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National Collaborating Centre for Women's and Children's Health (UK). When To Suspect Child Maltreatment. London: RCOG Press; 2009 Jul. (NICE Clinical Guidelines, No. 89.)

  • July 2019: Definition of multi-agency safeguarding arrangements added and section 4 of 'Using this guidance' amended by NICE to include arrangements. Recommendations 1.1.18 and 1.1.19 updated to reflect wording used in Royal College of Paediatrics and Child Health purple book. October 2017: Since publication of this guideline, NICE has produced a guideline on child abuse and neglect. Recommendations relevant to both health and social care practitioners appear in this guideline and the child abuse and neglect guideline. Clinical features (including physical injuries) are covered in this guideline. Recommendations 1.3.2, 1.3.3, 1.3.4, 1.3.10, 1.3.12, 1.4.1, 1.4.2, 1.4.3, 1.4.4, 1.4.5, 1.4.12, 1.4.13, 1.5.1, 1.5.2, 1.5.3, 1.5.4 and 1.5.5 have had minor edits in line with NICE's child abuse and neglect guideline. Recommendation 1.3.6 has had a link added to the NICE guideline on faltering growth. Recommendation 1.4.8 has been updated with information on Prader-Willi syndrome. 2013: The recommendation which states "Be aware that sexual intercourse with a child younger than 13 years is unlawful and therefore pregnancy in such a child means the child has been maltreated" (pages 8 and 55) should be accompanied by a footnote which states the following: "Under the sexual Offences Act 2003, any sexual intercourse with a girl younger than 13 years is unlawful and will be charged as rape. It is illegal for children aged 13-15 years to have sexual intercourse. However, The Crown Prosecution Service guidance instructs that children of these age groups involved in consensual experimentation should not be prosecuted."

July 2019: Definition of multi-agency safeguarding arrangements added and section 4 of 'Using this guidance' amended by NICE to include arrangements. Recommendations 1.1.18 and 1.1.19 updated to reflect wording used in Royal College of Paediatrics and Child Health purple book. October 2017: Since publication of this guideline, NICE has produced a guideline on child abuse and neglect. Recommendations relevant to both health and social care practitioners appear in this guideline and the child abuse and neglect guideline. Clinical features (including physical injuries) are covered in this guideline. Recommendations 1.3.2, 1.3.3, 1.3.4, 1.3.10, 1.3.12, 1.4.1, 1.4.2, 1.4.3, 1.4.4, 1.4.5, 1.4.12, 1.4.13, 1.5.1, 1.5.2, 1.5.3, 1.5.4 and 1.5.5 have had minor edits in line with NICE's child abuse and neglect guideline. Recommendation 1.3.6 has had a link added to the NICE guideline on faltering growth. Recommendation 1.4.8 has been updated with information on Prader-Willi syndrome. 2013: The recommendation which states "Be aware that sexual intercourse with a child younger than 13 years is unlawful and therefore pregnancy in such a child means the child has been maltreated" (pages 8 and 55) should be accompanied by a footnote which states the following: "Under the sexual Offences Act 2003, any sexual intercourse with a girl younger than 13 years is unlawful and will be charged as rape. It is illegal for children aged 13-15 years to have sexual intercourse. However, The Crown Prosecution Service guidance instructs that children of these age groups involved in consensual experimentation should not be prosecuted."

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When To Suspect Child Maltreatment.

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Appendix DStakeholder organisations

