Synopsis
Recognise injury patterns and contextual concerns that may indicate abuse or neglect, treat urgent medical needs, preserve objective evidence, and share concerns promptly through child and adult safeguarding pathways.
- Treat life-threatening injury and pain immediately; safeguarding assessment runs in parallel and must not delay CT, surgery, antibiotics or other necessary care.
- Record who gave each history, their exact words, timing, developmental abilities, witnesses, changes and previous attendances without accusatory or interpretive language.
- Examine the fully exposed patient with consent and chaperone, map every injury, photograph under policy with a scale and record normal as well as abnormal findings.
- In children, consider abuse when an explanation is absent or unsuitable, especially with bruising in a non-mobile baby, patterned lesions, fractures of differing age or high-specificity rib and metaphyseal patterns.
- Use a paediatrician-led investigation plan: blood tests, skeletal survey, CT or MRI head, ophthalmology and abdominal assessment are selected by age and findings and should not be improvised in isolation.
- Speak with a competent adult or developmentally appropriate child privately when safe, use open non-leading questions and never promise absolute confidentiality.
- Share necessary information promptly with the named safeguarding lead and children's or adult social care; immediate danger may also require police, while consent is not always required to prevent serious harm.
- Do not discharge, transfer or alert an alleged perpetrator without a documented multi-agency safety plan and clear handover of every medical, evidential and statutory action.
Key red flags
History that changes, is delayed, lacks explanation, conflicts with developmental ability or does not account for injury severity should prompt safeguarding assessment without assuming guilt from one discrepancy.
Bruising in a non-mobile baby, patterned injury, multiple injuries at different healing stages, unexplained fracture, burn, intracranial or abdominal trauma requires urgent senior child-protection evaluation.
Fearful behaviour, controlling companion, repeated delayed attendance, medication withholding, poor hygiene, pressure injury, malnutrition, genital trauma or unexplained financial and care dependence can indicate adult abuse or neglect.
Investigation priorities
Define injury, development, chronology and previous concerns.
Management branches
An injury or disclosure raises possible abuse, neglect or immediate danger.
- Run ABCDE, provide analgesia and complete time-critical imaging or surgery while alerting senior clinical and safeguarding staff.
- Separate the patient from a suspected perpetrator when safe, use a professional interpreter and ask open non-leading questions.
- Document exact words, developmental context, full examination, body maps and policy-compliant photographs and preserve forensic material.
- Contact statutory safeguarding services and police for immediate danger under the local pathway, recording the name, time and agreed safety action.