Clinical update

Recognising, assessing and responding to child abuse and neglect

National Institute for Health and Care Excellence offers guidance on supporting children and young people

National Institute for Health and Care Excellence offers guidance on supporting children and young people 

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Essential information

One in five children has experienced severe maltreatment, according to the National Society for the Prevention of Cruelty to Children. Cruelty to children and young people is a criminal offence, and child abuse and neglect can have serious adverse health and social consequences, according to the National Institute for Health and Care Excellence (NICE).

Child abuse and neglect can affect growth and physical development, and impair language development, behaviour and ability to socialise, play and learn. It increases the likelihood of being involved in antisocial behaviour, having suicidal thoughts and attempts to commit suicide. Adult survivors of childhood abuse are more likely to misuse substances and experience mental and physical health problems.

What’s new

Children and young people who display marked changes in behaviour or emotional state should be encouraged by nurses and other practitioners to talk about their well-being, according to NICE.

These changes should be a prompt to practitioners to explore concerns through sensitive enquiry, which will give the child the chance to disclose if they are being abused or neglected.

This process is one of five quality standards listed by NICE in guidance to improve the recognition, assessment and response to those under 18 who have experienced physical, sexual or emotional abuse. The guidance covers the importance of hearing the child’s voice and recording their views, as well as deciding suitable therapy.

Children who have experienced abuse should receive support from a consistent group of practitioners, NICE says. This will help staff to gain their trust and build better relationships with them. It will also protect children from being re-traumatised by having to explain their experiences multiple times.

Consistency helps the practitioners to get to know the child and their family, and to work more effectively with other agencies to protect children from further harm.

Safe communication

NICE also emphasises that children and young people who have experienced abuse or neglect need to agree with practitioners how they will communicate with each other. Their abuser may have access to their phone or email, which could place them at risk if a practitioner gets in touch.

Children need arrangements to get in touch with their practitioner safely, including urgent contact outside the usual working hours, or more frequently than agreed initially if required.

Individuals who have experienced abuse or neglect should be offered therapeutic interventions based on a detailed assessment of therapeutic needs, NICE advises. Practitioners need to identify each child or young person’s therapeutic needs using a detailed assessment before discussing the options with them, and their parents and carers if appropriate, and making a joint decision about the therapy.

Expert comment

Leila Francis, designated nurse for safeguarding children, NHS Mid Essex Clinical Commissioning Group

‘All nurses, whether they work directly with children and young people, or with adults whose lives affect children, must be able to identify children and young people at risk of possible child abuse.

‘Nurses must act in the best interests of the child. This means they must know what to look out for, where to access expert support and advice from, and what actions to take. They must also act according to local policy if they have concerns about the behaviour of staff, colleagues or volunteers in relation to the care and treatment of children.

‘Awareness and training on the need to safeguard children from abuse and neglect has increased over the years. This guidance has the potential to improve the care of children who are abused and neglected.

‘However, a willingness to recognise the importance of listening to children and young people, and being proactive in acting on issues and concerns, is also imperative in keeping children safe.’


Key points for nurses

  • Children and young people can find it difficult to tell someone or understand that they are being abused or neglected. They may communicate an emotional reaction to their experiences indirectly through their behaviour.
  • Children and young people who have experienced abuse or neglect should have their words accurately represented in notes that summarise their conversations with practitioners. They need to be confident that their voices are heard and that their words are captured accurately. Summaries of these conversations should be written up immediately and reflect only the facts as the children and young people presented them.
  • Putting safe and effective arrangements in place to stay in touch is essential to ensure that children and young people are not put at additional risk and can access support when they need it.
  • Some children and young people may not be ready or want the therapy straight away. This choice should be respected.

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