It is recommended that where children require intimate care, good practice guidelines are drawn up within the establishment and disseminated to all staff.

Parents / carers and the child should also be involved in discussions and decisions in relation to how intimate care will be managed.

These guidelines should be viewed as expectations upon staff, which are designed to protect both children and staff alike. In situations where a member of staff potentially breaches these expectations, other staff should be able to question this in a constructive manner.

Staff should be advised that if they are not comfortable with any aspect of the agreed guidelines, they should seek advice within the establishment. For example, if they do not wish to conduct intimate care on a 1:1 basis, this should be discussed, and alternative arrangements considered. For example, it may be possible to have a second member of staff in an adjoining room or nearby so that they are close to hand but do not compromise the child’s sense of privacy.

Protocol

An Intimate Care Plan is to be completed by the class teacher for all KS1 and KS2 children who require support with intimate care – see appendix 1 & 2.
For EYFS children an Intimate Care Plan will be created for children who need regular changing.
For children who have infrequent accidents a plan will not be created unless accidents become more frequent and continue.
Teachers must notify the SENDCo of all children requiring intimate care, including a scanned copy of the signed Intimate Care Plan, so that they can be added to the Intimate Care Register.
All intimate care will be recorded on the changing records Appendix 3, the location of these records will be listed on the Intimate Care Register.
All intimate care for KS1 & KS2 children will take place in the care suite (except where an accident has happened and it is not practical/appropriate to move the child).
In EYFS, intimate care will take place in the changing room or toilet cubicle. Where a child needs a full change of nappy or clothes this should take place in the changing room. If a child needs assistance with, for example, wiping after using the toilet, this may occur in the toilets.
A record will be made and reported via CPOMS regarding any of the below (this list in not exhaustive):

The child seems sore or unusually tender in the genital area.
The child appears to be sexually aroused by your actions.
The child has a very emotional reaction without apparent cause (sudden crying or shouting).
If you accidentally hurt the child or the child misunderstands or misinterprets something, record this information and inform a member of SLT. If necessary seek first aid assistance. Parents are to be informed.

Guidelines for good practice

1.0 Treat every child with dignity and respect and ensure privacy appropriate to the child’s age and the situation.

Privacy is an important issue. Much intimate care is carried out by one staff member alone with one child. Leeds LSCB believes this practice should be actively supported unless the task requires two people. Having people working alone does increase the opportunity for possible abuse. However, this is balanced by the loss of privacy and lack of trust implied if two people have to be present – quite apart from the practical difficulties. It should also be noted that the presence of two people does not guarantee the safety of the child or young person - organised abuse by several perpetrators can, and does, take place. Therefore, staff should be supported in carrying out the intimate care of children alone unless the task requires the presence of two people. Where possible, the member of staff carrying out intimate care should be someone chosen by the child or young person. For older children (eight years and above) it is preferable if the member of staff is the same gender as the young person. However, this is not always possible in practice. Agencies should consider the implications of using a single named member of staff for intimate care or a rota system in terms of risks of abuse.

2.0 Involve the child as far as possible in his or her own intimate care.

Try to avoid doing things for a child that s/he can do alone and if a child is able to help ensure that s/he is given the chance to do so. This is as important for tasks such as removing underclothes as it is for washing the private parts of a child’s body. Support children in doing all that they can themselves. If a child is fully dependent on you, talk with her or him about what you are doing and give choices where possible.

3.0 Be responsive to a child’s reactions.

It is appropriate to “check” your practice by asking the child – particularly a child you have not previously cared for – “Is it OK to do it this way?”; “Can you wash there?”; “How does mummy do that?”. If a child expresses dislike of a certain person carrying out her or his intimate care, try and find out why. Conversely, if a child has a “grudge” against you or dislikes you for some reason, ensure your line manager is aware of this.

4.0 Make sure practice in intimate care is as “care planned” as possible.

Line managers have a responsibility for ensuring their staff have a “care planned” approach. This means that there is a planned approach to intimate care across the agency, but which is also flexible enough to be planned to meet the specific needs (and wishes as appropriate) of individuals. It is important that approaches to intimate care are not markedly different between individuals, but also reflect individual needs and wishes.

5.0 Never do something unless you know how to do it.

If you are not sure how to do something, ask. If you need to be shown more than once, ask again.

