Solutions and who come directly into contact with children. Every individual has a responsibility to inform the Safeguarding Lead of concerns relating to safeguarding children. The Safeguarding Lead must decide if the concerns should be communicated to Children and Families Service or the police.

DEFINITIONS

Child/Young Person

Anyone who has not yet reached their 18th birthday. The fact that a child has reached 16 years of age, is living independently or is in further education, is a member of the armed forces, is in hospital or in custody in the secure estate, does not change his/her status or entitlements to services or protection.

Abuse

A form of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting by those known to them or, more rarely, by others. Abuse can take place wholly online, or technology may be used to facilitate offline abuse. Children may be abused by an adult or adults, or another child or children.

Physical Abuse

A form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child.

Emotional Abuse

The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to a child that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond a child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyber bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.

Sexual Abuse

Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse Sexual abuse can take place online, and technology can be used to facilitate offline abuse. Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.

Child Sexual Exploitation

Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.

Neglect

The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:

a) provide adequate food, clothing and shelter (including exclusion from home or abandonment)

b) protect a child from physical and emotional harm or danger

c) ensure adequate supervision (including the use of inadequate care-givers)

d) ensure access to appropriate medical care or treatment

It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.

Extremism

Extremism goes beyond terrorism and includes people who target the vulnerable – including the young – by seeking to sow division between communities on the basis of race, faith or denomination; justify discrimination towards women and girls; persuade others that minorities are inferior; or argue against the primacy of democracy and the rule of law in our society.

Extremism is defined in the Counter Extremism Strategy 2015 as the vocal or active opposition to our fundamental values, including the rule of law, individual liberty and the mutual respect and tolerance of different faiths and beliefs. We also regard calls for the death of members of our armed forces as extremist.

Awareness of Abuse and Neglect

All staff working for Tongue Tie Solutions will attend adequate safeguarding training in order to carry out their role and responsibilities under this policy. Individuals within the organisation need to be alert to the potential abuse of children both within their families and also from other sources including abuse by staff working for Tongue Tie Solutions.

All members of Tongue Tie Solutions should to respond to any suspected or actual abuse of a child in accordance with these procedures.

It is good practice to be as open and honest as possible with parents/carers about any concerns; however, you must not discuss your concerns with parents/carers in the following circumstances:

a) delay in sharing relevant information with an appropriate person or authority would increase the risk of harm to the child or young person

b) asking for consent may increase the risk of harm to the child, young person, you or anyone else.

What to do if children talk to you about abuse or neglect/ you witness abuse or neglect

It is recognised that a child may seek you out to share information about abuse or neglect, or talk spontaneously to individuals or in groups. In these situations, you must:

Listen carefully to the child. DO NOT directly question the child.
Give the child time and attention.
Allow the child to give a spontaneous account; do not stop a child who is freely recalling significant events.
Make an accurate record of the information you have been given taking care to record the timing, setting and people present, the child’s presentation as well as what was said. Recordings must be kept secure and in accordance with organisation procedures.
Use the child’s own words where possible.
Explain that you cannot promise not to speak to others about the information they have shared.

Reassure the child that:

you are glad they have told you;
they have not done anything wrong;
what you are going to do next.
Explain that you will need to get help to keep the child safe.
Children should not be required to provide multiple accounts of events within the organisation

You must:

treat all children and young people with respect
Respect a young person’s right to personal privacy
Recognise that caution is required when you are discussing sensitive issues with children or young people
Operate within the organisation’s principles and guidance and any specific procedures
Challenge unacceptable behaviour and report all allegations/suspicions of abuse.

You must not:

Have inappropriate physical or verbal contact with children or young people
Reach conclusions about others without checking facts
Either exaggerate or trivialise safeguarding issues

What you should do if you suspect abuse

You may become concerned about a child for a number of reasons, for example:

They have not spoken to you or avoid speaking to you
They are upset
Because of your observations
You are given information from another party about a child.

