PG53. Children who Travel Abroad for Surgery or Other Medical Treatment
This chapter provides guidance where parents are considering taking, or have taken children abroad for medical treatment, either temporarily or permanently, where there is a possibility that this may place the child at risk of significant harm. It is intended to provide practitioners with an understanding of their responsibilities, guidance about how to assess risk of harm and manage situations where travel and medical procedures abroad may put, or have put, a child at risk of significant harm.
Children may be taken abroad for a range of medical and surgical procedures, including to unregulated providers. This may include a child being taken abroad for palliative care. Parents are usually wanting to act in the best interest of the child, but there is a risk of harm if a child experiences procedures that are advised against by their health professional. Examples include:
- Bone marrow transplant for sickle cell disease;
- Stem cell treatments (intrathecal stem cell therapy) to ‘cure’ autism or ADHD;
- Double Mastectomy for a girl to remove her breasts (top surgery);
- Female Genital Mutilation (FGM) and Fabricated or Induced Illness/Perplexing Presentations.
In some cases the treatment may be experimental, irreversible, or could be illegal. In other instances, it may not be harmful, and may be acceptable to a health professional.
A sensitive discussion is needed with the parents, and a shared understanding is needed by professionals. As far as possible the views of the child should be included so that they can participate in decision making.
Risk assessments and actions are outlined for different timelines and circumstances as follows:
- The child is about to be taken abroad for surgery or medical treatment;
- The child has been taken abroad for surgery or medical treatment;
- The child requires palliative care and may be taken or has been taken abroad.
The child’s safeguarding needs should be considered carefully for each of these circumstances. In some instances, more than one child may be affected – e.g. bone marrow transplant and the potential risk to all children involved needs to be considered.
When it is found that there is intention of the family to take their child(ren) abroad for treatment or have already taken the child(ren) for treatment, it is the responsibility of the professional that first becomes aware of this to inform the GP, and any other lead clinician involved with the child (eg sickle cell consultant). The GP will be able to identify the lead clinical service (for example if a child with sickle cell is about to be, or has been, taken abroad for bone marrow transplant, they will have on record which hospital and which team looks after the child for this and the lead consultant for the service would need to be involved in decisions relating to the appropriateness of the care abroad).
In some instances there is no lead consultant clinician in the hospital or acute service, in which case the GP will be the lead contact for the purpose of this issue. The lead clinician must assess the medical appropriateness and risks involved and advise on who else needs to be consulted. As far as possible the views of the child should be included so that they can participate in decision making.
The Designated nurse and Doctor should also be involved in the response.
All discussions relating to any risk to the child from procedures abroad should be recorded in the child’s records and shared with relevant professionals. (See Information Sharing).
Practitioners should consider discussing the following with parents / carers and recording their responses:
- Is the final destination a safe place for your child and family including from environmental risks depending upon the destination e.g. malaria?
- Have you discussed with your treating clinician as some procedures are dangerous for some children and some children may not be able to travel safely ?
- Is this procedure illegal? – e.g. FGM would lead to prosecution in the UK?
- Have you researched that the clinic is certified. Is the provider a regulated provider?
- Have you thought about after care and family support?
- Will the procedure be covered by insurance including when there are complications and may have delay for travel?
- Is there accommodation for the family?
- Do you have sufficient funds to return home if there is an emergency?
- For further information see Treatment abroad checklist (NHS).
All agencies involved in a child’s care must consider if there is potential risk of travel for procedures abroad and need to discuss this with lead health practitioners and keep the GP informed to understand the level of health risk both from the travel and from the procedure. There needs to be a clear and shared understanding of both the medical risk of travel and the medical risk of the proposed procedure (including within the proposed healthcare setting).
There may also be risk to the family from the environment including risk of infection such as malaria, or from routine childhood infections. Current advice from the Foreign and Commonwealth Office on the possible risks of travel to that country should also be taken into account.
The lead health practitioner’s risk assessment should include consideration of the necessity of surgery or other treatment, and if possible, consider the appropriateness of this treatment within the country of destination and the proposed clinic setting.
There may also be risks from the journey that need to be considered for a child and clear up to date guidance needs to be provided for the family relating to care of their child if it is felt appropriate for the child to travel, aiming to reach a shared decision with the family as to the best interest of the child.
