1. 10 Areas of Danger and Concern 10aAreas of Dangerand Concern Introduction10Physical action including restraint carries risks. These include the possibility of seriousphysical and psychological trauma and even death. Such situations could result incriminal or civil proceedings or fatal accident inquiries. Disciplinary action mayresult from some situations. Although serious injuries and deaths have been reported in the UK, there is still alack of appropriate research to provide clear guidance. There is well founded andwidespread concern about certain aspects of practice. So far, these have focusedon the following: 10bNeck holdsHolding a child by the neck risks asphyxiation (suffocation) or restricting the blood owto the brain. It carries the risk of death. You should never use any form of neckhold. 10cObstructing Mouth or NoseChildren spitting or biting while being restrained are legitimate concerns for staff. Yourwelfare should be suitably protected and your concerns should be looked at byoccupational health services. While you may understandably wish to cover thechilds mouth to protect yourself from spitting or biting, you must never do so. 10dProne restraintThe term prone restraint simply means to hold a child face down, when on the ground,usually with their head to one side. There are many versions of this procedure.Risks associated with prone restraint can be reduced if the procedure used has aminimum effect on breathing and the health of the child is good (Graham 2002). However, the procedure may carry unacceptable risks if pressure is placed on the Return75Click here to returnto Contents Click here to return to Contents

2. 10 Areas of Danger and Concern childs torso or hips or the health of child gives cause for concern. Health concernsmay include obesity, asthma or other respiratory problems (Day 2002). Restraining children in a prone position carries a higher risk of serious harm thanother holds done correctly, and as such should always be treated as a nal option. Restraining children in a prone position is more likely than other forms, such asstanding or seated restraints, to be seen by them as a punishment or as abuse. Service providers should only approve the restraining of children in a proneposition when an assessment of risk shows that this is the least restrictive actionnecessary to achieve a safe outcome for all involved. 10eSeated holdsThere are many seated holds with different names in different systems and approaches torestraint. The research suggests that these techniques are seen by service users asless intrusive than prone restraint (McDonell et al. 1993). However, seated holds are not without risk. Hyperexion, where the individual isbent forward at the waist while seated, can severely restrict breathing and you mustnever use it. Hyperexion is also dangerous if it happens in a kneeling position(Paterson and Leadbetter 1998). 10fSupine restraintSupine simply means face up when on the ground, and there are again many varieties ofthis procedure. It is sometimes suggested that supine restraint is safer than pronerestraint but it may be associated with risks of a different type. It carries the riskof choking or inhaling vomit (Morrison et al 2001). Staff need to be aware of thisdanger. 10gBasket holdsBasket holds again exist in several versions involving combinations of one or two people with the staff and children involved variously standing or sitting. Though bad outcomes have been reported, the risks associated with basket holds can be reduced. Two variations give cause for concern. Firstly, if you are doing a basket hold ina seated position the child must not be bent forward, as this will interfere withbreathing. Secondly, staff can fall accidentally across a childs back (into a proneposition) but continue to hold on. A basket hold should never be continued underthese circumstances. Sometimes staff pull a childs hands across their chest from behind, and it is lessrisky practice to hold the childs hands down to their hips this should be donewithout pulling the arms back, as compressing a childs abdominal area willcompress the diaphragm and interfere with their ability to breathe. 76Click here to returnto Contents Click here to return to Contents 3. 10Areas of Danger and Concern10hPain compliancePain compliance is not an acceptable practice in child care. Getting a child to go alongwith what you say by inicting pain exists in a number of forms. These include, forexample, deliberately using pressure across a joint or the use of pressure points. Pain increases the power professionals have over vulnerable people and so thepossibility of abuse. At the same time the use of pain reduces the chance ofbuilding up a therapeutic relationship (Paterson et al. 2004). As a result, its use inchild care is not acceptable. 10iMedicationChildren may be receiving medication for a range of physical or psychological disorders.Some forms of medication may increase the risk of a child experiencing problemsafter a restraint. All risk assessments should take account of the possible sideeffects of medication both generally and in the context of restraint (Hughes andVan Dusen 1993). 10jConclusionIt is service providers and not those who provide training in physically restrainingchildren who are ultimately responsible for making sure that the methods used areappropriate and safe in their residential establishments. Their decisions will beguided by considering a wide range of issues, for example the needs of childrenwho are accommodated and the nature of the services provided. However, allservice providers should be working with their training providers towards reducingor getting rid of those procedures associated with a higher risk of problemsdiscussed here. Individual staff remain personally responsible for their actions inindividual situations.77Click here to returnto Contents Click here to return to Contents