It is good practice to ask a child or parent why they are upset or how a cut or bruise was caused, or respond to a child wanting to talk to you. This practice can help clarify concerns and result in appropriate action.

If you are concerned about a child, you must share your concerns. Initially you should talk to the Safeguarding Lead. You should make a note of your concerns and any actions agreed following your discussion with the Safeguarding Lead.

Informing parents

The GDPR and Data Protection Act 2018 place greater significance on organisations. Tongue Tie Solutions will be being transparent and accountable in relation to their use of data for collecting, storing, and sharing information.

Information to be shared with another agency will usually require explicit consent except where there are concerns for the welfare or safety of the child. In these circumstances the need for consent changes where it is believed that a child has or is likely to suffer:

Significant harm and/or;
Has developmental and welfare needs which are likely only to be met through provision of family support services (with agreement of the child's parent).

For cases not reaching this threshold, it is good practice to be open and honest at the outset with the parents/carers about concerns, and the need for a referral. All reasonable efforts should be made to inform parents/carers prior to discussing concerns with Children and Families Service; however, this should not be delayed if concerns cannot be discussed with the parents.

Where the child expresses a wish for his or her parents not to be informed, their views should be taken seriously and a judgement made based on the child’s age and understanding, as to whether the child’s wishes should be followed (see http://www.nspcc.org.uk/preventing-abuse/child-protection-system/legal-definitionchild-rights-law/gillick-competency-fraser-guidelines/).

There may be some circumstances where it is not appropriate to seek consent, either because the individual cannot give consent, it is not reasonable to obtain consent, or because to gain consent would put a child or young person’s safety or well-being at risk.

Where a decision to share information without consent is made, a record of what has been shared should be kept along with the reason why consent was not obtained.

Consultation with the Children and Families Service

Where concerns have been highlighted to the Safeguarding Lead, they will contact the Customer Contact Centre to discuss the concerns with the Children and Families Service. You may also wish to consult with the Children and Families Service in the following circumstances:

When you have been unable to contact the Safeguarding Lead and you believe the child is at risk of harm
When you remain unsure after internal consultation as to whether safeguarding concerns exist
When there is disagreement as to whether safeguarding concerns exist
When the concerns relate to any member of the organising committee.

Consultation is not the same as making a referral but should enable a decision to be made as to whether a referral to Social Services or the Police should progress.

Following consultation, the decision may be made to:

Make a Referral to the Children and Families Service

In order to make a referral to Children and Families Service, the Customer Contact Centre should be contacted in the first instance.This will usually be by the Safeguarding Lead.

Details for Children and Families Service will be found online dependent on the area that the child resides in.

A written confirmation of the referral must be completed and submitted within 24 hours.This will normally be completed by the Safeguarding Lead.Where possible the relevant referral form, should be used to ensure that all relevant information is provided to ensure that the referral can be progressed as effectively as possible.

When contacting the Customer Service Centre, the staff should:

Clearly identify themselves, their agency/relationship with the child(ren) and family,
Give details of where they can be contacted.
Provide as much relevant family information as possible and, clearly stating the name of the child, the parents/carers and any other children known to be in the household, the dates of birth and addresses and any previous addresses known
Provide details of any special needs or communication needs of either the child or any family member
State why they feel the child is suffering, or is likely to suffer, significant harm.
Share their knowledge and involvement of the child(ren) and family
Share their knowledge of any other agency involved
Indicate the child’s, parent’s/carer’s knowledge of the referral and their expectations
Ensure they record within their agency files the concerns and action taken

Share concerns with the family’s GP and Health visitor

In the event that the Children and Families Service does not feel that a referral should be progressed, staff should share their concerns with the family health visitor and/or GP (with the parent’s/ young person’s consent). Communicating amongst different agencies will enable the situation to be more effectively monitored increasing the safety of the child or baby.

Safeguarding a baby against abuse inflicted by staff working for Tongue Tie Solutions

All staff working for Tongue-Tie Solutions will be DBS checked.

