Intimate care of children | NSPCC Learning

Introduction

Safeguarding and child protection considerations

Intimate care is an essential part of making sure a child's basic needs are met. Organisations providing intimate care should ensure it is carried out in a safe, respectful and child-centred way.

What is intimate care?

Intimate care is a term used to describe activities involved in meeting the personal care needs of a child. It includes providing care which requires direct or indirect contact with, or exposure of, private parts of the body, such as:

changing nappies, underwear, continence pads or sanitary wear
helping a child use the toilet
bathing, showering or washing
providing some forms of specialist medical care (such as inserting suppositories or pessaries).

It can also involve other forms of physical care, sometimes referred to as ‘personal care’, including:

feeding
changing outer layers of clothing
applying or administering external or oral medication
hair care
washing non-intimate body parts
prompting children to go to the toilet.

Who needs intimate care?

Children of any age might need intimate care either occasionally or on a regular basis. The type and level of care a child needs depends on a number of factors, including: age; stage of development; and whether the child has any disabilities, special educational or additional needs, or medical conditions.

Why is safeguarding an important part of intimate care?

Providing intimate care involves working with children when they are particularly vulnerable. This can provide heightened opportunities for abuse. It’s important that settings put in place measures to prevent abuse, maintain children’s dignity and create an environment in which all children feel safe and comfortable. As part of this there should be procedures in place for reporting concerns about the conduct of another member of staff.

Intimate care also provides opportunities for focused, positive, one-to-one interaction with a child. Whilst providing intimate care a child might tell you about something which has happened to them, or you may identify potential safeguarding concerns. If a child tells you something concerning, you notice changes in a child’s behaviour, or you spot unexplained bruises or marks you should report your concerns to your nominated child protection lead immediately.

Guidance

National guidance across the UK highlights the responsibility of those in the early years sector to safeguard children from all forms of abuse and neglect.

Guidance for early years settings

In England, the Early Years Foundation Stage (EYFS) sets out the statutory framework of standards that school and childcare providers must meet for the learning, development and care of children from birth to 5, including safeguarding and welfare requirements.¹

In Northern Ireland, the Department of Health provides National minimum standards for childminding and day care for children under age 12 (PDF), including around safeguarding, child protection, health and wellbeing.² The Department has also produced intimate care policy and guidelines which are relevant for children of all ages.³

In Scotland, the Scottish Government has provided operating guidance setting out how early years settings can meet the National standard for early learning and childcare, including around health and wellbeing.⁴

In Wales, the National minimum standards for regulated childcare sets out the standard of care childcare and play work providers must meet to look after children under 12, including safeguarding, nurture and wellbeing.⁵

Guidance for children who have special educational needs, additional needs or disabilities

All four nations also provide guidance on supporting and safeguarding children with special educational needs, additional needs or disabilities.

Intimate care policies and plans

Intimate care policies

Organisations responsible for the intimate care of children should have a policy in place which sets out how they will meet children’s needs whilst protecting their safety, dignity and privacy. All staff should be familiar with and feel confident in following this policy. It should also be shared with parents and carers.

The policy should make it clear that children:

have the right to assistance that respects their privacy and dignity
have the right to feel safe and comfortable with the adults providing their care
should be encouraged to engage in the care procedure, know what’s happening and give permission at each stage
have their feelings about the care they receive recognised and respected
should be encouraged and supported to work towards becoming independent where possible.

Intimate care plans

Early years settings

It’s good practice for early years settings to work with parents or carers to develop an individual plan for the care of their baby or child.

This should include information about the child’s:

likes and dislikes
routines
support needs.

Information should be updated, in collaboration with parents or carers, on a regular basis.

Children who have special educational needs, additional needs, medical conditions or disabilities

If a child has specific intimate care needs you should work with them, their parents or carers and their health practitioner to agree how best to provide this support safely. This information should be recorded in their care plan.

The plan should set out:

what intimate care is needed
where it will be carried out
who will provide it.

This plan should be reviewed and updated on a regular basis.

> Read more about continence issues

Seeking permission for additional care

You should not carry out any ‘extra’ care or provide care in a different way without written agreement from parents or carers. If an unanticipated, urgent need to provide intimate care arises, you should report this to a senior member of staff and the child’s parents or carers as soon as possible. You should record the reason this care was needed and the type of care provided.

Staff and volunteers

Who should provide intimate care?

It’s important to identify in advance who in your organisation should be providing intimate care to children.

Choosing the right people

Anyone providing intimate care to children should have undergone the necessary training and safer recruitment checks.

People providing children with unsupervised intimate care in England, Northern Ireland and Wales need to have undergone an “enhanced with barred list” check. In Scotland, people providing personal services to a child need to undergo a Protecting Vulnerable Groups (PVG) check.

Carers should be trained appropriately, be comfortable with providing intimate care and feel confident about reporting any concerns they identify.

> Read more about safer recruitment

Consistency

Whenever possible, children should have a consistent adult who is responsible for their intimate care. This helps give children continuity and protects their dignity.

In early years settings every child should have a specific person, referred to in England as their ‘key person’, who is responsible for their care. Children with a care plan should have a named person, or people, who will provide their intimate care set out in their plan.

It's best practice for every child who needs support with intimate care to have a second named person who can provide cover for absences.

One-to-one care

Where possible care should be provided by one person to protect the child’s dignity. However, in some cases, two adults may need to be present, for example if they need to operate equipment such as a hoist.

You should let another member of staff know what you are doing before providing intimate care by yourself, and keep a record of the care provided.

> Find out more about best practice for lone working

Respect and boundaries

It is good practice to consider each care routine from the child’s point of view. Good experiences of intimate care can help children understand how adults should behave towards them. It can help children know that their body belongs to them and that their needs and wishes will be respected.

When providing intimate care, you should talk children through what you are going to do and - where possible - seek consent, encourage independence and offer choice. You should also talk to children about who they can go to if they are ever worried or uncomfortable about anything.

You can use our resources to reinforce these messages regularly in a child-friendly manner.

> Have a look at our free PANTS resources

> Use our Love Life resources to start conversations about privacy and boundaries