Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Immediate danger or inflicted life-threatening injury
Airway, intracranial, abdominal, skeletal and poisoning injuries from abuse can be occult or recurrent, while discharge to an unsafe setting permits further harm.
Action: Treat ABCDE and pain first, separate alleged perpetrator when safe, involve senior paediatric or adult and safeguarding clinicians immediately, document exact histories and complete examination objectively, preserve evidence, and do not discharge until a statutory safety and information-sharing plan is agreed.
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.
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.
Investigation priorities
01
First-line full clinical and record reviewFirst stepFirst line
Define injury, development, chronology and previous concerns.
Management branches
ImmediateTreat and preserve safety
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.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.