Introduction

• The effects of child maltreatment can be severe and last into adulthood.

• Children may present with both physical and psychological symptoms and signs that constitute alerting features of one or more types of maltreatment.

• Maltreatment may be observed in parent– or carer–child interactions.

• Obstacles to identifying child maltreatment exist. However, these should not stop healthcare professionals from acting to prevent harm to the child. Examples of possible obstacles include:

  • concern about missing a treatable disorder
  • healthcare professionals are used to working with parents and carers in the care of children and fear losing a positive relationship with a family already under their care
  • discomfort of disbelieving, thinking ill of, suspecting or wrongly blaming a parent or carer
  • divided duties to adult and child patients and breaching confidentiality
  • an understanding of the reasons why the maltreatment might have occurred, and that there was no intention to harm the child
  • losing control over the child protection process and doubts about its benefits
  • stress
  • personal safety
  • fear of complaints.

• Alerting features of maltreatment in children with disabilities may also be features of the disability, making identification of maltreatment more difficult.