High Risk Groups

Child maltreatment occurs in all sectors of society and in all age groups. There are also particular groups of children and young people who by nature of their socio-economic, physical or mental health, or because of pre-existing disability make them more vulnerable to all types of maltreatment.  These groups include children and young people who are 'Looked after' are refugees (particularly if unaccompanied) and/or who have physical or intellectual disability. 


Looked after children (LAC)

Definitions vary slightly across the UK but LAC is a diverse group that includes children and young people (CAYP) in local authority homes, foster care, unaccompanied asylum seekers and those accommodated compulsorily for their own protection or those around them (e.g. under the criminal justice system).

Care leavers
Those young people who have been under the care of the local authority for a period of 13 weeks which spans their 16th birthday.

Designated professionals
This role involves professionals with special responsibilities for Looked after CAYP. It varies across the UK. as to who fulfils the nominated and designated roles with GPs and nurses in some cases providing medical advice to fostering and adoption services. Lead Paediatricians for LAC  will often provide strategic advice for commissioners and planners.


  • Numbers of LAC have steadily increased since 1985 and is now at an all time high. The majority relate to abuse and neglect but there are also an increasing number of unaccompanied asylum seekers who have been trafficked.
  • Guidance applies up to age 25 years.
  • The 2015 Intercollegiate Safeguarding document on Looked After Children describes 5 levels of training cf. the safeguarding competences listed in the current general framework (2014). What does this mean for anaesthetists? The key knowledge, skills and competences are outlined on page 13. The key skill is to know to refer high risk CAYP to the relevant safeguarding professionals and/or the LAC team locally.

In terms of training there are no radical changes for anaesthetists who need as a minimum maintain level 2 competencies by relevant annual updates. However, it will be important to understand the background to this patient group. It is likely that routine annual safeguarding training will include scenarios which include local authority children and young people.There is no requirement for leads for safeguarding to undertake specific additional training. However, it may be useful to consider including scenarios which involve a looked after child/young person or a care leaver so that these issues are raised with anaesthetists, re-enforcing the need to be aware of increased risk.


Refugee and unaccompanied children and young people


Children and young people with disability

  • Children and young people who are less physically or intellectually able are more prone to all types of abuse. Further information about this can be found via the Disability Matters website.
  • The Council for Disabled Children in England published new Safeguarding findings and guidance in 2016 – a suite of free educational resources which cover all aspects of the care of disabled children, young people and young adults and designed for the UK workforce.
  • Specific NSPCC website resources which include case studies, statistics and research are also available via the following link.