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Level 4 – Development of the Baby or Child


  • Child/young person has severe/chronic health problems
  • Child/young person’s weight and height drop in centile
  • Other developmental milestones unlikely to be met; failure to thrive
  • Lack of food may be linked with neglect
  • Refusing medical care endangering life/development
  • Seriously obese
  • Dental decay and no access to treatment
  • Persistent and high-risk substance misuse
  • Dangerous sexual activity and/or early teenage pregnancy
  • Child sexual exploitation (CSE)
  • Suspected imminent risk of FGM (female genital mutilation)
  • Sexual abuse
  • Self-harming
  • Non-accidental injury
  • Acute mental health problems e.g. severe depression; threat of suicide; psychotic episode
  • Physical/learning disability requiring constant supervision
  • Disclosure of abuse from child/young person
  • Evidence of significant harm or neglect
  • Disclosure of abuse/physical injury caused by a professional

Emotional development

  • Puts self or others in danger e.g. missing from home
  • Severe emotional/ behavioural challenges
  • Unable to connect cause and effect of own actions
  • Unable to display empathy
  • Suffers from periods of severe depression
  • Self-harming or suicide attempts

Behavioural developments

  • Unable to determine boundaries, roles and responsibilities appropriately
  • Cannot maintain peer relationships e.g. is aggressive, bully, bullied
  • Regularly involved in anti-social/criminal activities
  • Repeated missing persons episodes
  • Prosecution of offences resulting in court orders, custodial sentences, ASBOs
  • Non-compliant or poor response to support
  • Professional concerns – but difficulty accessing child/young person
  • Unaccompanied refuge/asylum seeker
  • Privately fostered
  • Abusing other children
  • Young Sex Offenders
  • Serious or persistent offending behaviour likely to lead to custody/remand in secure unit/prison
  • Subject to Family Support or Child Protection Plan

Identity and self-esteem

  • Child/young person experiences persistent discrimination; internalised and reflected in poor self-image
  • Failed Education Supervision Order – 3 prosecutions for non-attendance: family refusing to engage
  • Socially isolated and lacking appropriate role models
  • Alienates self from others
  • Bullying
  • Lack of confidence is incapacitating
  • Victim of crime; may fear persecution by others
  • Poor and inappropriate self-presentation
  • Child/young person likely to put self at risk
  • Child sexual exploitation (CSE)
  • Evident mental health needs

Family and social relationships

  • Repeated missing persons episodes
  • Relationships with family experienced as negative (‘low warmth, high criticism’)
  • Rejection by a parent/carer; family no longer want to care for – or have abandoned -child/young person
  • Periods accommodated by Council
  • Family breakdown related to child’s behavioural difficulties
  • Subject to physical, emotional or sexual abuse or neglect
  • Child Exploitation (CE)
  • Suspected imminent risk of FGM (female genital mutilation)
  • Child is main carer for family member

Self care skills and independence

  • Severe disability – child/young person relies totally on other people to meet care needs
  • Child neglects to use self-care skills due to alternative priorities, e.g. substance misuse


  • Puts self or others at risk through behaviour
  • No, or acrimonious, home-nursery or school link
  • Young child with few, if any, achievements
  • No school placement
  • Child/young person is out of school
  • Has no access to leisure activities
  • Multiple fixed term exclusions or risk of permanent exclusion
  • Consistently poor or no educational attainment progress