Safe Caring

1. Introduction

Children who are Looked After away from their own homes must be kept safe and their wellbeing promoted. However, the history of a child who is looked after away from home may make them more vulnerable to harm and those people caring for them may be at risk of complaints or allegations.

Safe Care policies are about good practice. The objectives of safe care policies are to minimise the risk of harm to children looked after and ensure the child and the families caring for provide a safe environment.

The purpose of this policy is to:

• Keep foster children safe from abuse by adults;
• Keep children in the foster home safe from abuse by other children in the household;
• Keep members of the foster family safe from false allegations;
• Ensure that the foster home is a safe environment for children.

This policy covers:

• Providing suitable foster carers, including checks undertaken in new and existing foster carers;
• Appropriate matching of children to carers;
• Health and Safety in the home;
• Protecting children from abuse and neglect;
• Promoting children's health, development and educational achievement.

2. General Safeguards

There are a number of general safeguards that should be observed in all settings in which children live away from home including foster care.

These safeguards should ensure that:

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness to the external world and external scrutiny, including contact with families and the wider community;
• Staff and carers are trained in all aspects of safeguarding children;
• Staff and carers are alert to children's vulnerability and risks of harm, and are knowledgeable about how to implement Safeguarding Children procedures (see Hull Safeguarding Children's Partnership Guidelines and Procedures);
• Children who live away from home are listened to and their views and concerns responded to;
• Children have ready access to a trusted adult, e.g. a family member, the child's social worker, Independent Visitor, children's Advocate;
• Children should be made aware of the help they could receive from independent advocacy services, external mentors, and Childline;
• Staff recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• There are clear procedures for referring safeguarding concerns about a child to the relevant local authority, see Hull Safeguarding Children's Partnership Guidelines and Procedures;
• There are clear and effective allegations and complaints procedures which are readily accessible to staff, children and young people - see Hull Safeguarding Children's Partnership Guidelines and Procedures;
• Bullying is effectively countered and considered within the Foster Carer's Safe Care Policy;
• Recruitment and assessment procedures are rigorous and create a high threshold of entry to deter abusers;
• There is effective supervision and support for Foster Carers and member of staff in Children's Homes;
• Any commissioned staff are effectively checked and supervised when on site or in contact with children;
• Clear procedures and support systems are in place for dealing with allegations and expressions of concern by staff and carers about other staff or carers;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Staff and carers are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living away from home.

It is important that children in Foster Care have a voice outside the family. Social workers are required to see children in foster care on their own (taking appropriate account of the child's wishes and feelings), and evidence of this should be recorded. Dependent on their circumstances children may have an Independent Visitor who will advocate on their behalf.

3. Recording

Fostering Social Workers should advise the foster carers the importance of maintaining daily records and recording them in a timely fashion. It is essential that foster carers make a note of any incidents such as inappropriate behaviour or speech, worrying phone calls and anything that makes them feel uncomfortable or in any way concerned. Carers should note others present and keep accurate notes of any conversations of concern.

If a child makes a disclosure the foster carer should record what was said by whom, date, time and sign the record and record if any other person was present. If another adult was present they should also sign the record. For detailed advice refer to Hull Safeguarding Children's Partnership Guidelines and Procedures.

4. Actions when Child is Placed

The Safe Caring Policy should be reviewed upon the matching of any child with the Foster Carer household. Amendments to the Safe Caring Policy should be clear, understood and communicated to all the members of the household. This should be discussed and recorded at the Planning Meeting for any child matched and placed in a Fostering household.

Foster carers should be provided with full information about the foster child and his/her family, including details of abuse or possible abuse, both in the interests of the child and of the foster family. This should be provided in written form, where possible, but in the case of emergency placement, verbal communication of this information is sufficient. This must then be addressed the next working day.

Foster Carers should ensure that the needs of each child are adequately reflected in the family Safe Care Policy for each child living in the family home.

Foster carers should monitor the whereabouts of their foster children, their patterns of absence and contacts. Foster carers should follow the recognised procedure within Hull City Council whenever a foster child is missing from their home. This will involve notifying the Fostering Social Worker and the child's Social Worker and where necessary the Police of any unauthorised absence by a child.

The local authority's duty to undertake a Section 47 Enquiry, when there are concerns about Significant Harm to a child, applies on the same basis to children in foster care as it does to children who live with their own families.