  • Action for M.E.
  • Airedale Acute Trust
  • Alder Hey Children's NHS Foundation Trust
  • Ambulance Service Association
  • Association for Clinical Biochemistry
  • Association for Continence Advice
  • Association for Family Therapy and Systemic Practice in the UK (AFT)
  • Association for Improvements in the Maternity Services
  • Association for Psychoanalytic Psychotherapy in the NHS (APP)
  • Association of Catholic Nurses of England and Wales
  • Association of Child Psychotherapists
  • Association of Dance Movement Therapy UK
  • Association of Directors of Children's Services
  • Association of Educational Psychologists
  • Association of Paediatric Anaesthetists of Great Britain and Ireland
  • Association of Paediatric Emergency Medicine
  • Association of Professional Music Therapists
  • Association of Psychoanalytic Psychotherapy in the NHS
  • Association of Young People with ME
  • Barnsley Hospital NHS Foundation Trust
  • Barnsley PCT
  • Berkshire Healthcare NHS Trust
  • Birmingham City Council
  • Birmingham Women's NHS Trust
  • Bournemouth and Poole PCT
  • Breastfeeding Network
  • Brighton and Sussex University Hospitals Trust
  • British Association for Adoption and Fostering
  • British Association for Community Child Health
  • British Association for Counselling and Psychotherapy
  • British Association for Sexual Health and HIV
  • British Association for the Study and Prevention of Child Abuse and Neglect (BASPCAN)
  • British Association for the Study of Community Dentistry (BASCD)
  • British Association of Art Therapists
  • British Association of Drama Therapists
  • British Association of Otolaryngologists Head and Neck Surgeons (ENT UK)
  • British Association of Play Therapists
  • British Association of Psychodrama and Sociodrama (BPA)
  • British Dental Association
  • British National Formulary (BNF)
  • British Nuclear Medicine Society
  • British Paediatric Mental Health Group
  • British Paramedic Association
  • British Pregnancy Advisory Service
  • British Psychodrama Association
  • British Psychological Society
  • British Society for Children's Orthopaedic Surgery
  • British Society of Paediatric Dentistry
  • British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN)
  • British Society of Paediatric Radiology
  • Brook London
  • Buckinghamshire PCT
  • Calderdale and Huddersfield Acute Trust
  • Calderdale PCT
  • Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's)
  • Care Quality Commission (CQC)
  • Central Manchester PCT
  • Centre for Child and Family Research
  • Challenging Behaviour Foundation
  • Chartered Society of Physiotherapy (CSP)
  • Children and Family Court Advisory Support Service (Cafcass)
  • Children's Society
  • CIS'ters
  • Clinical Effectiveness Committee
  • College of Emergency Medicine
  • College of Occupational Therapists
  • College of Optometrists
  • Commission for Social Care Inspection
  • Community Practitioners and Health Visitors Association
  • Connecting for Health
  • Consultants in Paediatric Dentistry Group
  • Conwy & Denbighshire Acute Trust
  • Cornwall & Isles of Scilly PCT
  • David Lewis Centre
  • Dental Practitioners Association
  • Department for Children, Schools and Families
  • Department for Communities and Local Government
  • Department of Health
  • Department of Health, Social Security and Public Safety of Northern Ireland
  • Derbyshire Mental Health Services NHS Trust
  • Det Norske Veritas – NHSLA Schemes
  • Drinksense
  • Eaton Foundation
  • Education and Resources for Improving Childhood Continence
  • Education Otherwise
  • Faculty of Dental Surgery
  • Faculty of Forensic and Legal Medicine
  • Faculty of Sexual and Reproductive Healthcare
  • Fasawareuk
  • Ferring Pharmaceuticals
  • First Person Plural
  • Forensic Arts Therapies Advisory Group
  • Foundation for the Study of Infant Deaths
  • Gateshead PCT
  • Greater Manchester West Mental Health NHS Foundation Trust
  • Guy's and St Thomas' NHS Trust
  • Hampshire Partnership NHS Trust
  • Harrogate and District NHS Foundation Trust
  • Health and Safety Executive
  • Heart of England NHS Foundation Trust
  • Hertfordshire Partnership NHS Trust
  • International Association of Forensic Radiographers
  • KCC Children and Families Directorate
  • Kingston Hospital NHS Trust
  • Leeds Partnerships NHS Foundation Trust
  • Leeds PCT
  • Lincolnshire Teaching PCT
  • Liverpool PCT
  • Luton and Dunstable Hospital NHS Foundation Trust
