Any suspicion of non-accidental injury or neglect: get senior and safeguarding review, document meticulously, and do not discharge the child (or any siblings at risk) without a safeguarding plan. The child's safety overrides confidentiality.
Red flags
- History inconsistent, changing, or not matching the injury or development
- Delay in seeking help, or no explanation
- Bruising in a non-mobile infant, or patterned bruises (ears, neck, buttocks, torso)
- Fractures incompatible with the stated mechanism, retinal haemorrhages, torn frenulum, burns with clear margins
Immediate actions
- Treat the medical needs first
- Full documented examination (and genital or anal only if trained and indicated)
- Investigations as indicated: skeletal survey and CT head in infants, bloods for bruising, ophthalmology
- Photography and body maps per local policy
Possible concern
- Injury not matching history or development
- Delayed presentation
- Discuss with the safeguarding lead
High concern
- Bruising in a non-mobile infant
- Multiple or patterned injuries
- Refer to children's social care same day
Immediate danger
- Acute serious injury, risk to life
- Admit for safety and workup
- Involve police and social care now
Escalation
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1. Protect
Do not send the child home if unsafe. Involve the paediatric registrar or consultant and the named safeguarding lead now. Consider siblings.
Do not send the child home if unsafe. Involve the paediatric registrar or consultant and the named safeguarding lead now. Consider siblings.
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2. Refer
Refer to children's social care (and police if a crime or immediate danger) per your local multi-agency pathway, the same day.
Refer to children's social care (and police if a crime or immediate danger) per your local multi-agency pathway, the same day.
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3. Document
Record exactly what was said (in quotes), who was present, the time, and a diagram of every injury. Factual, contemporaneous, signed.
Record exactly what was said (in quotes), who was present, the time, and a diagram of every injury. Factual, contemporaneous, signed.
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4. Share and follow up
Share information on a need-to-know basis in the child's interest. Ensure a clear plan and handover; follow up that the referral was received.
Share information on a need-to-know basis in the child's interest. Ensure a clear plan and handover; follow up that the referral was received.
Also consider
- Fabricated or induced illness
- Neglect and emotional abuse (not just physical)
- Child sexual abuse and exploitation
- Domestic abuse and parental mental health or substance use
Pitfalls
- Accepting an implausible history at face value
- Discharging before social care involvement
- Not considering siblings
- Poor or non-contemporaneous documentation
MedPrep - www.medprep.uk - Educational revision aid only. Not clinical guidance. Doses are adult examples; check the BNF, current guidelines and local policy, and seek senior advice. Nov 2026