The Safe Care policy must be revised for each child placed in consultation with the child's social worker and should take into account

• Risk assessment, taking into account previous abuse suffered or perpetrated;
• Whether the child has been the subject of, or the perpetrator of bullying;
• Matching Issues (see Matching Children with Carers Procedure);
• Likelihood of child absconding and what action needs to be taken in the event of absconding;
• Any potential threats from parents or friends of child;
• Information from the child's parents;
• Information from previous foster carers.

Information from other people who have regular contact with the child, e.g. school staff

5. Searching

Members of staff in Children's Homes and Foster Carers are not permitted to conduct body searches or pat down searches. In addition, staff in children's homes are not permitted to do searches of clothing worn by children or of their bedrooms. Should Staff/Carers suspect that a child is carrying or has concealed an item which may place the child or another person at risk, they should try to obtain the item by co-operation/negotiation. If the child does not co-operate, Staff should consult the Social Worker/Fostering Social Worker or if guidance is required out of hours Foster Carers can contact the Emergency Duty Team or the Fostering Outreach Support Service.

6. Bullying

Bullying is defined as behaviour or actions of a person, group of people or a whole organisation designed to cause distress or to hurt a person or group of people.

Bullying can be overt and plain for all to see. It can be subtle and insidious.

Bullying can become part of the culture, recognised or believed by all or a significant number of people as 'acceptable'; it can even be encouraged and rewarded.

Bullying can include:

• Name calling, being sarcastic and spreading hurtful rumours;
• Assault or physical violence;
• Threats & intimidation;
• Spitting;
• Incitement of others to harass and intimidate;
• Destruction or taking property without permission;
• Extortion or undue pressure;
• Emotional aggression like tormenting and excluding people;
• Racial harassment, taunts, graffiti and gestures;
• Sexual aggression or harassment, unwanted physical contact or comments;
• Comments, threats or actions relating to people's disability;
• Cyberbullying - Using technology to torment, threaten, harass, humiliate, embarrass or otherwise target another person by using the internet, interactive and digital technologies or mobile phones. See Department for Education Advice for Parents and Carers on Cyberbullying (2014);
• Comments, threats or actions relating to people's sexual orientation.

Adults and children are capable of bullying; and of being bullied.

If there is a risk that a child is likely to be bullied or may be the perpetrator of bullying behaviour, carers should notify/consult relevant Social Worker(s) and the Fostering Social Worker with a view to developing a strategy for managing and reducing the risks. The arrangements/strategies should be outlined in a Placement Plan.

If bullying is persistent or serious, consideration should be given to making a Child Protection Referral. See Section 8, Child Protection Referrals

7. Serious Incidents

In the event of any serious incident (e.g. Accident, Violence or Assault, Damage to Property), Staff/Carers should take what actions they deem to be necessary to protect children/themselves from immediate harm or injury; and then notify the Social Worker/Fostering Social Worker (EDT out of hours).

If there is a risk of serious injury/harm or damage to property, Staff/Carers should notify the police, then inform the Social Worker/Fostering Social Worker.

It is the duty of the Foster Carer and member of staff in children's homes to record incidents and injuries to Looked After Children in compliance with the regulatory National Minimum Standards for Fostering or Children's Homes.

It is the responsibility of the Fostering Social Worker to notify the Group Manager for LAC of any serious injury, illness or incident involving a looked after child. A statutory notification will then be sent to the regulatory authority (Ofsted).

8. Child Protection Referrals

The following must be read in conjunction with the Hull Safeguarding Children's Partnership Guidelines and Procedures.

If Staff/Carers suspect or they receive a report that a child is suffering or likely to suffer from Significant Harm, they must:

• In an emergency: take steps that are reasonable and safe to protect the child from any immediate risk e.g. separate children from suspected perpetrators, seek assistance from the emergency services; then contact the child's Social Worker or the Fostering Social Worker (or EDT out of hours);
• If there is no immediate risk: contact the Social Worker or Fostering Social Worker (EDT out of hours);
• The suspected perpetrator must not be notified/informed of the actions taken by the Carer. The Carer should keep notes of all actions taken and any conversations and pass them to the Social Worker/Fostering Social Worker.

9. GP's and Hospital Appointments

All Looked After Children must be registered with a GP, optician and dentist, preferably of their choice.