  • Luton PCT
  • Medical Defence Union
  • Medicines and Healthcare products Regulatory Agency (MHRA)
  • Mental Health Act Commission
  • Mental Health Nurses Association
  • Mersey Care NHS Trust
  • Met Office
  • MIDIRS (Midwives Information & Resource Service)
  • Milton Keynes PCT
  • Mothersvoice
  • National Association for People Abused in Childhood (NAPAC)
  • National Association of Independent Schools and Non-Maintained Special Schools (NASS)
  • National Autistic Society
  • National Children's Bureau (NCB)
  • National Collaborating Centre for Cancer
  • National Collaborating Centre for Mental Health
  • National Coordinating Centre for Health Technology Assessment (NCCHTA)
  • National Patient Safety Agency (NPSA)
  • National Public Health Service – Wales
  • National Safeguarding Children Association for Nurses (NSCAN)
  • National Society for the Prevention of Cruelty to Children (NSPCC)
  • National Treatment Agency for Substance Misuse
  • NCC – National Clinical Guidance Centre (NCGC)
  • NHS Bedfordshire
  • NHS Clinical Knowledge Summaries Service (SCHIN)
  • NHS Direct
  • NHS Improvement
  • NHS Knowsley
  • NHS Plus
  • NHS Purchasing and Supply Agency
  • NHS Quality Improvement Scotland
  • NHS Sheffield
  • NHS Shfton
  • North East London Mental Health Trust
  • North Staffordshire Combined Healthcare NHS Trust
  • North Tees and Hartlepool Acute Trust
  • North Tyneside PCT
  • Nottinghamshire Acute Trust
  • Office of the Children's Commissioner
  • Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust
  • Parents Protecting Children UK
  • Partners in Paediatrics
  • Partnerships for Children, Families, Women and Maternity
  • Peach
  • Peninsula Primary Care Psychology & Counselling Services
  • PERIGON Healthcare
  • Pottergate Centre for Dissociation & Trauma
  • Public Health Research Group
  • Queen Mary's Hospital NHS Trust (Sidcup)
  • Queen Victoria Hospital NHS Trust
  • Royal College of General Practitioners
  • Royal College of Midwives
  • Royal College of Nursing
  • Royal College of Ophthalmologists
  • Royal College of Paediatrics and Child Health
  • Royal College of Pathologists
  • Royal College of Physicians of London
  • Royal College of Psychiatrists
  • Royal College of Radiologists
  • Royal Pharmaceutical Society of Great Britain
  • Royal United Hospital Bath NHS Trust
  • SACAR
  • Sandwell and West Birmingham Hospitals NHS Trust
  • Sandwell PCT
  • Scottish Intercollegiate Guidelines Network (SIGN)
  • Scottish Nutrition and Diet Resources Initiative
  • Sedgefield PCT
  • Selective Mutism Information & Research Association (SMIRA)
  • Sexual Violence and Awareness Network
  • Sheffield Children's NHS Foundation Trust
  • Sheffield PCT
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • Social Care Institute for Excellence (SCIE)
  • Social Interface
  • Social Perspectives Network
  • Solihull MBC
  • South Birmingham PCT
  • South Central Ambulance Service NHS Trust
  • South Essex Partnership NHS Foundation Trust
  • South West Wales Home Educators
  • Southampton University Hospitals NHS Trust
  • St Andrew's Healthcare
  • Staffordshire Ambulance headquarters
  • Staffordshire County Council
  • Staffordshire Moorlands PCT
  • Stockport PCT
  • Surrey PCT
  • Survivors UK
  • Sussex Partnership NHS Trust
  • Tavistock and Portman Foundation Trust
  • Tees, Esk and Wear Valleys NHS Trust
  • The Haemophilia Society
  • The Neurological Alliance
  • The Royal Society of Medicine
  • The Survivors Trust
  • The Young ME Sufferers Trust
  • Triangle Services for Children
  • Turning Point
  • United Lincolnshire Hospitals NHS Trust
  • University College London Hospitals (UCLH) Acute Trust
  • University of Nottingham
  • Welsh Ambulance Service Trust
  • Welsh Assembly Government
  • Welsh Association of ME & CFS Support
  • Welsh Scientific Advisory Committee (WSAC)
  • West Hertfordshire PCT & East and North Hertfordshire PCT
  • West London Mental Health NHS Trust
  • West Midlands Ambulance Service NHS Trust
  • West Midlands SHA
  • Western Cheshire PCT
  • Western Health and Social Care Trust
  • Wiltshire PCT
  • Wirral Hospital Acute Trust
  • York NHS Foundation Trust
  • Yorkshire and the Humber LSA
Copyright © 2009, National Collaborating Centre for Women's and Children's Health.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

Bookshelf ID: NBK57154

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