Welcome to 'Why language matters', a brand-new series exploring the language used in safeguarding and child protection, how this affects the actions and perspectives of those who work with children, and what we can all do to place the child front-and-centre in the words we use.
In this first article we’re looking at how a shift from health professionals recording children’s missed health care appointments as “did not attend” (DNA) to “was not brought” (WNB) can have a significant impact on the wellbeing of children.
What’s the difference?
The phrase “did not attend” implies that a child is responsible for attending an appointment and chose not to go. But young children can only attend an appointment if their caregiver takes them; they can’t travel independently and may not even know about the appointment.
A shift to recording a missed appointment as “was not brought” reminds practitioners that it is the adult who is responsible for ensuring that a child receives appropriate medical care, not the child.1 It prompts professionals to consider the causes and consequences of the missed appointment.
With this small three-word change, it opens opportunities for discussions and plans around support, safeguarding, and welfare for a child who just needs someone to recognise that they need help.
Why hasn’t the child’s parent or carer brought them in?
Poor communication with or from services, language barriers, and errors such as incorrect contact details could mean that reminders and other important messages from health services aren’t being received.
Alternatively, the caregivers may be finding it hard to access services. A caregiver’s work might mean that they aren’t able to attend appointments during certain times of the day; or a service might be too far away, or not easily accessible via public transport.
Missed appointments may also be a sign that carers are struggling to cope with the demands of caring for their child and need extra help. Or it could be part of a wider pattern of disengaging with or avoiding services.
Why does it matter?
Every appointment is made for a reason. A child’s health may need monitoring, their medication may need to be reviewed, a prescription renewed, or there may be important test results to collect. Without regular attention, a child’s medical issues may become worse.2 Even common conditions, such as asthma or diabetes, can lead to serious illness or death if left untreated.3 Not bringing a child to their appointment can also be a sign that the parent or carer is ignoring their child’s health problem.
Denying a child proper treatment is medical neglect, and a safeguarding concern. It’s vital to follow up on missed appointments to make sure that any health conditions are being properly treated.
If children aren’t being brought to appointments, they aren’t just missing out on important health care, they’re also not being seen by professionals who might be able to spot child protection concerns. While missed appointments are a fact of life for many busy families, a pattern of missed appointments can be an early warning sign that a child might need help. Services that are accessible by all, such as GPs and dentists, can be one of the first places for front line workers to step in and act to support a child, and be a starting point for access to early help services or a child protection intervention.
What should I do?
Some barriers to attending health appointments can be resolved by talking to the caregiver and identifying ways to support them to access services. But if appointments are repeatedly missed, professionals should consider who else they need to share the information with to make sure the child is protected, in line with their organisation’s child protection procedures.
ReferencesSolent NHS Trust (2019) Trust was not brought and did not attend policy for children and adults (PDF). Southampton: Solent NHS Trust
City and Hackney Safeguarding Children Partnership (2021) Serious case review: Child B City and Hackney: City and Hackney Safeguarding Children Partnership
Nottingham City Safeguarding Children Board (2017) Bite-size briefing: medical neglect (PDF) Nottingham: Nottingham City Safeguarding Board