To guide child protection workers in:
This entry is to be read in conjunction with:
Infants and babies (0-2 years of age) are extremely vulnerable to the effects of child abuse and neglect due to being totally dependent on others to meet their care needs, having restricted language and mobility, physical fragility and being socially 'invisible' due to having little contact with support services.
High risk infant refers to infants who are considered to be at risk of significant harm or death due to the presence of risk factors, such as:
Child protection workers must identify the risk factors which contribute to an infant being at high risk of abuse and neglect. The child protection worker's role is to undertake assessments to determine whether these risk factors are present in the family and if so, what impact they might have on the safety of the infant or unborn child.
Risk factors to be considered are grouped into the following three areas and are explored further in related resource, Determining whether an infant is at risk of significant harm:
When assessing risk factors, child protection workers should also be familiar with the Child Development and Trauma Guide, which provides information on infant milestones and development and possible indicators of trauma.
1. Bruising or injury to a non-mobile infant (physical abuse)
Bruising is not common in infants because they are non-mobile. As such, any bruising or symptom of injury located on a non-mobile infant must be further assessed by a paediatrician, preferably with child protection experience.
2. Abusive head trauma (AHT) (shaken baby) (physical abuse)
Abusive head trauma (AHT) refers to an injury to the skull or the intracranial contents (e.g. brain) due to inflicted blunt impact (infant being hit in the head or having their head hit against something) and/or shaking (whiplash). This type of injury can result in the most severe consequences for an infant's future wellbeing and is the leading cause of death amongst infants who have been abused.
Infants aged less than six months are most vulnerable to abusive head trauma from shaking because of the combination of a heavy head, weak neck muscles, soft and rapidly growing brain, thin skull wall and lack of control of the head and neck.
The greatest risk period for infants is between six weeks and four months of age when continuous crying can be particularly stressful for parents. If a child protection worker suspects that an infant has suffered AHT, urgent medical attention must be sought for the infant via an ambulance.
Severe symptoms of AHT:
Non-specific signs and symptoms of AHT:
3. Non organic failure to thrive (FTT) (neglect)
FTT is "significantly prolonged cessation of appropriate weight gain compared with recognised norms for age and gender…" (Block & Krebs 2005, Failure to Thrive as a Manifestation of Child Neglect).
Organic FTT occurs when there is an underlying medical cause for the condition. Non-Organic FTT is caused by environmental factors and/or the actions or inactions of the parent or caregiver. The child protection worker's role is to ascertain from medical professionals if the FTT has resulted from non-organic causes and if so, to facilitate services and supports to assist the infants parents to better care for them. Symptoms of FTT include:
FTT is often diagnosed by child and/or community nurses in conjunction with other health practitioners, who will conduct a medical assessment to exclude underlying medical conditions.
4. Co-sleeping and the risk of accidental suffocation (neglect)
Co-sleeping is the practice of a parent (or any other person) being asleep on the same sleep surface as an infant. The concern is that the parent or bedding items will accidentally suffocate the infant or that a mother may fall asleep while breastfeeding the infant, smothering the infant with the breast or body.
Where family domestic violence (FDV) is occurring, the adult victim may co-sleep with their infant as a protective measure, to protect themselves and/or the infant from the perpetrator. Where FDV and co-sleeping are occurring, the child protection worker should interview the adult victim alone in order to establish whether co-sleeping is being used as a protective measure, and use the common risk assessment tool in order to determine the level of risk to the adult victim and the infant whilst they remain in contact with the perpetrator.
Common risk assessment tool
There is evidence that co-sleeping is associated with a greater incidence of sudden unexpected deaths in infancy (SUDI). The risks associated with co-sleeping are increased when:
Parental risk factors:
Infant risk factors:
Environment risk factors:
Further information on safe sleeping is available through the e-learning packages Safe Infant Sleeping and Safe Sleeping E-Learning Package
 Investigation into ways that State Government departments can prevent or reduce sleep-related infant deaths, Ombudsman Western Australia, 2012.
Where referrals are received from medical professionals and hospital social workers regarding safety concerns for unborn infants or infants, the referrer must be consulted and the concerns thoroughly assessed.
Determining whether an infant is at risk of significant harm (related resources) is used to assist child protection workers to make a thorough and holistic assessment of the initial concerns regarding unborn infants and infants.
Where concerns about an infant are assessed as requiring no further action, a rationale for this decision must be documented in an Assist interaction or Initial Inquiry assessment and approved by the team leader. Feedback should be provided to the referrer.
As part of pre-birth planning and/or the safety and wellbeing assessment (SWA) of a newborn infant, child protection workers refer to, and work in accordance with the Bilateral schedule, Interagency collaborative processes when an unborn or newborn baby is identified as at risk of abuse and/or neglect, between: The Department for child protection and family support and WA health (related resources).
When undertaking pre-birth planning and SWAs with an unborn infant or infant assessed to be at high risk, Determining whether an infant is at risk of significant harm (Related resource) is used to undertake a psychosocial assessment of the parent's and family's circumstances. An assessment of any relevant psychosocial risk factors must consider:
Assessment should not solely rely on telephone contact or parents self-reporting their progress. Information must be gathered from multiple sources (parents during home visits, other professionals and the safety network.)
