Recognise Abuse or a Child at Risk

Last Updated on by FRCEM Intermediate

Categories of abuse

  • Physical abuse
  • Emotional abuse
  • Sexual abuse
  • Neglect

Risk factors

  • History of abuse: Previous history of child maltreatment in the family (health visitors and social workers may have useful information).
  • Domestic violence. Also domestic/marital conflict, and history of violent offending in the family.
  • Family psychiatric history: Mental health disorders, learning disability, physical illness or disability in the carers.
  • Drug or alcohol misuse: Drug or alcohol misuse in the carers – especially if unstable or chaotic drug misuse.
  • Unemployment: Housing or financial problems.
  • Life-limiting illness: Disability or long-term chronic illness in the child.
  • Single parents, especially if immature or unsupported.
  • History of animal/pet maltreatment.
  • Child or siblings are known to authorities: Children in the care system.
  • Some children are vulnerable to being “lost” by the system – for example, where the families are homeless or asylum seekers, or where children are carers or young offenders.



  • History of presenting complain — consistency of injury with the mechanism
  • Other injuries sustained
  • Past History:? other injuries
  • Developmental history
  • Social circumstances: socio-economic status, illicit drug dependence, other dependents
  • Failure to provide access to appropriate medical care or education(do not administer prescribed medication,failure to attend appointments, failure to engage with immunisations,screening and reviews,Unjustified poor attendance at school)
  • Consistencies in mother’s history; correlation with other sources
  • Collateral history important. Liaise with GP and other sources

Examination of Child

  • Observe the mother’s interaction with the child
  • Vital signs & GCS
  • Neurological examination including fundoscopy for retinal haemorrhages
  • Developmental: physical (height, weight & head circumference) and neurological

General examination:

  • Signs of neglect (general hygiene, dermatitis, poor clothing, poor medical care, malnutrition(evidence of failure to thrive)
  • Consider maltreatment where there has been a delay in presentation.
  • Bruising, burns, old fractures and injuries
    • Bruising or Burns and scalds in the shape of an object – fingertips, hand, ligature, stick, teeth mark or implement such as belt buckle,thermal injuries- iron, cigarette end
    • Any bruising, Lacerations, abrasions, Burns and scalds on a non-mobile baby (especially facial bruising).
    • Bruising or petechiae in the absence of a medical condition which do not have a suitable explanation
    • Multiple bruises, lesions, Lacerations, abrasions and scars
    • Bruises, lesions, Lacerations, abrasions, and scars of similar size and shape
    • Bruises, at sites where accidental bruising is unusual: face, eyes, ears (bruising around the pinna may be subtle), the ‘safe triangle’ of the neck (the neck and top of the shoulder), inner arms, buttocks, abdomen, groins – areas usually covered by clothing.
    • Bruising suggestive of strangulation on the neck.
    • Human bites,Animal bites
    • fractures: different ages.,The explanation is not consistent with the injury.,occult fractures on X-ray.,The child is not independently mobile.
    • There are associated retinal hemorrhages, rib or limb fractures, or other associated injuries.There are multiple subdural haemorrhages.


  • Behavior: detached, depressed, hostile, defensive
  • Drug affected,
  • unkempt
  • poor eye contact


  • Manage the injuries accordingly
  • if NAI suspected – safeguard Children
  • Inform named professional for child protection in a hospital or a consultant pediatrician
  • Refer to the local child social services.
  • if a risk of immediate serious harm, inform to the police
  • Notify the GP of hospital/A&E attendances


Was this article helpful?

Related Articles

Leave A Comment?

This site uses Akismet to reduce spam. Learn how your comment data is processed.