Each Looked After Child should have a Health Care Plan

Each child's file should contain a written medical consent form.

Any visits to doctors, dentists, opticians or other health professionals must be recorded.

If it seems necessary to make an appointment with a GP/Hospital, account should be taken of the child's wishes, for example, to see a practitioner of a preferred gender. If possible, the Social Worker and child's Parent(s) should be consulted and appointments should not disrupt the child's education.

All appointments and outcomes must be recorded.

10. Medical Emergency

In the event of a medical emergency, Staff/Carers trained to administer first aid should take any action appropriate to minimise the casualty's condition from becoming worse.

Other than for very minor injuries, professional medical attention must be sought as soon as possible (either take the child to see a medical practitioner or seek advice by telephone), even if the casualty's condition seems to improve following the administration of first aid.

In the event of a medical emergency, Staff/Carers should seek medical assistance and support as a matter of priority. Usually this will mean calling an ambulance or in some circumstances the assistance of other emergency services. These services are contactable by dialling 999 from landlines and most mobile phones, however, on some mobile phones the European Union emergency number 112, is also valid.

When calling the emergency services Staff should ensure they are able to provide the following details:

• The telephone number from where they are calling;
• The location of the incident or patient requiring medical assistance;
• The type and gravity of injury or symptoms of the illness;
• The number, sex and approximate ages of any casualties and any information you may know about their condition and medical history;
• Details of any other hazards that may be relevant.

Where Staff/Carers ringing for the emergency services were asked to do so by the first aider, they must remember to report back to them confirming that this has been done.

Once the casualty has been attended to and is safe, the Social Worker/Fostering Social Worker must be notified. The Social Worker should consider whether to notify the Parent(s).

The incident/outcome must be recorded clearly by the Foster Carer or the staff member and notified to the Group Manager for LAC by the Fostering Social Worker.

11. Medication and First Aid

Home Remedies, including Aspirin may not be given to children without the agreement of the Social Worker/Fostering Social Worker in consultation with the child's GP or a Medical Practitioner. The arrangements must be outlined in the child's Placement Plan.

Fully equipped First Aid boxes must be kept in each home and in each vehicle used to carry children.

If children are prescribed medication, including Controlled Drugs, the arrangements for storing, administration, recording and disposal must be agreed by the Foster Carer in consultation with the GP or a Pharmacist - and outlined in the child's Placement Plan.

12. Invasive Procedures

Invasive procedures include the following:

• Catheter care;
• Oxygen therapy;
• Providing assistance with rectal medication such as diazepam;
• The inserting of suppositories or pessaries;
• Injections;
• Feeding through naso-gastric or gastrostomy tubes;
• Supporting physiotherapy programmes and the management of prostheses;
• Tube feeding.

Invasive procedures may only be applied in the best interests of children and upon the advice of an appropriately qualified medical practitioner in consultation with the Social Worker/ Fostering Social Worker.

Appropriate Consent of the child must be sought and of the people with Parental Responsibility for the child.

Invasive procedures may only be applied by competent and properly trained or supported Carers/Staff.

The arrangements must be outlined in a Placement Plan.

13. Enuresis and Encopresis

If it is known or suspected that a child is likely to experience enuresis, encopresis or may be prone to smearing it should be discussed openly, with the child if possible, and Strategies adopted for managing it; these strategies should be outlined in the child's Placement Plan.

It may be appropriate to consult a Continence Nurse or other specialist, who may advise on the most appropriate strategy to adopt. In the absence of such advice, the following should be adopted:

• Talk to the child in private, openly but sympathetically;
• Do not treat it as the fault of the child, or apply any form of sanction;
• Do not require the child to clear up; arrange for the child to be cleaned and remove then wash any soiled bedding and clothes;
• Keep a record;
• Consider making arrangements for the child to have any supper in good time before retiring, and arranging for the child to use the toilet before retiring; also consider arranging for the child to be woken to use the toilet during the night;
• Consider using mattresses or bedding that can withstand being soiled or wetted.

14. Health and Safety in the home

The national minimum standards state:

Standard 6

"The fostering service makes available foster carers who provide a safe, healthy and nurturing environment."

