Child Abuse Suspected

Suspected Child Abuse / Neglect

Any person, who suspects that a child is being abused, or is at risk of abuse, has a responsibility to report their concerns to the health board. All staff working with children should be familiar with the "Children First" document, the national guidelines for the protection and welfare of children.

A child protection concern is likely to fall within one of four categories of child abuse which are :

(1) Neglect, (2) Sexual Abuse, (3) Physical Abuse and (4) Emotional Abuse.


A case of NAI may be: Clear cut or suspected.

Clear cut - a case is clear cut when:

  1. A parent, guardian or other person makes a statement about an injury
  2. To a child that he or another person has inflicted
  3. Clear medical evidence shows that ill-treatment has taken place.

In these cases arrangements must be made for the child to be medically examined by a Paediatrician.

Suspected - a case is suspected when there are indications that an injury or other condition (e.g. unexplained failure to thrive) is caused by the ill-treatment or neglect by a parent, guardian or other person but where no clear or medical evidence exists, or where no statement is made, or where the degree or type of injury is at variance with the explanation given.

In such cases it is important to identify the degree of risk to the child and to take any necessary steps to protect the child.

The priorities in dealing with child abuse are:

  1. to diagnose, treat, and document the child's injuries
  2. to interpret the pattern of injury or behaviour leading to the suspicion of abuse
  3. to notify and involve the on-call social worker at the hospital (9-5 pm)
  4. to provide, when parental consent is given, a verbal or written report to the HSE-S

Consent / confidentiality

The doctor must establish that consent (ideally written) has been given (by one of the child's parents / legal guardian) to perform a clinical examination and to provide a report to the Southern Health Board or the Gardaí. If the child is under a protection application then a nominee of the Southern Health Board is the child's guardian. If the family refuse permission to make a report:

Please complete proformas for suspected child abuse cases.

General Management

  1. Check the The Child Protection Notification System (CUH only).(ref 2)
  2. Past ED records should be reviewed.
  3. NCHD staff who feel unhappy about a child's injuries or the history should indicate this to the parent /carer.
  4. Language should not be confrontational or challenging "I can see how worried you are about these bruises".
  5. Remember a parent who has possibly injured a child has brought the child because of concern for the child.
  6. Record all information given and document the history and findings meticulously.
  7. The priority for the all staff is the safety of the child and the treatment of the presenting problem.
  8. All cases must be referred to the duty hospital social worker even if a child is discharged home or transferred to another institution for ongoing care.
  9. The General Practitioner should be notified.

Risk factors for Non Accidental Injury

Physical Abuse


  • A comprehensive examination of the child should include height and weight measurements. 
  • Careful inspection of all surfaces with special attention to the scalp, mouth, gums, eyes and behind the ears.
  • Use of body diagrams
  • Ensure descriptions are consistent with the following definitions:
    • Abrasion- a superficial scraping injury of the body surface with or without bleeding
    • Bruise- Leakage of blood from blood vessels discolouring the tissues of the body
    • Incision- A cutting type injury that severs tissues in a clean and generally regular fashion
    • Laceration- A tear or split in the tissues
  • Consider an ophthalmologic examination, particularly in the younger child, where a shaken injury is suspected as there may be no external signs of trauma.

Conditions suspicious of NAI include:

  • Inadequate or inconsistent explanations injuries
  • Retinal haemorrhages
  • Scalds, burns or poisoning - ? cigarette burns / rope marks
  • Long bone fractures in a child under 3 years
  • Repeated injuries
  • Facial bruising - loose teeth, injuries in the mouth
  • Perineal injuries
  • Human bites
  • Failure to thrive
  • Delay in seeking medical help
  • Frozen watchfulness
  • Excessive crying - may provoke abuse from parents or others responsible for the child.


Legal implications

Sexual Abuse

Neglect and Emotional Abuse

Child Welfare Concerns

Where referral to the Child and Adolescent Psychiatry Team / Adult Psychiatry Team is appropriate, there is currently no agreement that this in itself satisfies the hospital's child protection and welfare duty and therefore one should also make a referral to the hospital social worker.

The emergency department is NOT an appropriate "place of safety" (the paediatric ward is).

Admission to hospital

Useful Contacts

"Children First Department" CUH (Block 36, St. Finbarr’s Hospital Douglas Road, Cork). VPN 23220.

Social Work Department MUH:

Social Work Department CUH:

Garda Contact:

North South Child Protection Hub

Summaries of findings and information about local, national and international research in the field of child protection;

The HUB and and Childlink can be accessed via your HSE Athens account.


1. Children First-National Guidelines For The Protection And Welfare Of Children. DOHC 1999. Government Sales Office, Sun Alliance House, Molesworth House, Dublin 2. Back to text

2. Child Protection and Welfare Process- SHB Guidelines, Abbeycourt House, Georges Quay, Cork.  Print version horrible CUH Guide. are NOT responsible for this document! Back to text

Content by Dr David Coughlan, Dr Íomhar O' Sullivan 16/06/04. Reviewed by Dr ÍOS 13/11/2006, 14/11/2007, 18/12/2009. Last updated Dr Í20/02/17->te -->.