In the UK, surveillance by frontline services aim to identify children at risk of abuse or neglect, or of not having their needs met by their birth families. If a child is defined as being ‘in need’, their family will have social services involvement, and be provided with additional support. If this is inadequate to mitigate risk or to enable the child’s needs to be met, the child may be taken into care, usually to live with foster carers. A challenge when trying to safe-guard vulnerable children is how to identify them at an early stage, so as to expedite their removal from an abusive environment, or provide extra support to set the family on a more positive trajectory.

It is therefore important that early-life predictors of a child becoming in-need or looked-after are well understood. Patterns of health service usage may differ for vulnerable children relative to their peers, and as such could be a useful early marker of a child being at risk. We hypothesise that parents of children who become in-need or looked-after will be more likely to miss or cancel routine appointments for their child, to attend emergency out-of-hours appointments and A&E, and to not start or complete child vaccinations or other routine child health checks.

In our project we will use two birth cohort studies. We will identify which children are in-need or looked-after, and then we will examine whether their health service usage differed from their peers in early life by using record linkage.