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NICE consults on new draft guideline to improve response to child abuse


School nurses and other members of the profession coming into contact with children outside of hospitals should look out for “soft signs” that may indicate abuse, according to draft guidance.

A new draft guideline from the National Institute for Health and Care Excellence is aimed at helping more professionals who work with children recognise and respond to any form of abuse and neglect.

“It will help professionals spot the warning signs and then focus on what early help and interventions”

Corinne May-Chahal

The draft, out for public consultation from today, presents information on how professionals working with children outside of obvious healthcare settings can spot the signs of abuse or neglect.

It also highlights how to handle newly recognised forms of abuse such as female genital mutilation, sexual exploitation, child trafficking and forced marriage.

NICE has already produced separate guidance for health professionals on recognising common signs of maltreatment.

The new guideline will provide practical advice for anyone who works with children outside health settings, including social care professionals and staff working in education or custodial settings.

NICE stated it was intended for “all practitioners working with children and young people, including social workers, healthcare professionals and people in ‘lead professional’ roles in services such as education and local safeguarding children’s boards”.

It differentiates which physical and emotional behaviours indicate possible abuse or neglect and which should raise serious concern.

“Anyone working with children has to play their part in responding to abuse or neglect”

Gillian Leng

Recommended indicators described as ‘consider’ as potential signs of abuse may have another explanation for the child’s state.

It suggests that staff should look at these soft signs and make judgements based on what they know about how each child usually behaves and whether it differs from what would be expected for their age.

For example, staff should consider abuse if a child has frequent rages at minor provocation, excessive clinginess, low self-esteem or recurrent nightmares.

Indicators described as “suspect” abuse, should signal a more serious level of concern, these should not be seen as absolute proof but mean further investigation is needed.

These include a child regularly arriving at school unclean or with injuries, overtly sexual behaviours in children who have not reached puberty, and parents carrying out excessive physical punishment.

The draft recommendations call on all professionals who work with children to make sure children feel like they have been listened to, with discussions recorded in a way they understand and are comfortable with.

It also advises them to speak to colleagues from other organisations so children, and their parents or carers, do not have to repeat their concerns.

National Institute for Health and Care Excellence

NICE sets out ‘soft signs’ that could indicate child abuse

Corinne May-Chahal

In addition, it calls on them to think critically and use their professional judgement and not just rely on formal protocols, and to follow up any referrals they have made to ensure action has been taken.

Professor Corinne May-Chahal, a leading researcher in child protection at Lancaster University and chair of the NICE committee developing the guideline said: “It is difficult for professionals to keep track of the best ways to assess abuse and intervene effectively.

“This guideline is important as it will help professionals spot the warning signs and then focus on what early help and interventions can be provided,” said Professor May-Chahal.

“The guideline gives examples of soft signs, the behaviours or emotions a child is exhibiting, which could indicate something may be wrong,” she said. “These may not always be proof of abuse or neglect taking place, but they underline when to check on a child’s wellbeing.

She added: “It also provides further context on stronger signs that should trigger professionals to take a more in-depth look at the child’s circumstances and welfare.”

Professor Gillian Leng, deputy chief executive at NICE said: “Anyone working with children has to play their part in responding to abuse or neglect.


Gillian Leng

“Our previous guidance for this area focused on health professionals,” she said. “Now we want to help staff outside of hospitals recognise when a child may be at risk of harm.

“We want all professionals to be aware and recognise when they need to ask questions or follow up with colleagues about a child’s wellbeing. Not all cases will cause concern but if we do not ask, we may miss opportunities to protect children in their time of need.

The draft guideline says that when assessing children, staff should collect information on all significant adults in their life such as parents, carers or siblings. These people should be involved in any plans, unless they are under investigation for inflicting the harm.

It also describes using drawings to help very young children understand discussions, or in trafficking cases using interpreters from outside the community that exploited them.

The public consultation on the draft guideline will run until 19 April, with the final guidance expected to be published in September.

A YouTube video of guideline committee member Emma Harewood discussing what the guideline covers is also available.


Readers' comments (3)

  • As someone who has had personal experience of NHS Staff and safeguarding as is, where the parents were blamed for injuries inflicted by Medical, Nursing and Midwifery staff during procedures, then later conveniently blamed on those parents to protect the professionals who refused to acknowledge their actions being the cause - I think the current safeguards are more than sufficient. All this will do is cause more apprehension about taking a child to hospital especially those children seen who are not mobile, for fear of being labelled child abusers, Social Services called in leading to children being unnecessarily taken into care and as in our case adopted and parents sent to prison. We are not alone. Once the adoption has taken place nothing can be corrected.
    We understood the need for professionals to be suspicious- but their subsequent refusal to bolster their 'findings' by additional tests which would have most likely proven the injuries were not child abuse has been seen in other cases.
    Families are destroyed on suspicion rather than facts. No one likes to be the little boy telling everyone the Emperor is actually naked!
    The cases where there are facts available and go ignored is where the emphasis needs to be

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  • I have worked in paeds community HV for 20 plus years and on the whole i have found children taken into care only when definite need in meglect cases where care bad but not dire children often go back as especially recemtly LA cannot justify costs. Physical and sexual abuse may be more difficult to challenge if 'facts' are 'proven' by experts and dependent on social worker judge working case. Parents are treated more favourably if they work with professionals i e not hostile or resistant to assessments very difficult for some parents when majorly disagree with findings

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  • I think the issue is the quality of the training in child protection because some professionals may over-react to situations and do not fully take into account the circumstances and the views of the child or young person. This is a continuing professional development problem and a failure to distinguish between likely abuse and emotional difficulties. We know there are links between abuse and emotional/behavioural issues but the situation can be more complicated. If professionals do not possess the necessary skills and knowledge, it is far too easy to justify actions on the belief the welfare of the child is at risk. Reputation of professionals and the Judiciary is at all time low and potentially every child from a disadvantaged socio-economic background is at risk. We know professionals can judge people too harshly at times and a parent may choose to be unco-operative because of the professionals approach and attitude towards them. Often professionals are very secretive and could undermine the assessment process and prejudice outcomes. Children are often moved from one foster parent to another because the social worker believes something has happened even if the child has not suffered any harm and unlikely to suffer harm in the future. System is failing children. Professionals should be able to assess the parents values, beliefs and social norms and decide whether the child or young person is at significant risk. We also know even if abuse does occur the child or young person may still wish to stay with their mum or dad. Should a child be taken away and placed under a care order where life is unlikey to be normal (too many rules, 'professionalism' without love and friendship, taxi to and from school) or do we provide the necessary support to ensure the child has a good normal life with their family? Context is everything so if there are issues with parenting or social circumstances we should be doing more, e.g. life coaches, right conditions.

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