Guidance aims to spot child abuse

A watchdog has issued guidance to help healthcare workers spot early signs of child abuse to avoid another Baby P. Experts say the National Institute for Health and Clinical Excellence advice could mean more referrals of children who may not be at risk.

But it will ensure more of the right children are referred early for protection from abuse and neglect.

Last year’s 538,000 child referrals to social services is an underestimate of the numbers maltreated, they say.

Up to one in 10 children will suffer some form of maltreatment during their childhood, which includes neglect and emotional abuse as well as physical and sexual abuse.
   
This guidance is also about identifying the parents who need more help to look after their children
Dr Danya Glaser, chair of the guideline development group

But it can be difficult to spot when a child is at risk and what constitutes abuse.

The guidelines were in development long before the case of Baby Peter, who died in 2007 aged 17 months after suffering more than 50 separate injuries.

They give a summary of some of the signs to look for that should alert a healthcare worker that abuse might be occurring.

Warning signs

Unusual injuries without a suitable explanation, or a child who is consistently dressed in clothes or shoes that are inappropriate, tells the GP or other health worker to consider maltreatment and to keep a close eye, for example.

Some signs, such as bruising in the shape of a hand or a child who is persistently smelly and dirty or suffering persistent infestations such as scabies or head lice, are more suspect and should prompt referral to social care, says the guidance.
   
The authors say the advice is to protect children and not to punish parents.

Dr Danya Glaser, chair of the guideline development group and a consultant and child and adolescent psychiatrist at London’s Great Ormond Street Hospital, said: “Parenting is difficult, parents often do not intend to harm their children and this guidance is also about identifying the parents who need more help to look after their children.”

Dr Sheila Shribman, the national clinical director of children, young people and maternity services, said: “Spotting the signs of child maltreatment and protecting vulnerable children is an important but often difficult challenge for healthcare professionals.”

For example, a GP may be concerned that action may lead to more harm to the child or the relationship with the family.

Professor Steve Field, chairman of the Royal College of General Practitioners, said GPs played a crucial role, as they were often the first port of call for children and their families.

He said: “Maltreatment of children is an important problem and this guidance is helpful because it can often be extremely difficult for the GP to make the necessary decisions.

“We know that child maltreatment has been under-diagnosed in the past and all new GPs now routinely receive training in this area to recognise the possible presentations and understand how to deal with them.

“Sometimes the action we take can be straightforward; sometimes it can be much more difficult.”

Dr Rosalyn Proops, Child Protection Officer, Royal College of Paediatrics and Child Health, said: “Raising concerns about a child who may be harmed should now be much clearer for the health professionals who, when following the guidelines, will make decisions based upon evidence.”

Dr Ffion Davies of the College of Emergency of Medicine welcomed the evidence-based guidelines.

“Spotting children ‘at risk’ is a crucial role of the emergency department, where several million children per year attend with injuries and other problems.”