This guideline covers the signs of possible child maltreatment in children and young people aged under 18 years. It aims to raise awareness and help health professionals who are not child protection specialists to identify the features of physical, sexual and emotional abuse, neglect and fabricated or induced illness.  

In October 2017, NICE published a guideline on child abuse and neglect. Recommendations relevant to both health and social care practitioners appear in this guideline and the child abuse and neglect guideline. Clinical features (including physical injuries) are covered in this guideline. We made minor edits to recommendations 1.3.2 to 1.3.4, 1.3.10, 1.3.12, 1.4.1 to 1.4.5, 1.4.12, 1.4.13 and 1.5.1 to 1.5.5 in line with NICE’s guideline on child abuse and neglect. We also added a link in recommendation 1.3.6 to NICE's guideline on faltering growth and recommendation 1.4.8 was updated with information on Prader–Willi syndrome.


This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals

Is this guideline up to date?

January 2024: We have checked the evidence and plan to update recommendation 1.1.2 on when to suspect child maltreatment if there is bruising or petechiae not caused by a medical condition. For more information, see the surveillance decision.

Guideline development process

How we develop NICE guidelines

This guideline was previously called when to suspect child maltreatment.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.