When there is suspicion that an infant has been harmed, child protection workers must conduct a visual check for injuries and bruising by engaging and respectfully inviting the parents to undress the infant, including removal of the nappy. If the parents refuse, the child protection worker must move to a place of safety and consult the team leader immediately.
Infants with bruising, injuries, burns and/or other symptoms of injury such as vomiting, seizures, rigid appearance, a lack of response to stimuli, alterations in breathing/temperature, poor feeding, irritability or lethargy must be medically assessed immediately, via ambulance if necessary.
Any infant found to have any injury or symptoms of injury must be medically assessed on the same day by a paediatrician, preferably with child protection experience. If a decision is made not to take the infant for a medical assessment, this decision must be made in consultation with a team leader and the rationale clearly documented in case notes.
Where parents do not consent to an infant with symptoms of injury being medically assessed, child protection workers move to a place of safety and consult with their team leader immediately. The child protection worker must consider whether the infant is at immediate and substantial risk. Section 37 of the Children and Community Services Act (the Act) may be considered, in order to place the infant into provisional protection and care without warrant and allow for a medical assessment to be carried out. Any decision to enact s.37 of the Act is made by the district director.
 Psychosocial assessment: A holistic assessment which builds a comprehensive and broad understanding of a family's life, including mental health, drug and alcohol use, domestic violence, housing and other risk factors. Information is gathered from the family and other stakeholders.
Where an infant presents with bruises or symptoms of injury, the child protection worker must attend the medical service in person with the infant (and where possible, a parent or relative of the infant), or telephone the service and provide the paediatrician (or the hospital social worker), with details of the concerns.
In the metropolitan area, infants are referred to the Perth Children's Hospital (PCH) Child Protection Unit (CPU). The child protection worker should phone ahead and make an appointment, then accompany the infant there.
During business hours, PCH CPU services can be requested directed through the CPU Acute Service (6456 0089).
For after-hours, the duty social worker can be contacted through the PCH Switchboard on 6456 2222.
In regional areas infants are referred to their local medical service, where the assessing medical practitioner should consult their on call paediatrician as per their service's procedures.
The child protection worker must seek clarification from the paediatrician as to whether the injury has been deemed to be accidental or non-accidental (NAI – non accidental injury, also can be referred to as an inflicted injury).
Where an infant has been assessed by a medical practitioner who is not a paediatrician, for example a nurse, general practitioner or junior medical officer, the child protection worker must ask the medical practitioner whether they have consulted with a paediatrician linked with their service or 'on call' in their region. If this has not occurred, the medical practitioner and/or child protection worker must consult with PCH CPU on the same day.
PCH CPU is available to provide medical advice to child protection workers and/or other medical practitioners when required (6456 0089 – PCH switchboard).
A medical assessment by a paediatrician (preferably with child protection experience) is expected to:
Where an infant has been hospitalised as a result of a non-accidental or suspicious injury, safety planning needs to be implemented, monitored and tested, so that any future contact between the infant and the parents and/or possible perpetrators will not pose any further risk to the infant (e.g. supervision of contact between parents and the infant). Planning must also consider the safety of siblings/other children in contact with the parents or possible perpetrators.
Where the parents do not comply with a safety plan, or the risk to the infant and their siblings is so great that a safety plan may not prevent further harm, the child protection worker must consult with their team leader regarding whether intervention action is necessary to promote the infant's safety.
Infants do not have to be present during a family and domestic violence (FDV) incident to be harmed by family violence. When an adult victim is at high risk of serious harm, the same level of risk applies to the infant.
Screening for FDV occurs in all open child protection cases via the use of the Common risk assessment tool.
Child protection workers conduct separate discussions with the adult victim and the perpetrator, as the adult victim of FDV may, in the presence of the perpetrator, feel intimidated and minimise the risk to themselves and the infant. In some instances the adult victim may take the blame for violence which has occurred and be fearful to report their partner's abuse.
Where the adult victim, the infant and their siblings have been assessed to be at risk of significant harm by the perpetrator of FDV, the child protection worker must consult with their team leader, undertake safety planning and take action to manage the risk posed by the perpetrator and increase the victim, the infant and their sibling's safety.
Communities' response should both support the adult victim of FDV and also engage with and support behaviour change of the perpetrator (Chapter 2.3 Responding to perpetrators of emotional abuse – family and domestic violence).
A multi-agency case management (MACM) meeting convened by the child protection worker is required in order to share information with other agencies, develop a comprehensive risk assessment and plan strategies to mitigate risks and work towards child and adult safety and perpetrator accountability.
Child protection workers can use powers granted under the Restraining Orders Act 1997 s.10E to apply for a Family Violence Restraining Order (FVRO) on behalf of the infant and their siblings against the perpetrator (Chapter 2.3 Responding to perpetrators of emotional abuse – family and domestic violence).
Where all attempts to support the high risk infant and their siblings to safely remain with the adult victim have been exhausted, immediate consideration must be given to whether the high risk infant and their siblings are in need of protection.
