Excluded studies

National Collaborating Centre for Women's and Children's Health (UK)

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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.)

See 2019 Partial Update

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."

When To Suspect Child Maltreatment.

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Contents

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Excluded studies

4. Physical features

4.1. Injuries

4.1.1–4.1.7. Bruises, bites, cuts and abrasions, thermal injuries, cold injuries, hair loss

4.1.8. Fractures

4.1.9. Intracranial injuries

4.1.10. Eye trauma

4.1.11. Spinal injuries

4.1.12. Visceral injuries

4.1.13. Oral health and oral injuries

4.2. Anogenital injuries and features

4.2.1. Genital and anal symptoms

4.2.2. Genital and anal signs

4.2.3. Sexually transmitted infections

5. Clinical presentations

5.1. Pregnancy

5.2. Dehydration

5.3. Apparent life-threatening events

Table

5.4. Poisoning

5.5. Non-fatal submersion injuries (near drowning)

5.6. Repeated attendance at medical services

5.7. Fabricated or induced illness

5.8. Inappropriately explained poor school attendance

6. Neglect – failure of provision and failure of supervision

General features of neglect

6.1.2. Over- and under-nutrition

6.3.2. Oral health

7. Emotional, behavioural, interpersonal and social functioning

7.1. Emotional and behavioural states

Table

7.1.3. Sudden and unexplained behavioural or emotional change

7.1.4. Selective mutism (elective mutism)

7.1.5. Disturbances of attachment

7.1.6. Emotional dysregulation

7.1.7. Repeated nightmares in the absence of an obvious cause

7.1.9. Role reversal (compliance/role reversal)

7.1.10. Dissociation

7.2. Behavioural disorders or abnormalities either seen or heard about

7.2.1. Self-harm

7.2.2. Abdominal pain

7.2.3. Disturbances in eating and feeding behaviour

7.2.4. Head-banging and body rocking

7.2.5. Wetting and soiling

7.2.6. Sexualised behaviour

7.2.7. Runaway behaviour

8. Parent–child interactions

Parent–child interactions

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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.) Excluded studies.
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When To Suspect Child Maltreatment.

Excluded studies

4. Physical features

4.1. Injuries

4.2. Anogenital injuries and features

5. Clinical presentations

6. Neglect – failure of provision and failure of supervision

7. Emotional, behavioural, interpersonal and social functioning

7.1. Emotional and behavioural states

7.2. Behavioural disorders or abnormalities either seen or heard about

8. Parent–child interactions

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