What are the key signs and symptoms of child maltreatment that I should be aware of during consultations?

Healthcare professionals should be aware of a range of key signs and symptoms of child maltreatment during consultations, which include physical, emotional, behavioural, and social indicators.

• Physical signs: Unexplained or suspicious injuries such as bruises (especially in non-mobile children, multiple bruises, bruises in clusters, or bruises on non-bony parts like face, eyes, ears, buttocks, neck, ankles, wrists), human bite marks, lacerations, abrasions or scars with unsuitable explanations, burns or scalds with unusual patterns or locations, cold injuries without medical cause, fractures (including multiple or of different ages), and intracranial injuries should raise suspicion of maltreatment ³.
• Neglect indicators: Signs include faltering growth due to inadequate diet, lack of appropriate supervision leading to injuries, failure to provide adequate care, failure to administer prescribed treatments, repeated missed health appointments, poor engagement with health promotion (immunisations, screenings), untreated dental caries, and failure to seek medical advice when the child's health is compromised ³.
• Emotional and behavioural signs: Marked changes in behaviour or emotional state not explained by medical causes or other stressful but non-maltreatment events, such as recurrent nightmares, extreme distress, oppositional behaviour, withdrawal, excessive clinginess, indiscriminate affection seeking, excessive 'good' behaviour to avoid disapproval, coercive behaviour towards carers, dissociation, and repeated extreme emotional responses (e.g., frequent rages, inconsolable crying) may indicate maltreatment ³,¹.
• Social and interpersonal indicators: Substance or alcohol misuse, self-harm, eating disorders, suicidal behaviours, bullying involvement, running away from home or care, and excessive responsibilities interfering with normal activities are also alerting features ³,¹.
• Interaction concerns: Observing the interaction between the child and parent/carer for signs of neglect or abuse, such as lack of appropriate comfort or affection when distressed, or controlling behaviour by the child towards carers, is important ²,¹.

Healthcare professionals should use clinical judgement to assess explanations for injuries or symptoms and consider cultural factors without allowing them to justify harm. Any suspicion or disclosure should prompt referral to children's social care following local safeguarding procedures ²,³.