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Assessing the child

History and examination

Assessing a child with an injury or with possible signs of abuse or neglect starts with a thorough history, including:
    • details from the child and carer of any injury or presenting complaint

    • past dental history

    • medical history

    • family and social circumstances including the household composition (particularly in relation to unrelated adults living in the household as research indicates that children living in households with unrelated adults, particularly males, often mother’s boyfriend, are at significantly higher risk of abuse and neglect).61

Features of concern would include:
    • a delay in the presentation

    • discrepancies between the history and examination findings

    • developmentally inappropriate findings (does not fit with the age of the child)

    • previous concerns about the child or siblings.

A full examination should be carried out, noting in particular:

    • any dental, oral or facial injuries, their site, extent and any specific patterns

    • the general appearance of the child, their state of hygiene, whether they appear to be growing well or are 'failing to thrive'

    • their demeanour and interaction with their parents or carers and others (e.g. look particularly for signs of 'frozen watchfulness' where the child seems to take in everything going on, but in a detached, wary or fearful manner). 

Questions to ask yourself

A list of questions to ask yourself in such circumstances can be kept in the surgery to act as a prompt (print question prompts).

Within electronic patient records this could be incorporated into a custom screen as shown.

fig3.jpg Reproduced with permission of Software of Excellence

fig4gif.gif Reproduced with permission of Software of Excellence

Talking to the child

It is good practice to ask the child about the cause of any injuries and to allow them to talk if they volunteer information about abuse. You should avoid asking leading questions and should respond calmly and kindly with a non-judgmental attitude. A child who makes a disclosure of abuse should always be taken seriously. If requested to keep a secret, you should not do so but should explain that you may have to share information, but will explain with whom and when it will be shared.​