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Open for definitions of CONSIDER and SUSPECT and information on using this guidance.…read more

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When to suspect child maltreatment Definitions of consider and suspect
Definitions of consider and suspect
The alerting features in this guidance have been divided into two categories, according to the level of
concern, with recommendations to either `consider' or `suspect' maltreatment.
CONSIDER means maltreatment is one possible SUSPECT means serious level of concern
explanation for the alerting feature or is included about the possibility of child maltreatment
in the differential diagnosis. but not proof of it.…read more

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When to suspect child maltreatment
About this booklet
This is a quick reference guide that summarises the recommendations NICE has made to the NHS in
`When to suspect child maltreatment' (NICE clinical guideline 89).
Who should read this booklet?
This quick reference guide is for all healthcare professionals working in the NHS who work with children
and young people. It may also be of interest to people outside of the NHS who work with children and
young people.…read more

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When to suspect child maltreatment Contents
Contents
Definitions of consider and suspect 3
Using this guidance 3
Introduction 6
Sharing information about children and young people 6
Exclusions from the guideline 7
Key to terms used in this document 7
Physical features 8
Abrasions, bites (human), bruises, burns, cold injuries, cuts, eye injuries, fractures, hypothermia,
intra-abdominal injuries, intracranial injuries, intrathoracic injuries, lacerations, ligature marks, oral injuries,
petechiae, retinal haemorrhage, scalds, scars, spinal injuries, strangulation, subdural haemorrhage, teeth marks
Sexual abuse 10
Anal symptoms and signs,…read more

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When to suspect child maltreatment Introduction
Introduction
G The effects of child maltreatment can be severe and last into adulthood.
G Children may present with both physical and psychological symptoms and signs that constitute
alerting features of one or more types of maltreatment.
G Maltreatment may be observed in parent­ or carer­child interactions.
G Obstacles to identifying child maltreatment exist. However, these should not stop healthcare
professionals from acting to prevent harm to the child.…read more

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When to suspect child maltreatment Exclusions from the guideline
Exclusions from the guideline
The following topics were outside the scope of this guideline and have therefore not been covered:
G risk factors for child maltreatment, which are well recognised (for example, parental or carer
drug or alcohol misuse, parental or carer mental health problems, intrafamilial violence or history
of violent offending, previous child maltreatment in members of the family, known maltreatment
of animals by the parent or carer, vulnerable and unsupported parents or carers, pre-existing…read more

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When to suspect child maltreatment Physical features
Physical features
Alerting features that should prompt you to CONSIDER child maltreatment:
G Any serious or unusual injury with an absent or unsuitable explanation.
G Cold injuries (for example, swollen, red hands or feet) in a child, with no medical explanation.
G Hypothermia in a child, with an unsuitable explanation.
G Oral injury in a child, with an absent or unsuitable explanation.…read more

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When to suspect child maltreatment Physical features
G One or more fractures in a child if there is no medical condition that predisposes to fragile bones
(for example, osteogenesis imperfecta or osteopenia of prematurity), or if the explanation is absent or
unsuitable, including:
­ fractures of different ages
­ X-ray evidence of occult fractures (for example, rib fractures in infants).…read more

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When to suspect child maltreatment Sexual abuse
Sexual abuse
Alerting features that should prompt you to CONSIDER sexual abuse:
G Persistent or recurrent dysuria or anogenital discomfort, or an anal or genital symptom (for example,
bleeding or discharge) in a girl or boy, without a medical explanation (for example, worms, urinary
infection, skin conditions, poor hygiene or known allergies).
G Gaping anus in a girl or boy observed during an examination, without a medical explanation
(for example, a neurological disorder or severe constipation).…read more

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