Physical abuse Keeping children safe

It can be really hard to tell whether a child's injuries are caused by an accident or whether they're being physically abused so it's important that you get professional help.

If you've witnessed an assault or think a child is in immediate danger

Contact the police on 999, or call the NSPCC on 0808 800 5000, without delay.

If you're worried about a child, but unsure

Contact our helpline for advice. You can discuss your concerns with our trained counsellors who will assess the information you give them and can take action on your behalf, if necessary.

Alternatively, you can contact your local police or children's services.

Helping professionals to identify and assess physical injuries in children

This list of physical injuries can help anyone working with children and young people identifiy and assess whether they may be the result of child abuse.

We have compiled this list using our Core info leaflet series, a collaborative project by the NSPCC and Cardiff Child Protection Systematic Review Group at the Early Years research section of the Cochrane Institute of Primary Care and Public Health, Department of Child Health, School of Medicine, Cardiff University.

  • Always assess a bruise in the context of the child’s medical and social history, developmental stage and explanation given. Never interpret a bruise in isolation.
  • Consider whether the explanation of how the burn was caused is consistent with the child’s stage of development and the environment where the burn happened.
  • Look at whether the pattern of the burn fits with the description of the cause. 
  • Assess whether the clinical features of the burn fit with the description of the mechanism that caused it. 
  • If visiting the home, look at the room layout where the injury happened. If the child is said to have turned the hot tap on or climbed into a hot bath, assess whether this is possible. For a contact burn see if there is a household object that would match the burn, such as a lighter or hairdryer.
  • Always assess a fracture in the context of the child’s medical and social history, developmental stage and explanation given.
  • Make a careful evaluation to exclude child abuse where:
    • the child is under 18 months;
    • the fracture is inconsistent with the child’s developmental stage;
    • there are multiple fractures, particularly of different ages;
    • it’s a rib fracture;
    • a child who is not yet walking has a fractured femur.
  • There’s insufficient evidence to show whether siblings of an abused child should have a skeletal survey. The risk to each child must be assessed and a decision taken accordingly.
  • Ensure all parents are helped to know how to cope with their baby crying.  Excessive crying can be difficult to manage and may make babies more vulnerable to inflicted brain injury from parents who lose their temper.
  • Make sure any child with a suspected head injury, unexplained pain, neurological impairment, vomiting or associated injury is seen promptly by a doctor.
  • Babies with abusive injuries – such as fractures, bruises, burns, oral injuries or retinal haemorrhage – should have neuroimaging for possible abusive head trauma (AHT).
  • A child with abusive injuries and any symptoms of brain injury, for example seizures or falling unconscious, should have neuroimaging performed.
  • Ensure a child with suspected AHT has their eyes examined by an ophthalmologist and is given a full skeletal survey to identify possible fractures.
  • Make sure it is recorded whether the child has also suffered from apnoea (breathing difficulties) or seizures.
  • Abusive injuries to the mouth are not always obvious. They may only come to light when someone notices that the child is inexplicably missing permanent teeth. If a dental professional suspects a child is being abused, they must know and follow local child protection procedures.
  • If a paediatrician suspects a child is being abused they should make a routine examination of the child’s mouth and teeth and seek a dental opinion if there are concerns.
  • If a practitioner suspects a child has been bitten by an adult they must report their concerns to the designated person for child protection.
  • Any human bite could be abusive and should be fully assessed, ideally by a forensic scientist.

What we do about physical abuse

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We visit schools across the country, helping children understand what abuse is. We also provide professionals with advice, training and resources.
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