A Damaged Child Part 4a – A Medical Tragedy Waiting To Happen …
It feels like a very long journey arriving at this point in my son’s story, and I apologise for the length but I feel I have a duty to expose what is going on in many of our special needs schools. I also want to inform parents who, like ourselves, were not aware of what was happening to our child until it was too late. In Part 2 of ‘A Damaged Child’, I talked about the physical restraint techniques and seclusion that schools are legally allowed to practise and how to recognise the signs that it is happening. And in Part 3, I outlined which specialists a school should be contacting in order to prevent this from happening in the first place. Part 4 carries the biggest warning, because if a school does not seek specialist medical advice, your child is at risk of a life threatening injury and serious mental health problems. I never want to see another child experience what my learning disabled son went through at his old school and the continuing psychological damage from it two years later…
It seems odd to say this, but looking back at my son’s last year at his old school, I now realise that we were lucky he was left with ‘only’ post traumatic stress disorder, extreme anxiety and a new seizure type. The negligence of the special school could have led to serious physical injury or worse. Alarmingly, restraint and seclusion is still happening daily in schools all around the UK yet seemingly very few are addressing this abhorrent yet widespread practice.
In Part 4, I want to take this opportunity to explore the serious risks that a school takes should it fail to write a medical risk assessment or indeed seek the advice of a medical professional before engaging in restrictive practices on a learning disabled child with a complex medical condition. I will do so using examples of what happened to my son at his old school, taking into account his rare genetic neurodevelopmental epilepsy condition.
In the first part of this article (4a) I will cover the danger and overwhelming risks that schools are taking with our children’s health and in the second part (4b) I will share with you just what happened to my son.
It is also extremely important to point out that a large number of physically disabled, learning disabled and SEN children have profound and multiple medical conditions with comorbidities and are also faced with a similar risk.
Restrictive physical intervention (RPI) training providers
So do RPI training providers such as Team Teach, who are employed to train and advise school staff, actually recommend that these schools seek specialist medical advice before using their restraint techniques on children with complex medical conditions?
Interestingly, if you read Bleetman et al. (2020) ‘Medical Risk Assessment of Team Teach skills syllabus’, all the emphasis is on protecting school staff and seeking a health assessment for those injuries that staff might incur during their initial training course or later whilst actively restraining children. Presumably this is in order to protect the company from a legal claim of injury from school staff. Bleetman also implies injuries to children are inevitable: ‘any and all physical interventions may result in injury’.
Worryingly, I can find no similar recommendation in his report about seeking an assessment from a medical specialist in advance of undertaking restrictive physical intervention on the children being restrained, either with or without a medical condition, complex or otherwise. It is even more shocking when you discover that the average age of restraint on a child is six. At six years old, young bodies are developing, bones and joints are still growing and critically the brain is still maturing. Imagine the enduring and permanent physical injury and mental trauma which could and does occur when a fully grown adult repeatedly uses restraint, seclusion and restrictive practices on small children.
Who should schools be contacting to help them write a medical risk assessment?
The first line of contact prior to restraint and restrictive practices taking place on any child (neurotypical or otherwise) should be local health professionals. This might include the local General Practitioner (GP), School Nurse, Occupational Therapist (OT), Physiotherapist, Paediatrician, Ophthalmologist etc. Senior hospital consultant specialists will be mentioned later.
Astonishingly in my son’s case the school did not consult anyone
or even bother to write a medical risk assessment.
What are the implications of not seeking advice?
Known physical conditions
Eight months before school started using physical restraint on my son he broke the top of his humerus (lead photo) during a tonic clonic seizure (not at school). This had weakened his arm and made it susceptible to further damage during any subsequent tonic clonic seizure or during any other physical activity. This was so serious that the school nurse at the time made an adaptation to his health care plan stating that even after a tonic clonic seizure, he should not be placed in the recovery position unless absolutely necessary for fear that this injury might reoccur.
When the school started using restrictive physical practices on my son (such as the t-wrap - where arms are crossed across the body and held from behind), his pre-existing injury was not taken into account in any restrictive practice assessment or indeed at all by school when they made the decision to physically restrain my son in any manner that they chose. I am certain if they had informed the school nurse about what they were doing she would have strongly advised them against it. But they did not.
Unknown/hidden medical conditions
It is not only pre-existing medical conditions that should be taken into account by a school but it is likely that children with complex medical and genetic conditions often have hidden underlying physical conditions too.
During this period, my son had been referred to a physiotherapist to examine what was causing his uncoordinated gait and uneven posture. X-rays revealed he had developed scoliosis, namely curvature of the spine, which meant whilst in a sitting position his upper body naturally leaned forward and his rib cage stuck out prominently on one side, likely compromising lung capacity.
A t-wrap restraint, with both arms crossed in front of the torso and held from behind will result in forward flexion of the trunk and further restriction across the chest, and poses a serious risk to breathing. Even if a ‘Wrap’ (an updated t-wrap) was used, where arms are held down crossing below the belly button and hands held against the child’s hips (not across the chest) any struggling by my son could potentially cause injury to his protruding rib cage.
