Child abuse and neglect

What is the purpose of this guideline?

This guideline provides recommendations based on evidence on how to recognise and respond to child abuse and neglect. It offers a robust and rigorous review of the literature, in addition to lessons from practice, and provides an overview of the research into best practice in child protection. As a result it provides a reliable guide to what works and what is cost effective, as indicated by the best available evidence. It offers practitioners and commissioners a clear guide to the interventions and approaches that are most appropriate, and represent best value for money.

The Department for Education's statutory guidance on working together to safeguard children sets out the statutory responsibilities. This guideline will help practitioners to fulfil those responsibilities by providing recommendations for practice which:

Why do we need this guideline?

Cruelty to children and young people is a criminal offence, and child abuse and neglect can have serious adverse health and social consequences for children and young people. These include:

These negative consequences can persist into adulthood. Adult survivors of childhood abuse are more likely to misuse substances and to experience mental health problems and physical ill health.

Recognising and responding to child abuse and neglect, or its early signs, is complex. Key challenges practitioners face may include:

This guideline makes evidence-based recommendations aiming to support these areas of practice.

What does it cover?

The guideline makes recommendations about practice in relation to children and young people (under 18, including unborn babies) at risk of, experiencing, or who have experienced, child abuse or neglect, and their parents and carers. It is not a comprehensive manual for frontline practice with children and families; rather, it focuses on areas where practice needs to improve, and where there is a paucity of guidance in existence.

The guideline does not cover people who are suspected or known to abuse children or young people of whom they are not the parent, step-parent, partner of a parent, family member or carer. Abuse perpetrated by this group is covered, but response (interventions) for this group is not. This is because the principal focus of this guideline is on supporting children and young people, including through supporting their parents and carers. It also does not cover adults (aged 18 or older) who experienced abuse or neglect as children.

What is the status of this guidance?

The application of the recommendations in this guideline is not mandatory. While there is no legal obligation to implement our guidance, health and social care practitioners are actively encouraged to follow our recommendations to help them deliver the highest quality care. Our recommendations are not intended to replace the professional expertise and judgement of practitioners, as they discuss care and support options with people.

How does it relate to statutory and non-statutory guidance?

Practitioners must comply with the statutory functions of the agencies they work for under the Children Act 1989 and Children Act 2004, the Children and Families Act 2014 and the Children and Social Work Act 2017 and any other legislation relevant to their profession. They must also comply with the Department for Education's statutory guidance on working together to safeguard children. Practitioners should also follow the Department for Education's non-statutory guidance on what to do if you're worried a child is being abused. Links to 'Working together to safeguard children' are highlighted in each section.

This legislation and guidance describes what individuals and agencies need to do to keep children and young people safe. This guideline provides detail on how they can do this, based on best available evidence about effectiveness and cost effectiveness, and lessons from practice. The guideline will, in turn, be complemented by profession-specific guidance, such as the Department for Education's keeping children safe in education and the General Medical Council's protecting children and young people: doctors' responsibilities.

For more information on the statutory framework and other guidance, see appendices B and C of 'Working together to safeguard children'.

How has it been developed?

This guideline has been developed by a multidisciplinary guideline committee, using an extensive review of research evidence, expert witnesses and input from a children and young people's expert reference group. See the NICE guidelines manual for more information about how the guideline is developed.

Recommendations about who a particular intervention is for are based on the evidence base. This means that not all interventions are recommended for all groups.

Some recommendations are made with more certainty than others. We word our recommendations to reflect this. In the sections on interventions we use 'offer' to reflect a strong recommendation, usually where there is clear evidence of benefit. We use 'consider' to reflect a recommendation for which the evidence of benefit is less certain. For more information see making decisions using NICE guidelines.

In the section on recognition of child abuse and neglect, we use 'suspect' and 'consider' to indicate the extent to which an alerting feature suggests child abuse and neglect, with 'suspect' indicating stronger evidence of child abuse and neglect.

What evidence is the guideline based on?

To develop the guideline we looked for evidence about:

All the interventions recommended in this guideline are based on at least 1 well-designed study (randomised or quasi-randomised controlled trial). It is important to note that much of the evidence on effective interventions came from the US, but the applicability of this in a UK context was carefully considered by the guideline committee when making the recommendations.

How does it relate to other NICE guidelines?

This guideline builds on the NICE guideline on child maltreatment, which covers clinical features of maltreatment. This guideline is broader: it extends coverage of alerting features for child abuse and neglect to those which may be observed by other professional groups, and also addresses assessment, early help and response. The committee identified recommendations from the NICE guideline on child maltreatment that are relevant to both health and social care practitioners, and adapted them for this guideline (see section 1.3).

This guideline has also adapted recommendations from the NICE guidelines on children's attachment and domestic abuse. Other relevant NICE guidelines include harmful sexual behaviour among children and young people and looked-after children and young people.