Membership of the Royal College of Paediatrics and Child Health (MRCPCH) Child Protection, Ethics, Communication and Professional Practice Syllabus

Child Protection, Ethics, Communication and Professional Practice syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Child Protection, Ethics, Communication and Professional Practice in Membership of the Royal College of Paediatrics and Child Health (MRCPCH), not a summary of it.

1. 1

   Safeguarding and Child Protection

   5 topics

   • Recognition of physical abuse
     • Bruising, fractures and burns patterns
     • Abusive head trauma
   • Neglect and emotional abuse
   • Sexual abuse and exploitation
   • Fabricated or induced illness
   • Safeguarding processes and referral
     • Multi-agency working and documentation
     • Court reports and giving evidence
2. 2

   Ethics and Law in Paediatrics

   5 topics

   • Consent, competence and Gillick/Fraser guidance
   • Confidentiality and information sharing
   • Best interests and parental responsibility
   • Withdrawal and withholding of treatment
   • Research ethics in children
3. 3

   Communication and Shared Care

   4 topics

   • Communicating with children and families
     • Age-appropriate communication
     • Breaking bad news
   • Handling conflict and complaints
   • Interpreters and cultural competence
   • Working with the multidisciplinary team
4. 4

   Palliative, End-of-Life and Long-Term Care

   4 topics

   • Paediatric palliative care principles
   • Symptom control in life-limiting illness
   • Care of the child with complex needs and technology dependence
   • Bereavement support
5. 5

   Professionalism, Leadership and Patient Safety

   4 topics

   • Duties of a doctor and GMC standards
   • Human factors and error reduction
   • Incident reporting and duty of candour
   • Leadership, teamworking and reflective practice

Child Protection, Ethics, Communication and Professional Practice flashcards for Membership of the Royal College of Paediatrics and Child Health (MRCPCH)

21 of 51 cards from the Child Protection, Ethics, Communication and Professional Practice deck — real questions with worked answers.

1. What cutaneous findings are most suggestive of physical abuse rather than accidental injury in a child?

   Bruising in non-mobile infants ('those who don't cruise rarely bruise'); bruises away from bony prominences (ear, neck, trunk, buttocks, inner thighs); patterned marks (slap, grip, implement, ligature); and bruises of differing ages or in clusters.

2. Which fracture patterns carry a high specificity for physical abuse (non-accidental injury) in infants?

   Metaphyseal corner/bucket-handle fractures, posterior rib fractures, fractures in non-ambulant children, multiple fractures of differing ages, and scapular, sternal or spinous process fractures.

3. What triad of features characterises abusive head trauma (formerly 'shaken baby syndrome')?

   Subdural haematoma, retinal haemorrhages (often multilayered and to the periphery), and encephalopathy. Often without external signs of injury.

4. Define neglect as a category of child maltreatment.

   The persistent failure to meet a child's basic physical and/or psychological needs, likely to result in serious impairment of health or development — including failure to provide adequate food, clothing, shelter, supervision, medical care, or emotional responsiveness.

5. What clinical and behavioural features should raise suspicion of emotional abuse or neglect?

   Faltering growth without organic cause, developmental delay, poor hygiene, frozen watchfulness, indiscriminate attachment, missed appointments ('was not brought'), poor school attendance, and a child who is withdrawn, fearful or excessively compliant.

6. List recognised warning signs (red flags) of child sexual abuse.

   Anogenital injury or bleeding without explanation, recurrent STIs or UTIs, pregnancy in a young person, sexualised behaviour inappropriate for age, disclosure, and unexplained behavioural change (e.g. self-harm, soiling, sleep disturbance).

7. What is child sexual exploitation (CSE), and which model is often involved?

   A form of sexual abuse where a child is coerced or manipulated into sexual activity in exchange for something (gifts, money, affection, status, drugs). It frequently involves grooming and an imbalance of power, including online exploitation and the 'boyfriend' model.

