PG31. Medical Advice and Safeguarding

The risks associated with children not receiving immunisations are considerable and encompass both individual and public health concerns. Unimmunised children are significantly more vulnerable to contracting vaccine-preventable diseases such as measles, mumps, rubella, polio, and pertussis (whooping cough). These conditions can result in severe complications, including pneumonia, encephalitis, permanent disability, or death.

In addition, the lack of immunisation undermines “herd” immunity, thereby increasing the risk of outbreaks within the wider community. This poses particular risk to individuals who cannot be vaccinated due to medical reasons, as their protection relies on high vaccination coverage among the population. Outbreaks of preventable diseases also place additional strain on healthcare systems and can disrupt educational activities. For these reasons, immunisation remains a critical strategy for safeguarding both individual and community health.

There is no legal requirement for children (or adults) to be immunised. Some parents do not believe that their children should be immunised either because they believe that there is an inherent risk arising from the vaccine or because of their wider beliefs. However, parents may fail to ensure that their children are fully immunised because of their lifestyle or failure to understand the importance of their children being immunised. In the latter circumstances, this may constitute a safeguarding issue that should be assessed (see Referral and Assessment, Making and Receiving a Referral).

The failure to follow medical advice with children can have serious consequences for their health and wellbeing. Ignoring or delaying recommended treatments, check-ups, or interventions may lead to the worsening of preventable or manageable conditions, such as infections, asthma, diabetes, or allergies. In some cases, untreated illnesses can progress to more severe complications, resulting in hospitalisation, long-term health issues or death.

The failure to adhere to prescribed medication regimens or specialist referrals can hinder recovery and increase the risk of relapse or chronic illness. Children are particularly vulnerable because their bodies and immune systems are still developing, making timely and appropriate medical care essential for healthy growth and development. Ultimately, consistent engagement with medical guidance is crucial to ensure optimal health and to prevent avoidable harm.

Parents may choose to ignore or decline to follow medical advice because of their beliefs. They may not fully understand the consequences of failing to follow the advice provided, be unable to comply with the advice because of their lifestyle or wilfully ignore the advice provided. In these circumstances, it is important to understand why they are not complying with the advice provided and to consider whether or not the failure to follow the advice provided constitutes a safeguarding issue (see Referral and Assessment, Making and Receiving a Referral).

In the event of a child death, emergency services should be notified immediately. Any person that is aware of the death of a child must cooperate with medical examination and prompt registration of the death without delay. Any effort to obscure, misrepresent, or discourage the reporting of facts related to a child's death may result in criminal prosecution. Adherence to safeguarding requirements and timely, transparent reporting is essential to safeguard and protect the welfare of children.

It is a criminal offence under UK law to assist, facilitate, or conceal the circumstances surrounding the death of a child. Any individual who deliberately withholds information about a child's death, fails to promptly notify the appropriate authorities, or provides false or misleading information may face legal prosecution. This includes any actions that delay statutory notification, impede mandatory investigations, or otherwise obstruct due process.

See also:

• Children taken Aboard for Treatment – PG 51;
• Fabricated or Induced Illness / Perplexing Presentations (Non-standard treatment protocol (Alternative therapies, treatments from abroad / medication purchased on the web) – in preparation

The risks associated with women not receiving medical supervision during pregnancy and birth are considerable. Without regular antenatal care, conditions such as pre-eclampsia, gestational diabetes, infections, or growth restrictions may go undetected, potentially leading to complications for both mother and baby. Early identification and management of these conditions are crucial for safeguarding maternal and neonatal health.

Pregnant women are not obliged to inform any health services about their pregnancies, as antenatal care is offered and not compulsory. For some women, this is a positive choice. This is different from a concealed pregnancy where a woman, often vulnerable and experiencing a crisis during pregnancy, is concealing her pregnancy from everyone – including friends, family, colleagues etc. In some cases, a woman may be in denial that she is pregnant, or she may be totally unaware of the pregnancy. A failure to seek and act upon medical supervision and advice during pregnancy may be indicative of the likelihood that the woman will not be able to provide adequate parenting to their baby and consideration given to the possibility of providing additional support during the pregnancy and ensuring that appropriate arrangements have been made for the care of the child after birth (see Pre-birth Referral and Assessment).

Unassisted childbirth (also known as free birthing), involves giving birth without the presence or direct support of healthcare professionals, such as doctors or midwives. Women may elect this approach for reasons relating to personal values, past experiences, or a preference for autonomy during the birth process. However, free birthing carries certain risks and is not suitable for all pregnancies. 

The risks of Unassisted Birth: Unassisted birth may be perceived to offer autonomy and comfort, but it also carries significant risks:

• The absence of trained medical professionals means that complications such as excessive bleeding, prolonged labour, or foetal distress may not be promptly identified or managed. This can increase the likelihood of adverse outcomes for both the mother and the baby;
• Unexpected emergencies - such as shoulder dystocia, cord prolapse, or the need for neonatal resuscitation - require immediate medical intervention, which is not readily available in a free birthing setting. Delays in accessing emergency care can have serious or even life-threatening consequences. Therefore, it is crucial for those considering unassisted birth to have a well-prepared plan for rapid transfer to medical facilities if complications arise;
• During labour and delivery, the absence of skilled medical professionals increases the likelihood that complications - such as haemorrhage, obstructed labour, or foetal distress - will not be recognised or treated promptly. In emergencies, delays in accessing appropriate care can result in severe injury or even death for either the mother or the newborn. Therefore, ongoing medical supervision is vital throughout pregnancy and birth to monitor health, provide timely interventions, and reduce the risk of adverse outcomes.

It is not illegal to give birth without assistance. A woman does not have to accept any medical or midwifery care or treatment during childbirth. However, it is illegal for anyone other than a registered midwife or doctor to perform midwifery functions (e.g. an episiotomy). In some circumstances, the pregnant woman’s plan to have an unassisted birth may be considered to be unsafe and constitute a safeguarding concern.

See Pre-birth Referral and Assessment.

Should the newborn baby require medical attention because they are unwell when they are born, and the mother / parent(s) do not seek immediate medical assistance, then this would be a safeguarding issue (see Child Protection Enquiries - Section 47 Children Act 1989).

Either NHS England, the local Integrated Care Board or the Local Authority must be notified of an unassisted birth within 36 hours. Alternatively, this may be done through a Child Health Information Service. A birth must also be registered within 42 days with the relevant Registrar of Births and Deaths for the area in which the child was born. Both the notification and the registration are legal requirements. Should these not be complied with, that would provide a basis for concern (see Child Protection Enquiries - Section 47 Children Act 1989).