GP raised safeguarding concerns over daughter’s periods, itching and distress at appointment

[MyDearLeader]

DD age 10 under assessment for potential adhd (emotional dysregulation, sensory issues, sleep issues) has been showing signs of puberty for a few years (breast puds, hair etc) she is tall for her age. Anyway.. she started on what I believed to be her period on the 4th of July... we had been preparing for it but she is extremely private e.g when we went shopping for her first bra was extremely embarrassed and upset.. when she asked me to shave her armpits then got upset when I said she couldn't do it herself as needs supervision. She has big meltdowns shouting no no no over and over, i still sleep in her bed as she cannot sleep. Anyway the bleeding was very light lasted only a few days then went, it returned on the 19th unexpectedly.. 4 days very light. Anyway on the 1st it started again but this time heavier and bright red, she has also had intermittent itching on and off relieved by sudocrem. Due to all this I booked a gp appointment 1. To be sure this is actually start of period and not something else.

1. To investigate the itching and see if this was related to the bleeding.

My daughter initially refused to go crying hysterically (she wont even let me tell any family what is happening including her dad) I got her there i asked her should I speak or her she said me.

We saw a female dr, I explained everything she kept asking my daughter questions to which she kept hysterically crying shouting no no no.. the dr told me she was concerned at her distressed reaction I explained her history (which is all documented on her record including a diagnosis of anxiety disorder and camhs involvement) she said she was worried it was a trauma response? I informed her periods have been very much normalised in my house I have endometriosis and that she has emotional regulation problems never mind now with new hormones and she feels embarrassed.. she asked me to step out to talk to her alone, my daughter refused did not want to.. she wanted to swab her vagina.. my daughter went into meltdown screaming no no no, the dr said this was a concern?

She agreed it is likely period and the light bleeding were "test runs" gave me a swab to try at home but blindsided me by saying she has safeguarding concerns!!? I was absolutely blown away, I asked why she said the abnormal bleeding and itching.. said if her swab comes back as having thrush she will be formally reporting it? I said due to sensory issues she vigorously Wipes on repeat and I suffer with thrush frequently could she catch it from me? She said no.

Honestly i feel sick to my stomach. My daughter refused the swab by me and has let me supervise her doing it (very traumatic for her)

I just cannot believe it, i am an nhs professional and feel sick that I might need to report this to my line manager that I am being investigated.. my husband is distraught. I was just trying to ensure my daughter is definitely starting periods as mine did not do this and investigate the itching, she doesnt stay out and I sleep with her every night...

I understand processes need to be followed i am just so upset😥

Again, we agree. But in the event of a safeguarding flag do other medical reasons and diagnoses not happen?

I dont have an issue with the gp raising a safeguarding flag at all. Im a curious about other potential reasons though and what happens when it could be something else (both things can be true, yes?).

Eta to add some more detail as I realised I needed to afrer i had posted.

The itching could be a reaction to sanitary towels. I have the same issue. Some have a plastic top with holes in that the blood passes through, supposed to be a dry feeling, many of the Always brand are like this, it's the plastic that causes the itching. I can only use Always sensitive, body form or Sainsbury's cheap old fashioned ones. Changing pad could be a solution.

I think thrush in children is very rare and, similar to UTIs, often caused by poor hygiene or transfer of bacteria/yeast in that area. Obviously there are many cases which are harmless, but there must also be statistics proving that underage children with gynae issues (not necessarily STDs) are definitely at much higher risk of SA.

Another thing that survivors of SA mention is that they struggle to keep themselves clean as children. Understandably since the whole area feels dirty. So that contributes to infections that most children with normal hygiene habits don't have.

There's a girl in DD's class who I feel displays some red flags. Definitely past the age of potty training but once she wet herself out of the blue and her mum didn't care, didn't bother changing her and basically made her go into the car with wet underclothes and tights. It's not hard to imagine that regular situations like that can cause issues and that's why GPs are highly aware of it.

Hugs, @MyDearLeader
I suppose the GP has to do what she has to do, upsetting for the child though. I hope it can be sorted quickly so that the child's actual physical problems can then be sorted out. Please don't take any notice of smug comments here, especially re ND children, they should be glad they DON'T know or have to understand. I just commented on another thread in a similar vein - if people have nothing nice to say, useful to add, just scroll by..
I hope your child is ok. x

Her DD has underarm hair and from the original message is clearly not pre-pubertal. 10 is well within the expected age for a girl to start her periods (many are much younger) and this can be hugely distressing for young people with ND needs

Vulvovaginitis is also very common pre-puberty and rarely requires a safeguarding referral - and if you have concerns, you should speak to your safeguarding lead and arrange for the young person to see a specialist paediatrician, not try to examine a distressed child in a busy GP clinic

The gp doesn’t know you, the gp doesn’t know your family and friends and crucially the gp cannot discount the reaction your dd had was due to nd, she could miss abuse cases in making assumptions. It’s essential that nobody is above suspicion, I know of a doctor who was abusive. Your gp was doing their job

I disagree, I could be something ,,else,, but not being as sinister as GP suggesting.
Myself I remember when I was about 6-7 years old I fell on a concrete narrow wall I used walk on as child in front of our house.
I hit my crotch as I landed on it.
I didn't say anything until I started bleeding very lightly, which would look maybe like period starting, my mum took me to Dr. They didn't do any examination, just told us to keep an eye, it soon stopped.
Similarly my daughter when she was child I noticed she had some greenish discharge on her knickers, went instantly to GP, showed them the pants- he said its just a normal discharge, nothing to be concerned, didn't even offered anything or looked.
So yes it could be something totally innocent and I do understand the concern OP has about the bleeding..

