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Possible sexual abuse — DCH MCQ

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HardSafeguardingPossible sexual abuseDCH

A 5-year-old girl is referred because of intermittent vulval soreness and distress when her mother's partner is mentioned. There has been no disclosure, genital injury, bleeding or discharge. Which school observation would most specifically meet NICE criteria to suspect sexual abuse, rather than merely being a nonspecific contextual concern?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Repeatedly simulating oral–genital contact with dolls or peers

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

C is correct. NICE advises suspecting sexual abuse when a prepubertal child displays repeated, coercive or unusual sexualised behaviour; explicitly simulating oral–genital contact is a listed example. This is developmentally abnormal and more specific than the other findings. Preference for a trusted teacher, distress after a classroom change and occasional nightmares may reflect ordinary attachment or stress and are nonspecific. Perianal discomfort associated with hard stools has a plausible medical explanation, although persistent or unexplained anogenital symptoms would require further assessment. This finding does not prove abuse, but it should trigger referral through local multi-agency safeguarding arrangements and careful documentation of information provided without attempting an investigative interview.

Reference: NICE. Child maltreatment: when to suspect maltreatment in under 18s (CG89), recommendations 1.4.12–1.4.14 and Using this guidance. Last reviewed December 2025. https://www.nice.org.uk/guidance/cg89/chapter/Recommendations