Back to main websiteExploring Complex Care Needs
Children with complex care needs often require a coordinated approach from agencies such as health, education, and social care.
Safeguarding these children is particularly important as their increased vulnerability, due to physical, cognitive, or emotional challenges, can heighten risks of neglect, abuse, or exploitation. It demands a proactive, multi-agency approach that prioritises their voice, ensures consistent monitoring, and addresses both their medical and emotional well-being.
Practitioners should remain vigilant to signs of harm that may be masked by their care needs, advocating for environments that are not only safe but also nurturing and inclusive.
Sometimes, however, what may look like neglect or harm may not actually be the case. Interventions may need to be put in place to help the parent of a child with complex health needs cope better with every day life. If you have any worries or concerns, speaking to the complex care team as well as other agencies may be all that is required to better safeguard a child.
- Complex care team - click here for more information
- View the Complex care team one minute guide
- Short breaks - click here for information
- View the Short breaks one minute guide
- View all other SEND one minute guides
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Communication Barriers Many children with complex needs have speech, language, or cognitive impairments that make it difficult to express concerns or describe abuse.
They may not understand that what is happening to them is wrong or abusive. -
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Dependency on Adults These children often rely on multiple carers for intimate personal care, increasing the number of adults with unsupervised access to them.
Their dependency can make it harder to resist or avoid abuse, especially if they are physically or cognitively impaired. -
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Isolation and Limited Social Networks Children with complex needs are more likely to be socially isolated, with fewer trusted adults or peers to confide in.
They may be excluded from mainstream education or activities, reducing opportunities for others to notice signs of distress. -
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Misinterpretation of Behaviour Signs of abuse (e.g., withdrawal, aggression, regression) may be wrongly attributed to the child’s condition rather than seen as indicators of harm.
Practitioners may overlook safeguarding concerns due to over-identification with the challenges faced by parents/carers.
Changes in behaviours can often be a sign that something is wrong and may be the only sign of communication you get from a child and should be noted. Practitioners who know children well can often spot these subtle changes that need to be investigated. -
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Limited Access to Safety Education Many children with complex needs may not receive accessible education about relationships, boundaries, and personal safety.
This lack of awareness could make them less able to recognise or report inappropriate behaviour.Professionals can use the following resources to communicate boundaries in a simple but meaningful way:
Private Parts Song |These Are My Private Parts | Body Safety Song by Ollie | Songs for Toddlers
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Parental Stress and Carer Burnout Caring for a child with complex needs can be emotionally and physically exhausting, increasing the risk of neglect or abusive behaviour from overwhelmed carers.
In some cases, parents may also have additional needs that affect their capacity to provide safe care.
Short breaks may support at this time as well as referring to other targeted / universal services if appropriate. -
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Medical Vulnerabilities Frequent medical procedures and medication use can lead to risks such as misuse, unnecessary interventions, or neglect of medical needs.
Children may be at risk of fabricated or induced illness (FII), where a caregiver exaggerates or causes health problems.
Safeguarding Best Practices
To protect children with complex health needs, professionals should:
- Listen to the child’s voice, including non-verbal communication.
- Ensure accessible education on safety and relationships.
- Maintain professional curiosity, don’t assume behaviours are just part of the child’s condition.
- Work closely with families and multidisciplinary teams to monitor wellbeing.
- Provide extra pastoral support and safe spaces for disclosure.
Additional Training slides
The Complex Care Needs Team (CCNT)
If you work or volunteer with children with complex care needs, the CCNT have developed additional slides for you to either access or integrate into your own single agency training. For more information please contact the team direct.
