Children in a care setting need contact with familiar, consistent carers to ensure they can grow confidently and feel self-assured. At times children need to be cuddled, held and offered physical reassurance. Intimate care routines throughout the day are essential to children's basic needs. Yet NDNA members are increasingly expressing their concerns about the management of child/carer physical contact.
Issues
Potential issues providers face:
- Fear of risk of allegations against a member of staff
- Balancing the essential emotional needs of the child with messages received about touch and physical contact
- Using restraint with children when they are in danger, or risk putting others in danger
- Physically handling children with a disability or additional needs.
Good practice
The basic needs for care and physical contact are essential for children and meeting them is a fundamental element of good practice. Settings need to consider the result of their actions on the children and should regularly review and consider their practice to promote inclusion.
Good practice guidelines
It is essential to develop a good understanding of safeguarding children and promote children's welfare within the staff team. Key guidelines include:
- Ensure all staff have had all relevant checks completed before allowing them to be left alone with children (e.g. CRB clearances) and that you have robust internal procedures, such as reference checking and monitoring and regular updating of CRB checks.
- Make sure management and supervisory staff actively encourage, guide and support staff and share expertise and knowledge. Encourage staff with specific expertise and skills to coach and lead on practice with the team and offer support as appropriate. This may include staff who have specific roles, such as the SENCO.
- Ensure staff in all settings receive behaviour management training, which includes handling and safe essential restraint techniques for instances when children are a danger to themselves or others.
- Make sure management observes and reflects on practice to ensure that delivery is of a high quality and reflects the values and policies throughout the setting, including areas of safeguarding and promoting children's welfare.
- Ensure that the staff team has a genuine understanding of the value of attachment and emotional security.
- Promote real relationships with consistent carers and a key person, and form close links with family members to ensure consistency.
- Train staff to enable them to make use of a range of strategies to build children's self esteem and confidence (including physical contact).
- Ensure the staff team receives relevant training in caring for children with additional needs, including those with disabilities.
- Take responsible risks by evaluating the practice and training of staff.
- Ensure an overall consideration for children's rights and well-being is positively engaged by all staff.
In summary, managers and practitioners need to be willing to contemplate and challenge ideas and opinions. It is essential that they are prepared to analyse whether they are in line with the principles and ethos of their individual setting and review these reflectively to improve quality.
This is an edited extract from Briefing Paper no 3, 'Managing carer/child physical contact'. It has been developed by the National Day Nurseries Association with advice and input from childcare professionals, daycare settings, Scope and author Jennie Lindon. Non-members of the NDNA wishing to receive a free electronic copy of the full document should e-mail their details in full to info@ndna.org.uk
CASE STUDY: Jake
Jake is four years old. Other children his age only request contact when they need assistance, are upset or unwell. However, Jake has a disability that causes him to have high anxiety that can only be resolved through prolonged close contact with a trusted adult.
Jake's key person works with Jake and his parents to meet his individual needs. She has had a meeting with parents to gain information and share ideas to support Jake. This has been cascaded to other members of the staff team to ensure that a consistent approach is adopted and he receives the full amount of contact he needs. It was agreed with the parents that a contact sheet was completed to ensure that both staff and parents could monitor Jake; this details the types of contact most appropriate for him. They also report back on the amounts and types of contact he is being given and the outcomes for him - e.g. Jake was very upset this morning when he lost the toy he usually carries from home to nursery. His key person walked around with him, holding his hand and reassuring him. His toy was not found quickly and Jake became more distressed. His key person moved up to level two contact and rocked and sang to Jake until he calmed down and had a nap.
Frequently asked questions
Do two members of staff need to be present for intimate care routines such as changing nappies and toileting?
No. Intimate care routines, including changing times, are personal and provide a real opportunity for special one-to-one time with staff. It is a matter for each setting to assess. However, it is important to value the needs, feelings and privacy of the child. Part of assessing risks includes ensuring that staff caring for children on a one-to-one basis are always fully cleared with the CRB. All staff in the setting should be constantly vigilant about children's demeanours, such as when they seem to dislike or be worried about a particular routine or person, and should investigate all possible causes as part of keeping children safe.
Jennie Lindon comments, 'The witnessing approach to personal care is neither practical, nor does it genuinely ensure children's safety and emotional well-being. Babies, toddlers and very young children need a considerable amount of intimate personal care. If two people always had to be present at such times, the remaining group would be left without enough caring adults. Some children with disabilities will continue to need help with toileting or changing their clothes. Older children may increasingly feel that they want privacy, led by the discreet help of one adult.'
Further information:
A number of organisations offer advice, information and support including:
- Your local authority
- Scope - a disability organisation in England and Wales. Its aim is for disabled people to achieve equality. It can provide information, support, training and resources for early years workers that promote inclusion for all children. Visit www.scope.org.uk for further details.
- NDNA Legal Helpline - visit www.ndna.org.uk for further details.
- Kidscape is committed to keeping children safe from abuse. Kidscape provides resources necessary to keep children safe from harm and has good materials on personal safety skills as well as practical child protection issues. Visit www.kidscape.org.uk for information.
- NSPCC aims to see a society where all children are loved, valued and able to fulfil their potential. They provide detailed resources, information and training. Visit www.nspcc.org.uk and click on 'a childcare professional' for information.