Likely because she's neurodivergent.

Yep, or NT and just has more of a tendency to be reactive. Human beings vary on this, not everyone possesses a laid back temperament. I find it more surprising that a 10 year old would passively go along with an intimate examination, tbh, and am surprised that a GP would expect that. But then I don’t think they get much training in psychology.

This is where a good GP should first explore with the parent, possibly without the child present - and have a good read of the notes, especially the CAMHS history - and then talk to the safeguarding lead if still concerned. Coming in too heavy handed and trying to examine a distressed child with ND needs, will potentially be traumatising

Yes, I think the GP unfortunately exacerbated the child’s trauma.
If she had concerns fair enough, but she should have dealt with the situation much more sensitively. It sounds like she hasn’t received enough training in this area, or hasn’t sufficient experience, or both.

I understand there are red flags here. This is also perfectly normal behavior for an autistic 10 year old girl.

Regarding the itching. I am allergic to every disposable pad I have tried and I have sampled far and wide. Those things are awful. I’ve been to doctors and had labial biopsies trying to figure out the itching and strange rashes. Used all sorts of prescribed creams. The solution was simple. Cloth pads. They weren’t as ubiquitous as they are today. So many more choices.

For the toilet paper, you should try assorted brands. Some are more irritating than others.

my best solution was installing a bidet seat. A cheaper, quicker option is a perineal bottle. Your daughter can rinse instead of wiping as much and that will help with irritation.

I recently switched to a perineal bottle due to various issues and it’s been a revelation. Much less wiping required and you feel much fresher. Very simple, but very discreet and effective Great suggestion.

I broadly agree, but the GMC/NICE guidelines require a swab to check for the presence of candida, so if the GP has concerns they likely haven’t much choice unless it turns out that the vaginal bleeding is, in fact a period. OP indicated that this hasn’t been confirmed. There are only a few reasons why candida would be present in a girl of that age - recent antibiotic use is one, starting periods is another, but so unfortunately is the introduction of adult bodily fluids and other irritants as a result of CSA

You can think whatever you like but it’s the reality of life with autistic pre-teens whose maturity levels are a few years behind their peers! How fucking judgmental! Plenty of posters on here - including a professional- have stated how normal it is for autistic pre-teens to not sleep alone!

Wind your judgy neck in please.

Absolute nonsense! Both I and DD began getting occasional thrush from age 8 onwards and at 11, DD hasn’t yet started her periods and has been getting thrush probably every 3-6 months ever since her first at age 8 and exactly the same with me. I’m 42 and I’ve had thrush at LEAST 3 times per year since I was 8! GP reassured me again just recently that’s it’s relatively normal in pre-pubescent girls and that some are just more prone to it than others just like some of us as adults can have identical levels of cleanliness & hygiene yet some will be prone to it and others will rarely or even never ever get it (like my mum, who at 82 has never had Thrush in her entire life!)
Also, a little TMI probably but relevant - I’ve not been near a sexual partner in just over 10 years yet I’ve had thrush on at least 20 occasions during that time!

Stop scaremongering

But she has got signs of puberty.
I always thought girls could get thrush from wearing tight trousers / unnatural fabrics / sitting in damp swimwear etc.

The GP is getting a bashing here. Two things can be true at once. OP is entitled to feel upset and the GP is well within her reasons to follow protocols as well because let's be honest she does not know OP or her DD from Adam. Not just that.... I would air on the side of caution too if you only had a 10 minute appointment.

Yet the diagnosed neurodiversity is in the daughter's notes and should be taken into account

I’m not scaremongering at all. And unfortunately it’s not nonsense. If you look at the posts from actual GP’s on the thread they confirm. No-one is saying that OP’s DD has been the victim of CSA but there are red flags for a couple of things and the GP has a duty to investigate. There are a couple of conditions that can mimic thrush at that age but don’t involve the presence of candida - that’s why the GP has asked for a swab. Candida is only present in certain circumstances and is a red flag. What would you like to happen - for it to be ignored so that children who are victims of CSA fall through a safety net specifically designed for them ?

Signs of puberty yes, but until it’s confirmed that the bleeding is down to actual periods, there is room for doubt. There are some conditions that can mimic thrush without the presence of the candida bacteria. That’s why GP has requested a swab - it’s candida itself that is the red flag because there are limited circumstances in which it can be present. And yes, damp clothing/bad hygeine can be a cause. No one is saying CSA is the cause here, but it’s a possibility the GP can’t ignore.

Because the OP knows her daughter and the GP doesn't? The ' red flags' are also things that can have simple explanations as most parents would realise.

No you incorporate into your thinking that the patient might merely have high anxiety paying attention to the CAMHS history and the child's views also informed by the parents perspective, and you ask them both ' is there any way your daughter would prefer to be approached-
In other words try and offer a service in whatever way she might be able to accept it. It might take some relationship building, several appointments or maybe a social story- could you have some of these ready?
Here's an idea- maybe an MDT with CAMHs and school so you can understand how to approach the child for medical examinations, to see how other agencies have supported her.

You can raise the possibility of sexual abuse if there appears to be evidence of this. But You cannot just make a SSD referral a reason for not trying any other strategies. It's really important she is able to build a relationship with a GP for her future. A mash referral will not achieve this.
Also you could initiate a hospital passport which could support other medical professionals when they are dealing with her.
There is a lot a GP/ practice nurse can do here do you feel GPs have adequate training in this area?

For the issue to be addressed without causing more trauma to a probably ND child would have been better than what happened, surely?