Child maltreatment includes physical, emotional and sexual abuse, neglect, and fabricated or induced illness. A consideration of child maltreatment should be made in all cases and if necessary discussed with a senior clinician. Please follow the local child protection/safeguarding policies.

The following injuries should prompt you to suspect child maltreatment

• Bruising in the shape of a hand, ligature, stick, teeth mark, grip or an implement
• Bruising or petechiae not caused by a medical condition with an unsuitable explanation, including:
• in a child who is not independently mobile
• that are multiple or in clusters
• of similar shape and size
• on non-bony parts of the body, including the eyes, ears and buttocks
• on the neck/ankles
• Human bite mark thought unlikely to be caused by a small child.
• Lacerations, abrasions or scars on a child that have an unsuitable explanation, including:
• on a child who is not independently mobile
• that are multiple or have a symmetrical distribution
• on the areas usually protected by clothing, or the eyes, ears and sides of face
• on the neck, ankles and wrists that look like ligature marks.
• Burn or scald injuries on a child:
• with an absent or unsuitable explanation or
• who is not independently mobile or
• on soft tissue areas not expected to accidently come into contact with a hot object (for example, backs of hands, soles of feet, buttocks, back) or
• in the shape of an implement (for example, cigarette or iron) or
• that indicate forced immersion.
• One or more fractures in a child if there is no medical condition that predisposes to fragile bones or if the explanation is absent unsuitable, including:
• fractures of different ages
• X-ray evidence of occult fractures.
• Intracranial injury in a child if there is no major confirmed accidental trauma or known medical cause in one or more of the following circumstances:
• there is an absent or unsuitable explanation
• the child is under 3 years
• other inflicted injuries, retinal haemorrhages, or rib or long bone fractures
• there are multiple subdural haemorrhages with or without subarachnoid haemorrhage with or without hypoxic ischaemic damage to the brain.
• Retinal haemorrhages or injury to the eye in a child if there is no major confirmed accidental trauma or medical explanation
• Signs of spinal injury in a child if there is no major confirmed accidental trauma
• Intra-abdominal or intrathoracic injury in a child if there is no major confirmed accidental trauma, with an absent or unsuitable explanation, or with delay in presentation. There may be no external bruising or other injury.

Please refer to NICE guideline 89.

If a child with suspected inflicted injury needs transferring to MTC, please call NCS to facilitate referral and transfer.