Intended for healthcare professionals

Student Practical skills

An introduction to safeguarding

BMJ 2018; 360 doi: https://doi.org/10.1136/sbmj.j5647 (Published 12 February 2018) Cite this as: BMJ 2018;360:j5647
  1. Marina Soltan, academic foundation year 2 doctor1,
  2. Anthony Choules, consultant paediatrician2
  1. 1West Midlands Deanery, UK
  2. 2Queen’s Hospital, Burton upon Trent, UK

How to identify signs of child maltreatment and raise concerns

As a doctor, it is your duty to safeguard children and vulnerable adults by protecting them from abuse and neglect.1

Safeguarding is defined as protecting children from maltreatment, preventing impairment of children’s health or development, ensuring that children grow up in circumstances consistent with the provision of safe and effective care, and taking action that enables all children to have the best outcomes.2

Children can present with features of maltreatment to primary and secondary care centres, and to community services.3 In your role as a medical student or junior doctor, when you clerk patients, you are responsible for identifying when a child may have been maltreated and escalating your concerns to a senior member of staff or a designated safeguarding colleague in your area. Different professionals who deal with children, including healthcare professionals, each hold part of the picture of a child who is being maltreated; therefore, as a medical student or junior doctor, you can play an important part in contributing to the understanding of what might be going on.

Identifying child maltreatment

The National Institute for Health and Care Excellence (NICE) defines child maltreatment in three ways4:

  • Physical abuse

  • Physical and emotional neglect

  • Sexual abuse

Physical abuse

Suspected cases of maltreatment or neglect should be reported when there is no explanation for an injury or the child’s history does not correlate with examination findings. Keep a lookout for the following:

  • Bruises and injuries that are not consistent with the stated mechanism of injury, or are …

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