Recommendations for research

The guideline development group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. The guideline development group's full set of research recommendations is detailed in the full guideline.

1 Fractures

How can abusive fractures be differentiated from those resulting from conditions that lead to bone fragility and those resulting from accidents, particularly in relation to metaphyseal fractures?

Why this is important

The existing evidence base does not fully account for the features that differentiate fractures from different causes in infants and pre-school age children. A prospective comparative study of fractures in physical abuse, those resulting from conditions that lead to bone fragility and those resulting from accidental trauma would help address this question. Any such study should encompass a study of metaphyseal fractures.

2 Anogenital warts

What is the association between anogenital warts and sexual abuse in children of different ages?

Why this is important

Anogenital warts can be acquired by vertical transmission, sexual contact and by non-sexual transmission within households. A thorough prospective study is needed to investigate the differential causes of anogenital warts in children. Such a study should include full viral typing of the warts in the index case and contacts where possible.

3 Fabricated or induced illness

Are the indicators of fabricated or induced illness as described in the recommendations (see recommendations 1.2.11 and 1.2.12) valid for discriminating fabricated or induced illness from other explanations?

Why this is important

Although the alerting signs have been developed based on clinical experience and are considered clinically useful in detecting fabricated or induced illness, there is a need to establish their discriminant validity. This could be achieved by a prospective longitudinal study.

4 Emotional and behavioural states

What aspects of behaviours and emotional states as alerting individual signs discriminate maltreated children from non-maltreated children in the healthcare setting?

Why this is important

Much of the research in this area uses composite scores from instruments or scenarios to discriminate maltreated from non-maltreated children. To translate these scores into items that are usable for healthcare professionals who are meeting children for the first time, it is necessary to know whether particular behavioural and emotional states can be used to identify maltreated children. A prospective comparative study in the healthcare setting is required.

5 Recurrent abdominal pain

What is the association between unexplained recurrent abdominal pain and child maltreatment?

Why this is important

Recurrent abdominal pain is a common presentation in primary care and is often unexplained. A large observational study on the association between unexplained recurrent abdominal pain and child maltreatment is needed.