Child maltreatment: when to suspect maltreatment in under 18s

  • Clinical guideline
  • CG89
  • Published: 
  • Last updated: 
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Using this guidance

If a healthcare professional encounters an alerting feature of possible child maltreatment that prompts them to consider, suspect or exclude child maltreatment as a possible explanation, it is good practice to follow the process outlined in 1 to 5 below:

1. Listen and observe

Identifying or excluding child maltreatment may involve piecing together information from many sources so that the whole picture of the child or young person is taken into account. This information may come from different sources and agencies and includes:

  • any history that is given

  • report of maltreatment, or disclosure from a child or young person or third party. It is standard practice to refer to children's social services when a child or young person makes a disclosure of maltreatment (even though it may not be precise in every detail).

  • child's appearance

  • child's behaviour or demeanour

  • symptom

  • physical sign

  • result of an investigation

  • interaction between the parent or carer and child or young person.

2. Seek an explanation

Seek an explanation for any injury or presentation from both the parent or carer and the child or young person in an open and non-judgemental manner.

Disability

Alerting features of maltreatment in children with disabilities may also be features of the disability, making identification of maltreatment more difficult. Healthcare professionals may need to seek appropriate expertise if they are concerned about maltreatment in a child or young person with a disability.

3. Record

  • Record in the child or young person's clinical record exactly what is observed and heard from whom and when.

  • Record why this is of concern.

At this point the healthcare professional may consider, suspect or exclude child maltreatment from the differential diagnosis.

4. Consider, suspect or exclude maltreatment

Consider

At any stage during the process of considering maltreatment the level of concern may change and lead to exclude or suspect maltreatment.

When hearing about or observing an alerting feature in the guidance:

  • look for other alerting features of maltreatment in the child or young person's history, presentation or parent– or carer–interaction with the child or young person now or in the past.

Then do one or more of the following:

  • discuss your 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, having used professional judgement about whether to explain the need to gather this information for an overall assessment of the child

  • ensure review of the child or young person at a date appropriate to the concern, looking out for repeated presentations of this or any other alerting features.

Suspect

If an alerting feature or considering child maltreatment prompts a healthcare professional to suspect child maltreatment they should refer the child or young person to children's social care, following local multi-agency safeguarding arrangements.

This may trigger a child protection investigation, supportive services may be offered to the family following an assessment or alternative explanations may be identified.

Exclude

Exclude maltreatment when a suitable explanation is found for alerting features. This may be the decision following discussion of the case with a more experienced colleague or after gathering collateral information as part of considering child maltreatment.

5. Record

Record all actions taken in 4 and the outcome.