GPAtlas🧭 When to suspect
Domestic abuse is rarely the reason a family books an appointment – it is something you have to actively think of, often in a consultation that is ostensibly about something else. Around 1 in 5 children in the UK are exposed to domestic abuse during childhood, and roughly 1 in 15 live in a household where a parent is currently being abused. Many of these children are not known to any service.
The single most important shift in recent practice is a legal one: under section 3 of the Domestic Abuse Act 2021 (in force since 31 January 2022), a child who sees, hears, or experiences the effects of domestic abuse – and who is related to the victim or the perpetrator – is a victim in their own right, not merely a bystander “at risk”. A child does not need to be the direct target of violence to be harmed.
Your role in primary care is twofold and deliberately bounded: recognise and respond, and refer – do not investigate. You are not expected to prove abuse, complete a formal risk assessment, or confront anyone. You are expected to think of it, ask safely, document carefully, and route the family to the right agency.
| Presentations that should raise suspicion |
|---|
|
• Behavioural change in a child – new withdrawal, aggression, anxiety, regression, sleep disturbance, or secondary enuresis (bedwetting). |
|
• Unexplained, inconsistent, or poorly explained injuries, or a child who appears fearful or hypervigilant in the presence of a particular adult. |
|
• Frequent attendance, faltering growth, neglect, or developmental delay without a clear medical cause. |
|
• Parental risk factors – mental ill-health, alcohol or substance misuse, social isolation, or a parent who seems frightened, controlled, or constantly accompanied. |
|
• Pregnancy or the perinatal period – a recognised time of onset and escalation of domestic abuse. |
|
• Any direct disclosure by the child or the non-abusing parent – the most important alerting feature of all. |
|
🧠 Clinical pearl The law has moved the threshold for you. Because a child who simply witnesses abuse is now a victim in their own right, the question is no longer “is this child being hit?” but “is there a child in a home where abuse is happening?” – and if so, that child already meets the bar for a safeguarding response. Always ask yourself, in any adult consultation: are there children in this household? |
Source: NICE NG76 · NICE PH50 · Domestic Abuse Act 2021
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.