Bleetman also states that the t-wrap is ‘designed for smaller children’. My son was 15 and approaching the size of the adults restraining him. There is no wriggle room for a larger child if they attempt to struggle, only further constriction of the torso. School would not have been aware of his scoliosis at the time, but this doesn’t excuse them. Hidden medical conditions mean that schools are taking great risks with potentially severe unforeseen consequences when they practise restraint.
The unpredictability of using restrictive physical interventions (RPI) or any other restrictive practices.
When school staff are trained by organisations advocating restrictive physical interventions, the demonstration of the holds appear to take place on calm, compliant adult subjects. However, with a learning-disabled child nothing is predictable. The child is usually smaller than the adults that they practise the restraint moves on, children are likely to struggle and move about, panic, try to escape, react in unpredictable ways. The longer the struggle, the more likely they will start to become agitated, distressed, breathless and hypoxic,
I have already mentioned that Bleetman commented that a practitioner cannot guarantee to keep a child safe during restraint. So what about the risk, not only to those with known physical disabilities, but also to children with hidden physical disabilities. Can they also guarantee that a subsequent seizure, fall or accidental impact against something during the restraint process won’t lead to a serious life-changing injury to the child or even death? The answer is definitively no.
H-shaped mark on my son’s back
On several occasions my son returned from school with bruises on his body which we assumed were due to boyish rough and tumble activities in the playground. It was only when an odd H-shaped mark appeared on his back (photo) with extensive bruising and broken skin that we started asking questions. I asked school to investigate and they conceded that it had been caused by a coat peg on the wall behind his desk but no one knew how it had happened (despite my son naming someone). Looking back after reading the Subject Access Request documents, I do wonder how many of these injuries were actually the result of incidents of restraint where my son fought back, increased force was used, and an accident occurred – incidents that should have been reported and recorded.
To parents I would say, keep a record and take dated photos of all suspicious looking injuries. For example, bruises around the ankles could indicate holding the legs down, small circular bruises (finger tip impressions) on the arms or chest (photo) can indicate a child is being moved around school against their will, or they have been involved in some form of forcible restraint. Take photographic evidence of the injury, take your child to a GP or A&E to get the injury officially recorded, particularly if it necessitates serious investigation (by the police). Always question your school about any injury, and ask if there is an incident form for that day. Talk to the school’s safeguarding team who have a duty to investigate and record the incident at a higher level. Even more importantly, without using any leading questions try to ask your child how it happened and record this conversation.
Finger tip bruises on a child’s chest
It is important to mention that restrictive practices also happen in mainstream schools. Popular at the moment is the use of seclusion rooms, particularly in secondary schools. If your child has a medical condition which could be compromised by being put into a small room with a single desk and often artificial light and no windows then please take note.
My friend’s 6ft 5in tall, 15 year old learning disabled teenage son who has rod-cone dystrophy and struggles to see in certain lighting conditions, was frequently placed in seclusion, comprising a tiny cubicle with black and white walls and artificial light. It was so small that he would literally have to curl up to fit in there. His parents asked to see this space but the request was refused. Astonishingly the fact he had rod-cone dystrophy made no difference to the school’s approach and they ignored medical advice provided by the parents. As a result, after leaving the seclusion room, he was frequently temporarily blind, causing him to walk into walls, and even inadvertently step into traffic. The head of school was alerted to this, especially the traffic incident, but refused to engage.
The reason for his seclusion was that this learning disabled teenager was being repeatedly bullied and he was reacting inappropriately to that bullying. The school didn’t help or provide support and astonishingly told the parents due to his learning disability they should “expect him to be bullied”. As a result of this treatment by members of school staff, he subsequently received a clinical diagnosis of PTSD which still affects his daily life four years later.
Interestingly it was only after this young man made a phone call to Childline in desperation that his Local Authority started to take action and notified the school of several concerns they had received including the use of the seclusion room. I just cannot understand why it should take this level of hierarchical pressure before a school actually stops and modifies what it is doing. For this reason, if your child is cognitively aware enough to be able to articulate their feelings and you have nowhere else to turn, then I would recommend your child phones Childline (0800 1111).
Unfortunately in my son’s case he was unable to effectively articulate his feelings and cognitively didn’t understand what was happening to him and why. Furthermore, the school didn’t notify us as to what exactly they were doing. My vulnerable son was completely alone in a school that made no attempt to seek professional or medical advice for his condition. This negligence contributed to his declining mental health, deteriorating epilepsy condition and even more critically could have led to serious injury or death.
In the second part (4b) to appear on Monday, I will share with you the sickening reality of what happened to my vulnerable learning disabled son and the significant threat to his life.
A Damaged Child – Part 4b– A Medical tragedy waiting to happen – my son with epilepsy