This guidance provides a summary of the clinical features associated with maltreatment (alerting features) that may be observed when a child presents to healthcare professionals. Its purpose is to raise awareness and help healthcare professionals who are not specialists in child protection to identify children who may be being maltreated. It does not give healthcare professionals recommendations on how to diagnose, confirm or disprove child maltreatment.

Children may present with both physical and psychological symptoms and signs that constitute alerting features of one or more types of maltreatment, and maltreatment may be observed in parent– or carer–child interactions.

Contents

• Correction to the full version published in July 2009
• Guideline Development Group membership and acknowledgements
• 1. Guidance summary
  • 1.1. Summary
  • 1.2. How to use this guidance – summary
  • 1.3. Recommendations
  • 1.4. Research recommendations
• 2. Background and scope
  • 2.1. Child maltreatment
  • 2.2. Aim of the guidance
  • 2.3. Understanding the obstacles to recognising maltreatment
  • 2.4. Areas outside the scope of the guidance
  • 2.5. Terms used to describe age groups
  • 2.6. Definitions of child maltreatment
  • 2.7. For whom is the guidance intended?
  • 2.9. Who has developed the guidance?
  • 2.10. Other relevant documents
  • 2.11. Guideline development methodology
  • 2.12. Schedule for updating the guidance
• 3. How to use consider and suspect in this guidance
  • 3.1. Consider and suspect definitions
  • 3.2. How to use consider and suspect
  • 3.3. Communicating with and about the child or young person
• 4. Physical features
  • 4.1. Injuries
  • 4.2. Anogenital symptoms, signs and infections
• 5. Clinical presentations
  • 5.1. Pregnancy
  • 5.2. Dehydration
  • 5.3. Apparent life-threatening events
  • 5.4. Poisoning
  • 5.5. Non-fatal submersion injury (near-drowning)
  • 5.6. Attendance at medical services
  • 5.7. Fabricated or induced illness
  • 5.8. Inappropriately explained poor school attendance
• 6. Neglect – failure of provision and failure of supervision
  • 6.1. Provision of basic needs
  • 6.2. Supervision
  • 6.3. Ensuring access to appropriate medical care or treatment
• 7. Emotional, behavioural, interpersonal and social functioning
  • 7.1. Emotional and behavioural states
  • 7.2. Behavioural disorders or abnormalities either seen or heard about
• 8. Parent–child interactions
  • GDG considerations
• Appendix A. Declarations of interest
• Appendix B. Clinical question
• Appendix C. Delphi consensus surveys
• Appendix D. Stakeholder organisations
• Appendix E. Abbreviations
• Appendix F. Glossary of terms
• References
• Excluded studies
• Search strategies
• Evidence Tables

Revised reprint Dec 2009

Update 2013: The recommendation which states "Be aware that sexual intercourse with a child younger than 13 years is unlawful and therefore pregnancy in such a child means the child has been maltreated" (pages 8 and 55) should be accompanied by a footnote which states the following: "Under the sexual Offences Act 2003, any sexual intercourse with a girl younger than 13 years is unlawful and will be charged as rape. It is illegal for children aged 13-15 years to have sexual intercourse. However, The Crown Prosecution Service guidance instructs that children of these age groups involved in consensual experimentation should not be prosecuted."

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.

This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient.

Implementation of this guidance is the responsibility of local commissioners and/or providers.