8. Define Fabricated or Induced Illness (FII) and give examples of how it presents.

   A condition where a carer fabricates, exaggerates or induces illness in a child. Presentations include reported symptoms not observed by staff, signs that appear only in the carer's presence, inconsistent histories, induced signs (e.g. poisoning, suffocation), and persistent demands for investigations or treatment ('perplexing presentations').

9. What are the four statutory categories of significant harm used in UK child protection plans?

   Physical abuse, emotional abuse, sexual abuse, and neglect.

10. Outline the immediate steps a paediatrician should take when a safeguarding concern arises.

    Ensure the child's immediate safety, document carefully (verbatim, dated, signed), discuss with the named/designated safeguarding professional, make a referral to children's social care (followed up in writing within 48 hours), and inform parents unless doing so would increase risk to the child.

11. What is the threshold for a Section 47 enquiry under the Children Act 1989?

    When a local authority has reasonable cause to suspect that a child is suffering, or is likely to suffer, significant harm — triggering a multi-agency investigation to decide what action is needed to safeguard the child.

12. Define Gillick competence.

    A child under 16 is Gillick competent if they have sufficient maturity and understanding to fully appreciate the nature, purpose, benefits, risks and consequences of a proposed treatment, allowing them to give valid consent to that treatment without parental involvement.

13. What are the Fraser guidelines and to what do they specifically apply?

    Criteria for providing contraceptive (and sexual health) advice/treatment to under-16s without parental consent: the young person understands the advice; cannot be persuaded to involve parents; is likely to continue having intercourse with or without treatment; their physical/mental health is likely to suffer without it; and it is in their best interests to provide it.

14. In the UK, can a competent child refuse life-saving treatment that their parents/court consent to?

    No. A Gillick-competent child can consent to treatment, but a refusal of life-saving or essential treatment can be overridden by a person with parental responsibility or the court if it is in the child's best interests.

15. At what age is a person presumed to have capacity to consent to medical treatment in England, and what governs 16-17 year olds?

    From 16, a young person is presumed to have capacity to consent (Family Law Reform Act 1969 / Mental Capacity Act 2005). Capacity is assessed under the MCA two-stage test once they turn 16; under 16 competence is assessed using Gillick.

16. State the general rule on confidentiality for young people and its key exception.

    Young people are owed the same duty of confidentiality as adults. It may be breached only with consent, when required by law, or when disclosure is in the public interest / necessary to protect the child or others from serious harm — sharing the minimum necessary information.

17. What are the 'seven golden rules' principles underpinning information sharing in safeguarding?

    Data protection is not a barrier to sharing; be open and honest; seek advice if unsure; share with consent where appropriate (but a lack of consent can be overridden if there is risk); consider safety and wellbeing; share necessary, proportionate, relevant, accurate, timely and secure information; and keep a record of the decision and reasons.

18. How is 'best interests' determined for a child who cannot consent?

    By weighing the child's medical, emotional, psychological and social welfare — considering the views of the child (where ascertainable), the family, the clinical team, the benefits and burdens of treatment, and the child's quality of life. The child's welfare is the paramount consideration.

19. Who automatically has parental responsibility (PR) for a child in England and Wales?

    The mother automatically; the father if married to the mother at the time of birth or named on the birth certificate (births registered from Dec 2003); and the second female parent in certain circumstances. PR can also be acquired by court order, agreement, or local authority care order.

20. When treatment decisions conflict between parents and the clinical team, what is the legal route of resolution?

    If consensus cannot be reached through discussion, mediation and second opinion, the case is referred to the courts. The court (Family Division) decides based on the child's best interests, which is paramount and not simply the parents' wishes.

21. Distinguish withholding from withdrawing treatment, and what is the ethical principle regarding them?

    Withholding means not starting a treatment; withdrawing means stopping one already begun. Ethically and legally there is no difference between the two — a treatment that may be withheld may also be withdrawn if it is no longer in the child's best interests.

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