‘Decisions about medical treatment for children are based on their best interests, arrived at through a process of shared decision-making with the child’s parents/caregivers. Paediatricians and primary care professionals should encourage parents to discuss their hopes and plans for their child. Such discussions are only likely if parents perceive the health professionals as open-minded, supportive and willing to engage in dialogue. Clinicians should empathically explore parents’ understanding of a child’s illness and prognosis, their reasons for seeking treatment abroad, and their priorities and concerns’ (Birchley, 2021, p. 1143).
For appropriate treatment, doctors in the UK should advise parents and support them where appropriate in identifying reputable institutions who would be prepared to liaise with the local clinician and also advise that the parents need to be aware of the need for legal cover if something goes wrong.
‘If the travel to the proposed destination, treatment and aftercare is of questionable benefit, but the [procedures] are legal and of low risk, it may be reasonable for parents to pursue it’. (Birchley, 2021, p.1144).
If there are significant concerns about the travel or procedure, the lead health practitioner should detail how and why the proposed surgery or treatment abroad may place the child at the risk of significant harm, including if the journey or lack of appropriate health care could put the child at particular risk, and should share this with parent / carer, and other professionals involved in the child’s care.
If the parent/carer is choosing to travel with their child against health professional’s advice, then immediate referral is needed to Children’s Social Care (see Referral and Assessment). If there is an allocated Social Worker, they should also be contacted.
Children’s social care should consider whether there is evidence of a risk of significant harm and therefore a need to convene a strategy meeting / discussion. If there is an allocated social worker, then they should discuss with their manager the need to convene a strategy meeting / discussion. It is likely that the strategy meeting / dicussion will need to seek legal advice.
Should the date / time of travel be imminent, and there is evidence of a likely risk of significant harm, then consideration should be given to a request to the police to invoke their powers of Police Protection.
Where the outcome of the risk assessment does not identify any risk to the safety and welfare of the child/ren from this instance of travel or procedure, no further action is required. This needs to be documented in the records and shared with all professionals involved with the child as appropriate.
Should a practitioner become aware that a child has already been taken abroad for treatment this should be raised with the child’s lead practitioner (via a health professional if the lead is not known).
If not already done, the lead health practitioner should carry out a risk assessment retrospectively and discuss with their safeguarding lead.
If the outcome of the risk assessment is that the parent / carer had travelled against advice and that the child was put at risk, then referral to Children’s Social Care must be made to indicate how the child was placed at risk of significant harm. If there is an allocated social worker, then they should be contacted. The decision making involved in the risk assessment must be clearly documented as well as documenting any other current harms or risks.
Children’s social care should consider whether there is evidence of a risk of significant harm and therefore a need to convene a strategy meeting / discussion. If there is an allocated social worker, then they should discuss with their manager the need to convene a strategy meeting / discussion. It is likely that the strategy meeting / dicussion will need to seek legal advice.
If there are reciprocal arrangements with the receiving country it may be deemed necessary to try to bring the child back from that country if they are still abroad. Advice may be sough from CFAB – see below.
Where the outcome of the risk assessment does not identify any risk to the safety and welfare of the child/ren from this instance of travel or procedure, no further action is required. This needs to be documented in the records and shared with all professionals involved with the child as appropriate.
Children may be taken abroad because they have exhausted the options for local care and prefer palliative care abroad or are hoping for other treatment. This requires supportive discussion and involve key members of the health team and GP.
However, if the parent / carer decision to take the child abroad for palliative care is against health professional advice, a referral should be made to children’s social care with a request for a strategy meeting / discussion including the health provider who understands the needs of the young person and be discussed in the context of any wider safeguarding concerns for the child and family. If there is an allocated social worker, then they should discuss with their manager the need to convene a strategy meeting / discussion. It is likely that the strategy meeting / dicussion will need to seek legal advice.
A decision must be made about the child protection status of the child and others in the family and any actions that are needed.
Where the outcome of the risk assessment does not identify any risk to the safety and welfare of the child/ren from this instance of travel or procedure, no further action is required. This needs to be documented in the records and shared with all professionals involved with the child as appropriate.
CFAB – Children and Families Abroad (UK Branch of International Social Services) - Website
Acknowledgements
Anita Erhabor and Ann Lorek, Designated Safeguarding Nurse and Doctor, Greenwich ICB
References
For related issues see:
Children’s Cancer and Leukemia group Why do UK families go abroad for treatment? Retrieved November 19th 2024
Treatment abroad checklist (NHS)
Last Updated: April 13, 2026
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