Synopsis
Recognise skin findings that merit safeguarding consideration, stabilise medical emergencies, document neutrally, distinguish important mimics, and use proportionate child and adult protection pathways without claiming that morphology proves causation.
- A skin finding can raise concern but rarely establishes cause by itself; combine morphology with development, mechanism, timing, health history, behaviour and wider examination.
- Any unexplained bruise in a baby who is not independently mobile is uncommon and needs prompt paediatric assessment, while concern is not the same as a concluded diagnosis of abuse.
- Protected-site, patterned, clustered or unusually numerous bruises and an account inconsistent with the child's abilities increase concern and justify escalation.
- Clearly demarcated immersion burns, patterned contact burns, cigarette-like burns or lesions of different ages are concerning, but accidental, cultural and medical mimics must be examined.
- Congenital dermal melanocytosis, capillary and melanocytic birthmarks, phytophotodermatitis, bleeding disorders, vasculitis, infection and connective-tissue disease can resemble inflicted injury.
- Lichen sclerosus, irritant dermatitis, constipation fissures, infections and acute genital ulcers can cause genital findings; no single lesion automatically proves or excludes sexual harm.
- Treat pain, infection, bleeding and other urgent illness at once; safeguarding assessment and necessary healthcare proceed together.
- Use open prompts, record spontaneous words verbatim and avoid leading questions, repeated interviews or asking the child to demonstrate the event.
- Explain examination and photography, obtain consent and age-appropriate assent, use a chaperone and expose only what is necessary; clinical images need a scale, label and secure storage.
- Share relevant information with the right professionals when necessary for protection, record the legal and clinical reasoning and never promise absolute secrecy.
Key red flags
Bruising in a non-mobile infant, patterned or clustered injury, burns with clear demarcation or immersion distribution, injury to protected sites, multiple injuries of different apparent ages, an implausible or changing account, delay in seeking care, disclosure, coercive behaviour, unsafe discharge or serious medical symptoms warrants prompt senior safeguarding assessment.
A direct disclosure, threatening accompanying person, strangulation symptom, unsafe home plan or serious associated injury requires action even if the skin finding itself is non-specific.
Investigation priorities
Treat illness and identify the full injury and medical-differential pattern.
Management branches
A skin finding or account creates reasonable safeguarding concern without an immediate resuscitation emergency.
- Treat pain and illness, speak with the child or adult safely, use open prompts and record spontaneous words verbatim without seeking a detailed investigative narrative.
- Perform the minimum necessary systematic examination with consent, assent and a chaperone and document objective measurements and a medical differential.
- Discuss promptly with the named safeguarding professional and make the appropriate social-care or police referral according to local thresholds, recording the safe disposition and owner.