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When to suspect child maltreatment overview

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These are the paths in the When to suspect child maltreatment pathway:

When to suspect child maltreatment HAI

About

What is covered

This pathway covers the alerting features in children and young people (under 18 years) of physical, sexual and emotional abuse, neglect and fabricated or induced illness.
The effects of child maltreatment can be severe and last into adulthood.
Children may present with both physical and psychological symptoms and signs that constitute alerting features of one or more types of maltreatment.
Maltreatment may be observed in parent– or carer–child interactions.

Updates

Updates to this pathway

22 July 2014 Link to constipation pathway added
9 January 2014 Footnote 1 in the Sexual abuse node has been further amended to ensure it accurately reflects Crown Prosecution Service guidance.
A new footnote has also been added to this node reflecting Crown Prosecution Service guidance.
2 January 2014 Minor maintenance updates
22 March 2013 Minor maintenance updates
8 February 2013 Minor maintenance updates
29 May 2012 Minor maintenance updates

Topics outside the scope of this pathway

The following topics were outside the scope of this pathway and have therefore not been covered:
  • risk factors for child maltreatment, which are well recognised (for example, parental or carer drug or alcohol misuse, parental or carer mental health problems, intrafamilial violence or history of violent offending, previous child maltreatment in members of the family, known maltreatment of animals by the parent or carer, vulnerable and unsupported parents or carers, pre-existing disability in the child)
  • protection of the unborn child
  • children who have died as a result of child maltreatmentIt should be noted that there are special procedures that should be followed when a child dies unexpectedly.
  • diagnostic assessment and investigations (for example, X-rays)
  • treatment and care of the child if maltreatment is suspected
  • how healthcare professionals should proceed once they suspect maltreatment
  • healthcare professionals' competency, training and behaviour
  • service organisation
  • child protection procedures
  • communication of suspicions to parents or carers, or the child or young person
  • education and information for parents or carers, or the child or young person.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Short Text

This pathway covers the alerting features in children and young people (under 18 years) of physical, sexual and emotional abuse, neglect and fabricated or induced illness.

What is covered

This pathway covers the alerting features in children and young people (under 18 years) of physical, sexual and emotional abuse, neglect and fabricated or induced illness.
The effects of child maltreatment can be severe and last into adulthood.
Children may present with both physical and psychological symptoms and signs that constitute alerting features of one or more types of maltreatment.
Maltreatment may be observed in parent– or carer–child interactions.

Updates

Updates to this pathway

22 July 2014 Link to constipation pathway added
9 January 2014 Footnote 1 in the Sexual abuse node has been further amended to ensure it accurately reflects Crown Prosecution Service guidance.
A new footnote has also been added to this node reflecting Crown Prosecution Service guidance.
2 January 2014 Minor maintenance updates
22 March 2013 Minor maintenance updates
8 February 2013 Minor maintenance updates
29 May 2012 Minor maintenance updates

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
When to suspect child maltreatment. NICE clinical guideline 89 (2009)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Topics outside the scope of this pathway

The following topics were outside the scope of this pathway and have therefore not been covered:
  • risk factors for child maltreatment, which are well recognised (for example, parental or carer drug or alcohol misuse, parental or carer mental health problems, intrafamilial violence or history of violent offending, previous child maltreatment in members of the family, known maltreatment of animals by the parent or carer, vulnerable and unsupported parents or carers, pre-existing disability in the child)
  • protection of the unborn child
  • children who have died as a result of child maltreatmentIt should be noted that there are special procedures that should be followed when a child dies unexpectedly.
  • diagnostic assessment and investigations (for example, X-rays)
  • treatment and care of the child if maltreatment is suspected
  • how healthcare professionals should proceed once they suspect maltreatment
  • healthcare professionals' competency, training and behaviour
  • service organisation
  • child protection procedures
  • communication of suspicions to parents or carers, or the child or young person
  • education and information for parents or carers, or the child or young person.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Supporting information

Glossary

Under 13 years
Includes physical, emotional and sexual abuse, neglect, and fabricated or induced illness. The definitions of child maltreatment in Working together to safeguard children (2010) are used in this guidance.
Maltreatment is one possible explanation for the alerting feature or is included in the differential diagnosis.
Transient episodes of detachment that are outside the child's control and that are different from daydreaming, seizures or deliberate avoidance of interaction.
Repeatedly defecating a normal stool in an inappropriate place.
Under 1 year
Serious level of concern about the possibility of child maltreatment but not proof of it.
An unsuitable explanation is one that is:
  • implausible, inadequate or inconsistent:
    • with the child or young person's presentation, normal activities, medical condition (if one exists), age or developmental stage, or account compared with that given by parent and carers
    • between parents or carers
    • between accounts over time
  • based on cultural practice, because this should not justify hurting a child or young person.
13–17 years

Paths in this pathway

Pathway created: January 2012 Last updated: July 2014

Copyright © 2014 National Institute for Health and Care Excellence. All Rights Reserved.

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