14.1 Seat Belts and Car Safety

Foster Carer may be facing considerable dilemmas about how best to transport children safely if they have more than the 2.4 children that most car manufacturers envisage in their designs! The position about potential overloading is often of concern. As far as insurance is concerned, whilst overloading of a vehicle would not necessarily negate cover under a motor insurance policy, it would certainly be considered in the event of an accident, with the possibility of contributory negligence, depending on the circumstances. Foster Carers should discuss the issue of safe transport with their Fostering Social Worker.

Children and Young People's Services expects children to be suitably restrained in cars, and leaflets setting out the legal requirements are available from the Fostering Service. The cost of installing restraints in the cars of new foster Carers and the loan of seats necessary will be met by the Hull Fostering Service. Foster Carers replacing their vehicles are expected to purchase a vehicle with suitable seat belts or meet the cost of installation.

Children and young people should always be encouraged to sit in the back seat of a car. Babies and children should always be securely strapped into car seats for every journey, no matter how short. No car ride can ever be completely safe, but if a child is using the right safety restraint, the likelihood of being injured in an accident is reduced by two-thirds. Here are some more rules about care safety.

14.2 Safety in the Home

The following items (appropriate to the age range of the Carer approval) require attention at approval and review. For those foster carers who live within the boundary of Hull City Council, the Home Safety Check will be conducted by the carers in conjunction with their local Children's Centre practitioner, who will advise on home safety issues.

When a child is placed with a carer outside of their age range, or were their development or needs indicate that additional measures need to be put in place to ensure their safety within the home, the Home Safety Check will be reviewed at the Planning Meeting and appropriate equipment resources or advise given.

Any amendments to the Home Safety Check should be clearly noted within it and reviewed each year at the Foster Carer's Review.

For those carers how live outside the Hull boundary, the responsibility lies with the Fostering Social Worker to ensure that the Home Safety Check is undertaken and is consistent with those undertaken for carers within Hull. Appropriate advice should be given and necessary equipment resourced.

General

• Windows are fitted with locks. Catches should be out of the reach of younger children;
• Safety gates are used properly;
• Stairways are safe - i.e. handrails and banisters;
• Glass doors are protected by plastic film;
• Fire guards are fitted, where appropriate;
• There is adequate floor space, free of hazards - where children can play;
• There is safe storage and protection of ornaments and glassware, and plants, etc;
• The use of free standing paraffin or calor gas fires is prohibited;
• Low level electrical sockets are covered;
• Dangerous liquids, etc. and equipment are stored out of the reach of children;
• There should be no outstanding building work - this represents a hazard;
• Foster Carers Homes should be safe, clean, warm, and well ventilated;
• Bedroom space must be adequate.

Bathroom and Toilet

• There are adequate toilet and washing facilities;
• There is provision for soiled nappies, if appropriate;
• Medicines are out of the reach of children;
• Water temperatures can be controlled so that children are not at risk of scalding.

Kitchen

• Facilities are adequate;
• A fire blanket/extinguisher is available;
• Flexes are not trailing.

Garden

• The garden is fenced and secure;
• It is clean and safe to play in;
• Water containers and ponds are securely covered;
• Garage doors, sheds and greenhouses can be locked;
• Play equipment is safe and secure;
• Dustbins are covered;
• Drains and manhole covers are clean and secure.

Toys and Equipment

• There are sufficient toys and of a suitable range for young children, if appropriate;
• All toys and equipment are safe and clean.

14.3 Safety and Accident Prevention

Burns and Scalds

• Don't drink or eat anything hot with a baby or child on your lap;
• Beware dangling kettle and iron flexes, table cloths, protruding pan handles;
• Always have fire guards in front of all fires when in use.

Falls

• Bouncing chairs on the floor;
• Use straps for high chairs and pushchairs and provide and use stair gates;
• Supervise children in baby walkers;
• Ensure rails round landings and upstairs windows are in place and working.

Choking and suffocation

• Plastic bags, ribbons and strings should be kept away from young children;
• Young children often put small objects including peanuts into the mouth, nose and ears - be vigilant.

Cuts

• Glass doors and low windows must be protected;
• Don't let young children walk around carrying anything made of glass, or other sharp objects including pencils in mouths;
• Keep knives and scissors stored safely.

Poisons

• Medicines must be kept in a locked cabinet out of reach of children;
• Household and garden chemicals must be stored safely;
• Know your plants, berries, seeds and toadstools;
• Teach children not to put anything other than food or drink in their mouths.

