Effect of covid-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK

Joanna Garstang, Geoff Debelle, Indu Anand, Jane Armstrong, Emily Botcher, Helen Chaplin, Nutmeg Hallett, Clare Morgans, Malcolm Price, Ern Ern Henna Tan, Emily Tudor, Julie Taylor

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
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Objectives: To determine any change in referral patterns and outcomes in children (0–18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years.

Design: Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown.

Setting: Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children.

Participants: Children aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018–2020.

Main outcome measures: Numbers of referrals, source of disclosure and outcomes from CPME.

Results: There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns.

Conclusions: School closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.
Original languageEnglish
Article numbere042867
Number of pages6
JournalBMJ open
Issue number9
Publication statusPublished - 29 Sept 2020


  • child protection
  • community child health
  • non-accidental injury
  • Humans
  • Child Protective Services/methods
  • Coronavirus Infections/epidemiology
  • Male
  • United Kingdom/epidemiology
  • Pandemics/prevention & control
  • COVID-19
  • School Health Services/statistics & numerical data
  • SARS-CoV-2
  • Child Welfare/statistics & numerical data
  • Pneumonia, Viral/epidemiology
  • Betacoronavirus
  • Female
  • Population
  • Child Abuse/prevention & control
  • Social Isolation
  • Communicable Disease Control/methods
  • Social Work/methods
  • Child

ASJC Scopus subject areas

  • Medicine(all)


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