Red Flags for Children at Risk: Jackie Kilding


Child protection is all about working together, sharing information and concerns and building up a picture piece by piece.

There is probably very little which comes through a G P’s surgery that is diagnostic of abuse, but if the possibility of abuse doesn’t ever cross the mind as a differential diagnosis then it will surely be missed.

The evidence base for child protection is increasing and useful resources are the Core-info leaflets which can be accessed on the NSPCC and the core-info websites.


Physical abuse

Consider the history and the signs- do they match up? Is the history consistent?


Those who don’t cruise rarely bruise-consider developmental age of child

Sites of bruising-think twice if buttocks, lower back, face, neck, ears, hands.

Patterns of bruising-clustering of bruising with a positive or negative imprint of an implement or hand, grab marks


The younger the child with the fracture the greater the likelihood of abuse


Sexual Abuse

Disclosure commonest presentation-always listen no matter how busy the surgery

Do not ask any leading questions or examine.

Persistent vaginal discharge in prepubertal child

FB in vagina of prepubertal child

Recurrent abdo pains

Self harming

Think about sexual abuse in young girl requesting contraception/pregnant ? power differential


Emotional Abuse

Behaviour of parent towards the child-emotionally unavailable, hostility and scapegoating, exposure to domestic violence, expectations beyond age, corrupting, used for own fulfilment



Physical, medical, educational, safety, emotional,

What is ‘good enough’ parenting?

Frequent accidents due to lack of supervision, untreated or inconsistently treated medical conditions, dirty and smelly in inadequate clothing, FTT, developmental delay, not immunised or many DNAs.


Risk Factors

Can help to alert but are not diagnostic



Parent indifferent, intolerant, over anxious

History of family violence

Socio-economic problems

Premature, LBW

Parents abused/neglected

Step parent

Young mother

Mental illness/drug or alcohol misuse

>24hrs separation at birth

Handicapped child

Children close in age