6.0 If you are concerned that during the intimate care of a child:

• You accidentally hurt the child

• The child seems sore or unusually tender in the genital area

• The child appears to be sexually aroused by your actions

• The child misunderstands or misinterprets something

• The child has a very emotional reaction without apparent cause (sudden crying or shouting)

Record any such incident as soon as possible as ‘a cause for concern’ on CPOMS. This is for two reasons: first, because some of these could be cause for concern, and secondly, because the child or another adult might possibly misconstrue something you have done.

Additionally, if you are a member of staff who has noticed that a child’s demeanour has changed directly following intimate care, e.g. sudden distress or withdrawal, this should be recorded on CPOMS and discussed with your designated person for child protection.

7.0 Encourage the child to have a positive image of her or his own body.

Confident, assertive children who feel their body belongs to them are less vulnerable to abuse. As well as the basics like privacy, the approach you take to a child’s intimate care can convey lots of messages about what her or his body is “worth”. Your attitude to the child’s intimate care is important. As far as appropriate and keeping in mind the child’s age, routine care of a child should be enjoyable, relaxed and fun.

Intimate care is to some extent individually defined, and varies according to personal experience, cultural expectations and gender. Leeds LSCB recognise that children who experience intimate care may be more vulnerable to abuse:-

• Children with additional needs are sometimes taught to do as they are told to a greater degree than other children. This can continue into later years. Children who are dependent or over-protected may have fewer opportunities to take decisions for themselves and may have limited choices. The child may come to believe they are passive and powerless.

• Increased numbers of adult carers may increase the vulnerability of the child, either by increasing the possibility of a carer harming them, or by adding to their sense of lack of attachment to a trusted adult.

• Physical dependency in basic core needs, for example toileting, bathing, dressing, may increase the accessibility and opportunity for some carers to exploit being alone with and justify touching the child inappropriately.

• Repeated “invasion” of body space for physical or medical care may result in the child feeling ownership of their bodies has been taken from them.

• Children with additional needs can be isolated from knowledge and information about alternative sources of care and residence. This means, for example, that a child who is physically dependent on daily care may be more reluctant to disclose abuse, since they fear the loss of these needs being met. Their fear may also include who might replace their abusive carer.

Appendix 1: Intimate Care Plan (with example comments)

Name
Date
Date of Birth
Assessor
Relevant Background Information
Setting of care to be given	Hygiene Suite Toilet
Consent given
Identified need – specific individual requirement e.g. cream applied
Communication	Use of symbols? Signs? Verbal prompts? Object of reference etc?
Self care skills	Fully dependent/aided Supported/independent
Mobility	Independent/steady/grab rail Unsteady/wheelchair user
Fine motor skills	Can do – tapes/zips/buttons/taps/towels/adjust own clothing
Moving and handling Assessment Step by step guide to what happens	Tracking/mobile hoist or S, M, L or own sling in chair transfer using mobile hoist. Walking frame/support to table/physical turntable
Facilities	Environment to provide dignity safety Handwashing
Equipment	Gloves, wipes, aprons, waste bins foot operated Rise and fall bed. Changing mat/moving and handling equipment. Continence produce/nappy size/paper towels/liquid soap/spray cleaner
The disposal of soiled articles of clothing as agreed with parents/carers	Solid waste into the toilet. Clothes sent home in tied plastic bag. Indicate in bag or in diary contents of bag.
Frequency of procedure required	On arrival/mid morning/lunchtime/mid afternoon/ whenever necessary/on request
Review date	Whenever needs change

Advice Only

If your child needs cleaning, plain water will be used with a few drops of a sensitive baby wash liquid cleanser added to the water.

Please advise if this is not suitable for your child and send in an alternative.

I/we have read, understood and agree to the plan for Intimate Care

Signed ………………………………………………………………

Name ………………………………………………………………..

Relationship to child ………………………………………………

Date ……………………………

Appendix 2: Intimate Care Plan

Name
Date
Date of Birth
Assessor
Relevant Background Information
Setting of care to be given
Consent given
Identified need – specific individual requirement e.g. cream applied
Communication
Self care skills
Mobility
Fine motor skills
Moving and handling Assessment Step by step guide to what happens
Facilities
Equipment
The disposal of soiled articles of clothing as agreed with parents/carers
Frequency of procedure required
Review date