Once an infant has been assessed as being at high risk, and a safety plan is developed with the parents, the infant must be seen by the child protection worker at a minimum of once per week.
Child protection workers should consult with other staff (including the Aboriginal Practice Leader) when planning home visits and initial attempts to engage families who are Aboriginal or culturally and linguistically diverse (CaLD). Consideration is to be given to the specific cultural background of the family, factors (e.g. intergenerational trauma), which may hinder attempts to engage the family and what strategies can be taken to promote engagement with the family.
Where parents prevent the child protection worker from seeing the infant, the child protection worker must persist and attempt to see the infant, regardless of whether the infant is sleeping. If the child protection worker is unable to see the infant, on the same day they must consult with their team leader regarding the next steps to be taken.
The more elevated the risk, the more frequent the visits – where necessary, daily visits should be carried out. Additional visits can be undertaken by the child protection worker and/or other approved safety people such as BB Plus worker, the child health nurse and/or a home visiting service.
Engaging the infant
At each visit, the child protection worker and/or other safety people (e.g. BB Plus worker/child health nurse) need to engage the high risk infant by holding them, interacting with them and actively assessing their presentation and circumstances.
During home visits child protection workers should respectfully ask the parents if they (the child protection worker) can hold the infant, then engage the infant in a playful way, speak to them softly, engage in eye contact (mutual gaze) and demonstrate enjoyment in engaging the infant.
Child protection workers should explain the benefits of eye contact to parents. Engaging the infant in this way assists the child protection worker to assess the infant's presentation whilst also providing appropriate role modelling to parents.
Observe the high risk infant at each visit
Observe the environment
Child protection workers should consider who is residing at the home, whether the environment is overcrowded, unhygienic and/or dangerous, chaotic, what the sleeping arrangements are for the other occupants and whether the infant has their own uncluttered bassinet or cot.
Engaging the parents
It is important for child protection workers to use a naïve enquirer approach while taking a particular interest in the parents, their backgrounds and family of origin, current functioning, feelings towards the infant and the changes the infant has brought into their lives.
Safety goals make clear what parents need to do and for how long, in order to maximise safety and visibility in the community for the infant.
The Signs of Safety planning process must include regular meetings with the parents, professionals and the safety network, as well as rigorous safety planning which considers:
Child protection workers review safety planning weekly with the parents, their network of support people and professionals undertaking both a monitoring and supportive role.
Where the high risk infant and/or their family are Aboriginal, the Aboriginal Practice Leader must be consulted.
When working with Aboriginal families, the child protection worker must engage other staff and consult resources to plan for how best to engage the family and to deliver culturally informed and responsive practice, giving particular consideration to intergenerational trauma and Aboriginal child rearing practices.
Where the infant and/or their parents are from culturally and linguistically diverse (CALD) backgrounds, the parents may have additional needs due to having experienced trauma in their country of origin, long lengths of time in refugee camps and having few supports in Australia.
The child protection worker must gather information relevant to the family's culture via online research, from the CALD sharepoint site, and/or consultation with a CALD officer or a cultural advisor from the community (providing confidentiality is upheld).
When an unborn infant or an infant aged 12 months or younger is identified as being at risk of significant harm, the child protection worker must consult with the local Best Beginnings Plus (BB Plus)team leader and forward a referral. It is important the BB Plus worker(s) is included in Signs of Safety planning meetings and safety planning.
BB Plus home visits may be included in a visiting schedule set out as part of a robust safety plan where the infant is seen and monitored regularly by a safety network. Visits undertaken by BB Plus are in addition to those carried out by the child protection worker.
If parents do not engage with BB Plus, BB Plus will use alternative strategies and/or active efforts to engage the parents. If this is unsuccessful, the child protection worker must discuss this with the team leader and consider whether in the absence of BB Plus's involvement, there is sufficient safety for the infant. Specific consideration must be given as to whether further actions are required in order to increase the infant's safety.
Where child protection workers have been unable to locate a high risk infant due to the parents or caregivers of the infant concealing them, or the child protection worker being unable to enter a place where the infant is believed to be, an application must be made for a warrant (access), to enable the child protection worker to assess the high risk infant. See Chapter 3.3: Intervention action and s.34 of the Child and Community Services Act 2004.
Where safety concerns remain for the infant and the infant's whereabouts are unknown due to the parents moving, being transient or avoiding contact with the child protection district office, all reasonable efforts must be taken to locate the infant. Child protection workers are expected to refer to Chapter 2.2: Case allocations, management, transfer, requests for co-working or services, shared case management and case closure and undertake strategies to locate the family, including:
Where it is suspected that the infant may have been taken interstate, the child protection worker must alert other states and jurisdictions of the concerns via the interstate liaison officer. Include other family member's details on alerts as appropriate.
Case closure can only occur after the parents have demonstrated engagement with services, the safety plan has been enacted, tested and monitored and is being adhered to for a timeframe agreed to by the team leader. Referring parents to a service and then closing the case is not sufficient to create safety for a high risk infant.