Intended for healthcare professionals

Practice Guidelines

When to suspect child maltreatment: summary of NICE guidance

BMJ 2009; 339 doi: (Published 22 July 2009) Cite this as: BMJ 2009;339:b2689
  1. Julia Saperia, lead research fellow1,
  2. Monica Lakhanpaul, clinical co-director1, senior lecturer child health2,
  3. Alison Kemp, professor of child health3,
  4. Danya Glaser, consultant child and adolescent psychiatrist4
  5. on behalf of the Guideline Development Group and Technical Team.
  1. 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA
  2. 2University of Leicester, Department of Medical Education and Social Care, Leicester Royal Infirmary, Leicester
  3. 3School of Medicine, Cardiff University, University Hospital of Wales, Cardiff CF14 4XN
  4. 4Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London WC1N 3JH
  1. Correspondence to: D Glaser dglaser{at}

    Why read this summary?

    Maltreatment of children is common, with 538 500 reported referrals to social services departments in England1 and 43 411 in Wales2 in the year ending 31 March 2008, although these probably underestimate the true scale of the problem. Child maltreatment includes neglect; physical, sexual, and emotional abuse; and fabricated or induced illness. It may present in various ways to different healthcare professionals, who have a “duty . . . to be proactive in safeguarding children”3 but often find it difficult to act on what they find.

    Child maltreatment has short and long term harmful effects on a child’s health and wellbeing; emotional, interpersonal development; and behaviour; and in extreme circumstances it may lead to death. Children may present with both physical and psychological symptoms and signs that constitute alerting features of one or more types of maltreatment, which may also be observed as part of the interaction between the parent or carer and the child.4 The effects of maltreatment may continue throughout adulthood and include physical disability or disfigurement as well as the profound psychological consequences of anxiety, depression, substance misuse, and self destructive or antisocial behaviours, which may lead to difficulties in forming or sustaining close relationships, sustaining employment, and parenting capacity.3

    Child maltreatment is under-recognised and inconsistently reported to children’s social care by healthcare professionals in England and Wales.5 The recent death of Baby Peter is yet another reminder of the consequences of missing the alerting features of child maltreatment.6 The recently published guidance from the National Institute for Health and Clinical Excellence (NICE) aims to raise the awareness of healthcare professionals to the alerting features of child maltreatment.7 It also aims to support healthcare professionals who are not specialists in child protection in identifying children who may be being maltreated and …

    View Full Text

    Log in

    Log in through your institution


    * For online subscription