Tongue Tie Solutions will not discriminate in relation to age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; and sexual orientation. Any allegations of discrimination or victimisation will be fully investigated. During this period the service user will be fully supported. If the allegations are sustained Tongue-Tie solutions will make the necessary steps to ensure that corrective measures are implemented so that it will not happen again

Ankyloglossia (tongue-tie) is an abnormally short or tight lingual frenulum that restricts the mobility of the tongue and it is thought to cause many problems with infant feeding.

Frenotomy is a procedure that divides the Ankyloglossia, freeing the restricted tongue and enabling normal tongue function.

To perform frenotomy the baby is lay supine facing the, trained and qualified, tongue tie practitioner. An assistant holds the baby’s head still. The practitioner’s finger lifts the baby’s tongue superiorly making the tongue tie clearly visible. Care is taken to avoid injury to the submandibular duct and other surrounding structures. The tongue tie is then divided using the free hand with a pair of blunt-tipped scissors. A clinical decision is made at the time of the procedure regarding the amount of tongue tie released. It needs to be sufficient to ensure safety and adequate tongue mobility. A further two cuts are considered acceptable to ensure the ankyloglossia is completely divided.

Restraint

During the tongue tie release procedure, the baby’s head must be restrained to prevent movement and to prevent accidental injury.
Parents will be informed in advance of the procedure that restraint will be necessary and consent will be obtained.
The restraint applied will be carried out by a trained professional.
The restraint will be the minimal amount needed to ensure that the baby remains safe and secure during the procedure.
The baby may be swaddled in a light blanket or sheet during the procedure to reduce movement and accidental interference from limbs.
The baby will be released from the swaddle immediately following the completion of the procedure.
The baby’s head will be released as soon as the procedure is completed.
It is not anticipated that the baby should be restrained for longer than 5 minutes
The restraint will not result in any injury to the baby’s head, face or neck.

Acceptable Risks

Potential risks include; bleeding, infection, pain, reattachment and damage to surrounding structures. However, there is a very low complication rate with frenotomy. Heavy bleeding following frenotomy is extremely unusual. Guidelines for the Association of Tongue-Tie Practitioners advise keeping the baby calm and giving a feed is an effective way to achieve hemostasis. If this is not possible or fails to stop bleeding applying pressure with gauze for 5 minutes continuously and a further 5 minutes if needed should stop 99.7% of bleeding. However, if bleeding persists transfer to A&E department via ambulance would be necessary. Parents will be made aware of the above risks prior to the procedure and sign a consent form to acknowledge that they understand that these risks can occur.

Unexpected Complications

In the event of serious complications or injury caused to a baby services will be immediately suspended until a full investigation has occurred. This may be an internal investigation or external via the baby’s hospital trust. Referral to the Nursing and Midwifery council (NMC) may also be necessary if misconduct is considered to have occurred.

Auditing to Ensure Safety

It is anticipated that complications from frenotomy are very rare and therefore should not be experienced regularly by clients of Tongue Tie Solutions. Follow-up consultations will be given to all clients of Tongue-Tie Solutions at one-week post frenotomy to determine if any complications occured. In the event that frequent complications are reported an internal investigation will be commenced. If it is considered that complications are arising more frequently than anticipated the service will be suspended until the tongue-tie practitioner has completed supervised practice satisfactorily or the cause of the complications has been identified and rectified.

Complaints Procedure to Ensure Safety

The Safeguarding policy and complaints procedure will be easily accessible to all service users of Tongue-Tie Solutions. Complaints will be acted upon within 72 hours of receipt. In the event of serious complications or injury caused to a baby services will be immediately suspended until a full investigation has occurred. All clients will be made aware that they can escalate complaints to the NMC if they are concerned that misconduct has occurred. Further details can be found at:https://www.nmc.org.uk/concerns-nurses-midwives/concerns-complaints-and-referrals/member-public-referral/