9 Child and adolescent psychiatry9.4 Child protection
9.4 Child protection
3 min read
Written by Resident Doctor Committee · Published
Forms of maltreatment
Form | Defining feature |
|---|---|
Physical abuse | Inflicting physical harm, including poisoning |
Sexual abuse | Involving a child in sexual activity, including non-contact and online abuse |
Emotional abuse | Persistent harmful treatment that damages emotional development |
Neglect | Persistent failure to meet basic physical or psychological needs |
Neglect is the most frequently recognised category in UK data, ahead of emotional, physical and sexual abuse.
Risk factors
Infancy carries the highest risk, which peaks in the first year and falls thereafter, so older age is not a risk factor.
Level | Risk factors |
|---|---|
Child | Disability, with communication difficulty and dependence on carers |
Parent and family | Substance misuse (a strong risk factor), domestic abuse between parents, young parenthood |
Society | Poverty and low socioeconomic status, gender inequality |
Affluence, high income and older parental age do not raise risk.
Warning signs
Form | Signs that suggest it |
|---|---|
Physical abuse | Injuries of different ages, a small round burn, a changing account, delay in seeking care, refusal to discuss the injury |
Sexual abuse | Sexualised behaviour beyond the child's age, genital discomfort, repeated urinary infections, fear of one particular adult |
Emotional abuse | Self-denigration, a new speech disturbance such as a stammer, self-soothing such as rocking or head-banging |
Neglect | Constant hunger, tiredness, poor hygiene, unsuitable clothing, lateness, untreated dental and ear infections |
A single sign or disclosure can justify referral, so do not wait for several; consider medical and developmental explanations too.
Fabricated or induced illness
Fabricated or induced illness (Munchausen syndrome by proxy, factitious disorder imposed on another) is harm caused when a carer fabricates, exaggerates or induces illness in a child.
Feature | Detail |
|---|---|
Perpetrator | Mostly mothers, with about 80% of perpetrators female |
Child's age | Mainly preschool: mean age at diagnosis about 4 years, and about three-quarters under 6 (Sheridan 2003) |
Delay | Diagnosis lags onset by about two years |
Commonest presentation | Apnoea, because it is described at home, unwitnessed, and leaves no objective sign |
Most specific feature | Signs that depend on one carer's presence and settle when the child is apart from that carer |
Genuine illness can coexist, and the safeguarding term does not by itself establish the carer's factitious disorder diagnosis or motive.
Responding to a concern
Assess immediate safety and medical need, and call emergency help if danger is imminent.
Listen calmly, use open prompts, avoid leading questions and never promise secrecy.
Leave the formal evidential interview to the trained multi-agency process (Achieving Best Evidence in England and Wales).
Record the child's words, injuries, date, time and those present, separating fact from opinion.
Seek named or designated safeguarding advice without delaying an urgent referral.
The law across the UK
Jurisdiction | Main statute | Route into compulsory action |
|---|---|---|
England | Children Act 1989; Working Together to Safeguard Children 2026 | Children's social care and family courts |
Wales | Social Services and Well-being Act 2014; Children Act 1989 | Social services enquiries and court orders |
Scotland | Children (Scotland) Act 1995; Children's Hearings Act 2011 | Children's Hearings on statutory grounds |
Northern Ireland | Children Order 1995 | Health and Social Care Trust and courts |
Section 47 enquiries in England and Wales follow reasonable cause to suspect significant harm.
An emergency protection order (section 44) lasts up to eight days at first; police protection (section 46) is also time-limited.
The psychiatrist's duty
Safeguarding duties apply even when the child is not your patient, and GMC guidance permits disclosure without consent where needed to protect a child.
Do not warn anyone before sharing if that could increase danger.
Assess a non-abusing parent's ability to protect without assuming complicity, since domestic abuse can constrain their choices.