In July 2009, NICE published guidance for healthcare professionals (HP) regarding how to identify child maltreatment.

The guidance lists some “alerting features” of potential maltreatment, such as signs of physical abuse, unusual clinical presentations (eg, pregnancy), evidence of neglect, and emotional abuse. It then outlines a best practice process for healthcare professionals to adopt, should they encounter an alerting feature. These include:

  • Listening and observing: taking into account the whole picture of the child/young person using all the sources of information available.
  • Seeking an explanation for the alerting feature. Unsuitable explanations are defined as ones that are implausible, inadequate or inconsistent and ones that are based on cultural practice.
  • Making a record of exactly what is observed and heard from whom and when into the child/young person’s clinical record and explain why it is of concern.  

The healthcare professional must then reach a conclusion as to whether they “consider” maltreatment (defined as circumstances where maltreatment is a possible explanation), “suspect” maltreatment (defined as a serious concern about the possibility of maltreatment), or “exclude” the possibility of maltreatment.

If maltreatment is considered, healthcare professionals are required to look for other alerting features in the child/young person’s history and either discuss any concerns with an appropriate health professional (more experienced colleague, community paediatrician, named nurse or child/adolescent mental health service colleague), gather collateral information from other agencies and health disciplines, or ensure a review is carried out at an appropriate later date.

If maltreatment is suspected, the child must be referred to children’s social care, following Local Safeguarding Children Board procedures.

The guidance can be found here.