The guidance sets out alerting features that should prompt a healthcare professional to consider child neglect, physical, sexual or emotional abuse, or fabricated or induced illness. These include bruises, cuts, ano-genital signs and symptoms and neglect or emotional abuse in parent-child interactions.

Brighton and Hove GP Dr Christine Habgood said the guideline gave front-line health workers the information they needed to identify children who have been maltreated and need protection and help.

Although most clinical encounters with children involve physical, behavioural or emotional issues, child maltreatment needs to be in the list of possible causes for many of these presentations,' she said.

She added: ‘We are asking GPs and others to think really carefully about what they are seeing, to discuss their suspicions with other colleagues if necessary or refer children on to the appropriate agencies if they suspect them to be maltreated. Every child should feel safe and secure and we all need to make sure this happens.'

RCGP chairman Professor Steve Field said: 'GPs play an important role in helping children we suspect have been, or consider to have been, maltreated. This guidance from NICE complements the RCGP/NSPCC toolkit for GPs Safeguarding Children and Young People which is being used as part of the GP training curriculum. We have also produced an e-learning session on domestic violence with the RCPCH (Royal College of Paediatrics and Child Health) and include child protection in the annual continuing professional development evidence of the RCGP submission programme.

'Child maltreatment can include neglect and emotional abuse as well as sexual and physical abuse, and often has long lasting effects into adulthood.

'The GP's role is crucial.  We are often the first port of call for children and their families. Maltreatment of children is an important problem and this guidance is helpful because it can often be extremely difficult for the GP to make the necessary decisions.    

'We know that child maltreatment has been under-diagnosed in the past and all new GPs now routinely receive training in this area to recognise the possible presentations and understand how to deal with them. Sometimes the action we take can be straightforward; sometimes it can be much more difficult.    

'The RCGP is committed to playing an important role in improving standards in primary care. We welcome this guidance.'

tom.moberly@haymarket.com

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