Drowning

• Babies and young children can drown in the bath - take care;
• Be vigilant with children in paddling pools or in the sea;
• Ponds should be fenced or covered;
• Teach children about the dangers of water and to swim as early as possible.

Electricity

• Provide safety covers for electric sockets;
• Beware of worn flexes on any appliance;
• Provide a cooker guard if children are very young.

In the Car

• Special baby seats, car seats, seat belts, booster seats, carry cot belts must be used. Check regularly for wear or fault.

15. Safer Caring Plan

Family safer caring plans are about helping children to feel safe but they are also, about ensuring that you are mindful about the possibility of allegations or complaints from children or young people in your care.

Below, are various elements of safer caring that you will need to consider when drawing up your safer caring plan. Discussions and agreements reached must involve the child themselves, subject to their age and level of understanding. Other key people that should be consulted about your safer caring plan include parents of the child where possible, the child's placing Social Worker, your Fostering Social Worker and any adults/children living within your household including any adults that may live out of your home that have responsibilities for babysitting.

Key points that should be included:

General points

Carers should avoid encouraging children to refer to them as "mummy" or "daddy".

Encourage children to call you by your first name, or use another term that the child feels comfortable with.

Where a child indicates that they want to refer to you as "mummy" or "daddy", the views of the child's parents where possible is to be explored and considered.

Showing and receiving Affection

Children and young people in foster care should not be deprived off physical contact.

Carers should ensure they have as much information as possible about the children in placement particularly where abuse is known or suspected. This is of particular importance as some children may view physical affection as a prelude to abuse.

Children are individuals and should be asked how they want their carers or other household members to show affection. When a child is first placed it is important that they know that they can say no about certain aspects of affection should they not feel comfortable. Types of affection may differ over time and should be developed at the pace of the child.

Agreements from an individual child should not affect previous agreements with other children in the household about how affection is shown to them.

Privacy, Personal Care and Bath times

We would advise that children are not invited into a carer's bedroom, there maybe exemptions to this i.e. to view the carer's room as part of introductions or to see a sibling that sleeps in a cot in the carer's room.

Bed sharing is not advisable and the general position is that this should not happen. Occasionally there maybe agreements reached from a therapeutic prospective that it would be appropriate for a very young child to be taken to the foster carer's bed. If a carer feels that other circumstances apply for an individual child then we would ask you to be open with the child's placing Social and your Fostering Social Worker so this can be explored.

Try and find out about the child's previous experiences of bath time i.e. who did the bathing at home or in a previous fostering placement. In the absence of this information you will need to rely on your own communication and observational skills with the child. The most basic advice is to leave doors unlocked and ajar, and encourage children to be as independent as their age; development or disability allows for and be alert to signs of unease.

Bullying

Bullying has to be tackled assertively wherever it occurs and whatever its form. You may need to work alongside school and other agencies to deal with perpetrators and reassure children that may be a victim of bullying that you are committed to keeping them safe.

Caravan's, tents and holidays

Sleeping arrangements whilst away may need to be more flexible and should be discussed with a child's placing social worker prior to going away.

Where a fostering household frequently uses a caravan or tent, sleeping arrangements will be clear within your safer caring plan.

Travelling in cars

Carers must comply with legislation and ensure their car is roadworthy, insured and has age appropriate car seats/seat belts.

Whether children sit in the back or front seats should be based on the foster carer's assessment of safety in the situations that they are facing every day.

Behaviour, discipline and Sanctions

Carers are advised not to drift into play fighting i.e. rough play, tickling without fully thinking this through. Some children are unable to self regulate their own behaviour and may result in them becoming angry or upset.

All sanctions must be imposed by adults, birth children should not be permitted to impose any forms of discipline or sanctions unless they are an approved babysitter.

Training in TCI F is promoted by Hull City Council and must be adhered to at all times.

Physical interventions is termed "any type of physical contact that restricts a child or forces a child to do something" must only be carried out when there is immediate risk of harm to the child or others. Any incidents must be notified to your Fostering Social Worker and agreements will be reached about future behaviour management for that child. In rare circumstances it may be required that carers are training in physical holds.

Overnight Stays, Play Dates and Going Out with Friends

All arrangements will be agreed upon as part of "Delegated Authority" at the point of placement or at subsequent LAC Reviews for the child.

