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.
• 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 law has changed: section 3 of the Domestic Abuse Act 2021 has been in force since 31 January 2022.
Under it, 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.
In primary care you recognise and respond, and refer – do not investigate.
You are not expected to:
• Prove abuse
• Complete a formal risk assessment
• Confront anyone
You are expected to:
• Think of it
• Ask safely
• Document carefully
• Route the family to the right agency
| Presentations that should raise suspicion |
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• Behavioural change in a child – new withdrawal, aggression, anxiety, regression, sleep disturbance, or secondary enuresis (bedwetting). |
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• Unexplained, inconsistent, or poorly explained injuries, or a child who appears fearful or hypervigilant in the presence of a particular adult. |
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• Frequent attendance, faltering growth, neglect, or developmental delay without a clear medical cause. |
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• Parental risk factors – mental ill-health, alcohol or substance misuse, social isolation, or a parent who seems frightened, controlled, or constantly accompanied. |
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• Pregnancy or the perinatal period – a recognised time of onset and escalation of domestic abuse. |
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• Any direct disclosure by the child or the non-abusing parent – the most important alerting feature of all. |
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🧠 Clinical pearl • The law has moved the threshold for you. • 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?” • 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
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