Sunburnt children or neglected tooth decay? Watch out for child abuse, UK's health watchdog says.
The new guidelines of the National Institute for health and Clinical Excellence (NICE) are addressed to health care professionals who do not work primarily in child protection fields. Hopefully they can now spot early signs of abuse or neglect and refer them to children's services.
Doctors should 'suspect' neglect, and therefore inform children's services, if a child is persistently smelly or dirty.
The document said: "Children often become smelly or dirty during the course of the day. However the nature of the child's smell may be so overwhelming that the possibility of persistent lack of provision or care should be taken into account."
If maltreatment is 'suspected' then the child should be referred to children's social care and if maltreatment is being 'considered', further information should be sought and discussions held with senior colleagues.
Bedwetting where there is no known stressful situation or a medical explanation, should prompt doctors to consider maltreatment, the document said.
Punishing a child for bedwetting despite being advice that wetting is involuntary should also prompt professionals to consider maltreatment.
The document said: "Achieving a balance between an awareness of risk and allowing children freedom to learn by experience can be difficult. However, if parents or carers persistently fail to anticipate dangers and to take precautions to protect their child from harm it may constitute neglect."
Maltreatment should be considered when there is any serious or unusual injury where there is no suitable explanation.
A pregnancy in a girl aged between 13 and 15 should trigger doctors to consider maltreatment and because sex with a girl under the age of 13 is unlawful, any pregnancy in younger girls means she has been maltreated.
The guidance is separated into sections on physical abuse; sexual abuse; neglect; emotional, behavioural, interpersonal and social functioning; fabricated or induced illness and clinical presentations and parent-child interactions, giving early signs that should be considered maltreatment and where maltreatment should be suspected.
One in ten children will suffer some form of maltreatment during their childhood with neglect and emotional abuse being the most common, Danya Glaser, chairman of the guideline group, said.
"All children will get bruises at some time or another, it is the persistence of these features that is often the hallmark of possible maltreatment," Ms.Glaser noted.
She also agreed that more children might be referred to social services because the guidance could 'lower of the bar' at which maltreatment is suspected but said it was about 'ensuring the right child is referred'.
She added that cultural reasons given for abuse, such as in excessive physical punishment, should not be a taken as an acceptable explanation of maltreatment.
Further research should be done to establish if other factors like persistent abdominal pain is a sign of possible maltreatment and more work is needed to help doctors to identify which bone fractures are probably deliberately caused and which are likely to have been accidents, the document said.
The guidance, which was under way before the Baby Peter abuse case came to light, was welcomed by the Royal College of Paediatrics and Child Health.
Margaret Morrissey, of campaign group Parents Outloud, said most of the guidance was good common sense and pointed to factors which do in most cases indicate maltreatment.
But the problem is repeated infestations of headline or the sunburn might not necessarily be a result of neglect or abuse. One could try utmost, still the problem could persist.
"We need to make sure that we are not putting parents in a position where they are terrified of approaching their doctors in case they are accused of abuse. A lot of these factors are signs of abuse or neglect but we need to be careful we do not go too far," Ms.Morrissey warned.
Vijay Patel, a policy adviser with the National Society for the Prevention of Cruelty to Children (NSPCC) said: "Healthcare professionals are often in the frontline of protecting vulnerable children so any support they can get in spotting abuse is going to be invaluable.
"Every year many thousands of children have child protection plans but sadly others slip through the net and do not get the help they need. That's why this guidance is a step forward in ensuring that more children are protected from abuse at an early stage."