Digital and Internet Technologies

IT equipment provided by Hull Fostering will be monitored by Netopian who provide appropriate monitoring to ensure children and young people can only access sites appropriate to their age and understanding and that any safeguarding concerns that arise are alerted to Fostering.

Location of equipment, supervision levels will be individual led and will form part of a risk assessment. Hull Fostering provides training to its foster carers to assist you in promoting safe internet use.

Dependent on the child's plan there maybe restrictions on the usage of photograph's and this matter should be discussed with the child's placing Social Worker.

Working with Other Agencies and Services

Carers are advised to follow the "Foster Carer Charter" which can be located on our website or in your Fostering Handbook.

Any safeguarding relating to this fostering household

Within your safer caring plan you may need to detail any persons connected to the household that have restricted contact with looked after children.

Finally safer caring plans should not remain static; we recommend that these are regularly reviewed through supervision with your Fostering Social Worker. Changes in family dynamics i.e. a new child moving in should prompt a review of your plan as well following an allegation or complaint. The template Safer Caring Plan for use by Foster Carers can be accessed here.

16. Body Piercing and Tattoos

It is illegal for tattooists to tattoo anyone under 18 years old, even with Parental Consent. Children can have their bodies pierced at any age.

Children who express an interest in body piercing or tattoos should be treated on a case by case basis depending on their age and level of understanding, but on principle, Foster Carers and members of staff in children's homes should discourage them, pointing out the possible implications and health care risks; for example, from unsafe materials, needles etc.

Under no circumstances may Foster Carers or members of staff encourage or give consent to children to have their bodies pierced without explicit agreement between the child's parents and the child's Social Worker. If children appear determined to have their bodies pierced, they should be asked to discuss the matter with their Parent(s) and Social Worker beforehand.

Whether Consent is given or not, children cannot be prevented from being pierced. If they continue to be determined, Foster Carers and member of staff in children's homes should ensure that measures used for piercing are as safe and hygienic as possible; preferably undertaken by a reputable person.

Piercings may not be undertaken or in any way supported by Staff.

If a child does allow their body to be pierced or tattooed, the Social Worker must be informed and asked to decide whether to notify the Parents.

17. Caring for Babies

All Carers should seek direct advise from their appropriate medical practitioner or Health Visitor. There is no sure way to prevent Sudden Infant Death Syndrome, a rare occurrence, but studies have shown that the following precautions reduce the risk:

17.1 Sleeping Position

Babies should be laid down to sleep: (a) on their backs or (b) on their sides with the lower arm forward to stop them rolling over. Do not be worried that babies might be sick and choke if laid on their backs there is no evidence that this happens. Some babies who require special care or who have particular medical problems need to be nursed on their tummies. Your doctor, or health visitor, will explain why.

For babies who have been sleeping on their tummies try them on their backs or sides. They may not like the change and find it difficult to settle. If this happens then it is probably wise not to upset them by insisting on the new position. If you are at all worried then speak to your health visitor or doctor. The right sleeping position is only important until babies are able to roll themselves over in their sleep. Once they can do this it is safe to let them take whichever position they prefer.

17.2 Temperature

Babies should be kept warm, but they must not be allowed to get too warm. Keep the temperature in the baby's room so that you can feel comfortable in it. Use light weight blankets which you can add to, or take away according to the room temperature. Do not use a duvet or baby nest which can be too warm and can easily cover a baby's head. All bedding should have a British Standard Safety Mark on it.

17.3 Recommended Developmental Reviews

Health and development checks are usually done by the family doctor and the health visitor. Young children should be seen at 6-8 weeks; 6-9 months; 18-24 months and then at 36-48 months. Sometimes the regular developmental review is included when the child has a statutory medical examination. Foster Carers should check that this is the case. Parents need to be consulted about these reviews and may wish to be present or take the child.

17.4 Milestones: Infants aged 0-1 years, 1-2 years

Babies develop according to a recognized pattern. Milestones are the ages at which a child first smiles, sits, crawls, walks, etc. It is a good idea to keep a record of when Milestones are reached. This information may be very helpful when assessing a child's development. It is also of interest to the child as he or she grows up and may be included in the life story book. The personal child health record, as issued by Health Trusts, includes the times of developmental reviews.