Synopsis
Recognise and respond to child maltreatment and exploitation without attempting an investigation, share information proportionately through the correct national pathway, and use ACE and trauma-informed concepts without deterministic scoring or forced disclosure.
- Create a child-centred encounter: adapt to age, development, disability, neurodivergence, language and communication, offer private discussion when safe, and explain confidentiality and its limits.
- Listen calmly and use open, non-leading prompts only to clarify immediate safety and healthcare needs; clinicians should not conduct the investigative interview or repeatedly elicit the story.
- Record who said or observed what, when and where, separating fact from interpretation and preserving the child's own words where possible.
- Do not wait for certainty, a complete account, a safeguarding meeting or a designated professional to become available when urgent protection or referral is needed.
- NICE uses consider when maltreatment is one possible explanation and suspect when concern is serious; neither word means that abuse is proved.
- Seek and record the child's views and explain proposed sharing where safe, but consent is not a prerequisite, and often is not the appropriate data-protection basis, for safeguarding. Apply the nation-specific concern or reporting threshold and lawful basis, sharing information that is necessary, proportionate and sufficient for the recipient to act.
- England's Working Together to Safeguard Children 2026 is statutory guidance for England, not for the whole UK; Wales, Scotland and Northern Ireland have distinct national frameworks and local routes.
- ACEs are population-level exposures associated with later risk, not an individual diagnosis, prognosis or destiny; never use a total ACE score to predict outcome or ration support.
- Assess present safety, health, functioning, strengths, protective relationships and specific exposures rather than replacing clinical formulation with a trauma label.
- Trauma-informed care promotes safety, trust, choice, collaboration, empowerment and cultural awareness; it neither requires a detailed trauma narrative nor replaces evidence-based trauma treatment or safeguarding action.
Key red flags
A child says they are unsafe, describes abuse or exploitation, fears going home, or reports threats involving siblings or another child; take the account seriously without demanding proof.
Injury, poisoning, pregnancy, sexually transmitted infection, genital symptom or strangulation with an absent, implausible, changing or developmentally inconsistent explanation requires prompt safeguarding and medical consideration.
Repeated self-harm, missing episodes, substance supply, gifts, debt, hotel or car journeys, older controlling contacts or online sexual coercion may signal criminal or sexual exploitation.
Extreme hunger, poor hygiene, untreated illness, inadequate supervision, failure to provide essential medicine or repeated absence from care can represent neglect while poverty and access barriers must also be addressed.
A carer blocks private conversation, answers for the child, threatens them, minimises serious symptoms, seeks unnecessary procedures or repeatedly prevents treatment; assess coercion and fabricated or induced illness possibilities.
A baby or child with acute neurological change, unexplained bleeding, significant burn or serious injury needs urgent paediatric assessment and preservation of potential evidence alongside safeguarding action.
Investigation priorities
Locate current danger, alleged source, urgent injury, suicide, siblings at risk and a safe place for the child.
Management branches
A child discloses harm or the clinical picture raises a safeguarding concern.
- Address urgent medical and safety needs, listen calmly with non-leading clarification, and do not confront or alert a possible perpetrator.
- Record the child's words, objective findings, context and decisions, then apply the national and local referral or reporting threshold without waiting for proof or a generic seriousness label.
- Explain next steps and information sharing when safe, confirm receipt by the protecting agency and retain responsibility for ongoing healthcare.