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When to suspect child maltreatment

More than 530,000 children and young people identified ‘at risk' of maltreatment were referred to social services departments in England in the 12 months to 31 March 2008 (Department for Children, Schools and Families 2008). But the actual number being affected is likely to be much higher.

Maltreatment can affect all aspects of a child or young person's health, development and wellbeing. It can result in anxiety, depression, substance misuse and self-destructive or antisocial behaviour. Physical abuse may result in lifelong disability or physical scarring, as well as psychological damage - and may even be fatal.

As adults, children and young people who have been maltreated may find it difficult to form or sustain close relationships, maintain a job or cope with being parents.

‘The high cost of abuse and neglect both to individuals (and to society) underpins the duty on all agencies to be proactive in safeguarding children,' states the National service framework for children, young people and maternity services for England.

NICE is now offering practical advice to healthcare professionals involved with children and young people aged under 18 years to help prevent and combat this abuse.

‘When to suspect child maltreatment', which was published in July, provides a summary of the ‘alerting features' that could suggest a child or young person is being maltreated. These have been divided into two categories or ‘levels'.

One level prompts the healthcare professional to consider whether there is a problem, by looking for other signs in the child or young person's history and presentation or in their interaction with their parents or carers (now or in the past). In addition, it advises them to do one or more of the following:

  • Discuss their concerns with a more experienced colleague, a community paediatrician, child and adolescent mental health service colleague, or a named or designated professional for safeguarding children.
  • Gather collateral information from other agencies and health disciplines.
  • Ensure the child or young person is reviewed at a date appropriate to the concern, looking out for repeated presentations of this or any other alerting features.

At any stage, the healthcare professional can halt the process if they no longer believe there is a cause for concern. Alternatively, if as a result of the above actions, they suspect maltreatment, they are advised to ‘refer the child or young person to children's social care, following Local Safeguarding Children Board procedures'. They are also advised to carefully observe and record their concerns.

Danya Glaser, Chair of our Guideline Development Group that produced the recommendations and a Consultant Child and Adolescent Psychiatrist, explains: "Healthcare professionals can find it difficult to acknowledge and act on the signs of maltreatment and may be concerned that action may lead to more harm to the child or the relationship with the family. However, this should not preclude them from following the appropriate course of action to prevent further harm to the child.”

She adds: “Parents often do not intend to harm their children and this guidance is also about identifying the parents who need more help to look after their children."

More than 12,700 copies have been ordered by healthcare professionals and local authorities since the guideline was published in July.

It can be read here.

Issued: 14 September 2009

This page was last updated: 10 May 2010

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.