GPAtlas🧭 When to suspect
Safeguarding is everyone's responsibility. Maltreatment covers physical abuse, sexual abuse, emotional abuse, neglect and fabricated or induced illness, and concern usually builds from a pattern of events, behaviours or unexplained injuries over time rather than a single incident. Always consider the wider family context – domestic abuse, parental substance misuse and parental mental illness (sometimes called the “trigger trio”) all raise risk.
The clinical skill in primary care is threefold: recognise the alerting features, decide whether to consider, suspect or exclude maltreatment, and act through the safeguarding pathway. A crucial point of principle runs through everything below – in general practice you recognise and refer; you do not have to investigate, prove the cause, or confront anyone.
| Category | What it involves |
|---|---|
| Physical abuse | Hitting, shaking, burning, poisoning or otherwise causing physical harm, including fabricating or inducing illness. |
| Sexual abuse | Forcing or enticing a child into sexual activities (contact or non-contact, including online and exploitation), whether or not the child is aware. |
| Emotional abuse | Persistent emotional maltreatment – conveying worthlessness, inappropriate expectations, witnessing abuse of another, or serious overprotection. |
| Neglect | Persistent failure to meet basic physical and/or psychological needs – food, shelter, supervision, medical care, immunisations or emotional warmth. |
| Fabricated or induced illness (FII) | Reported or induced symptoms inconsistent with findings; investigations and observations that do not fit the history. |
Source: NICE CG89 · NICE NG76 · Working Together to Safeguard Children
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