A child safeguarding review in Rochdale has revealed that a severely neglected 19-month-old toddler was rushed to hospital in critical condition just 19 days after social services closed her case. The toddler, referred to as Child K1, was found to be 'incredibly emaciated' with 'paper-thin skin' and open pressure sores extending along her back, hips, and bottom.
Critical Condition
Child K1 was admitted to critical care in 2024 weighing just 9.7lb (4.4kg), less than half the average weight for her age. The review, conducted by expert reviewer Nicki Walker-Hall, noted that the child was suffering from hypothermia, hypoglycaemia, severe malnutrition, dehydration, and renal failure. Ms Walker-Hall stated that these conditions 'could have led to death if it had not been identified and emergency treatment initiated.'
Background of the Case
The toddler's mother was just 17 when the baby was born and had struggled with anxiety and low mood. She relied on the child's grandmother for care. In April 2024, the grandmother took Child K1 to hospital because she was refusing feeds overnight. During that visit, a family member told hospital staff that the mother was neglecting the child, claiming to have seen her sleeping on a couch while the toddler cried alone upstairs.
The hospital referred the case to Rochdale's Children's Social Care team. Social workers visited the mother, who was deemed 'willing to accept support.' However, the team was unable to reach her over the following weeks. Health visitors conducted visits and found the child's basic needs seemed to be met.
Anonymous Tip and Closure
In mid-December 2024, an anonymous tip was submitted to Rochdale's Early Help and Safeguarding Hub (EHASH), alleging severe neglect: matted hair, long dirty fingernails, dirty unchanged clothes, and 'leaking wax' from her ears. Social workers visited the same day and confirmed the toddler's condition, but the upset mother refused to consent to social care involvement. Numerous calls were made between January 7 and 21, 2025, to try to engage her in a Child and Family Assessment, but these were unsuccessful.
A multi-agency strategy meeting in February 2025 decided that the threshold had not been met to progress the case under Section 47 of the Children Act 1989, which requires investigation when there is reasonable cause to suspect a child is suffering or likely to suffer significant harm. The case was closed.
Hospital Admission and Review Findings
Nineteen days after that meeting, Child K1 was admitted to critical care. Ms Walker-Hall noted that the child had 'no fatty tissue' on her body, wasting to the buttocks, and pressure sores along the spine to the sacrum and across the hip bones. The skin was paper-thin, and there was excoriated skin breakdown across the entire nappy area and genitals.
The review highlighted several learning points, including that practitioners needed to be 'more curious' about a child's daily experience and that more should have been done to investigate the care the child was receiving. Ms Walker-Hall found it 'problematic' that officials had decided not to proceed to Section 47 with only partial information, stating that they could have gathered further information and reconvened the strategy meeting.
A spokesperson for Rochdale Borough's Safeguarding Children Partnership said: 'We accept the findings of the recent review and are taking action to ensure existing policies and procedures are followed by all professionals to ensure the safety of our children and young people.'
