What does safeguarding children mean for health professionals?
A child is anyone under 18. Safeguarding means protecting children from maltreatment inside or outside the home, including online, preventing harm to their health or development, and helping every child have the best outcomes. In England the statutory guidance is Working Together to Safeguard Children, which was revised in 2026. The Children Act 1989 and 2004 provide the legal framework.
Safeguarding is everyone's responsibility, including staff who mainly treat adults. A paramedic attending a parent's overdose, a pharmacist supplying a parent with substance misuse, or a mental health nurse caring for a parent in crisis may be the first to notice risk to children at home. Think family: ask who else lives there and who looks after the children.
Every NHS organisation has named safeguarding professionals who can advise you. Know how to reach your safeguarding team and your local children's social care front door, sometimes called a multi-agency safeguarding hub.
What are the four categories of child abuse?
Children often experience more than one type of abuse at once, and concerns usually build from several small observations rather than a single event. The signs below are reasons to be curious, not proof.
| Category | What it means | Features that may raise concern |
|---|---|---|
| Physical abuse | Causing physical harm, including fabricated or induced illness | Bruising in a baby who is not yet mobile; bruises on ears, neck, cheeks or buttocks; patterned marks; injuries that do not fit the explanation or the child's development; delay in seeking help |
| Emotional abuse | Persistent emotional ill-treatment, including making a child feel worthless and exposure to domestic abuse | Withdrawal, anxiety, low self-esteem, a carer who is persistently hostile or rejecting |
| Sexual abuse | Involving a child in sexual activity, including online abuse and grooming | Age-inappropriate sexualised behaviour, sexually transmitted infection or pregnancy in a young child, a much older partner |
| Neglect | Persistent failure to meet a child's basic physical or psychological needs | Poor growth, untreated tooth decay, poor hygiene, repeated missed appointments, not seeking medical care, inadequate supervision |
Other forms of harm to recognise
- Child sexual exploitation and child criminal exploitation, including county lines. Signs include going missing, unexplained money or phones, new older associates and travel to other towns.
- Online harm: grooming, image sharing and bullying.
- Radicalisation, raised through your organisation's Prevent lead.
- Female genital mutilation. In England and Wales, regulated health and social care professionals must report to the police if a girl under 18 tells them she has had FGM, or if they see physical signs that appear to show it.
- Domestic abuse between adults in the home, which harms children who see or hear it.
Why is bruising in a non-mobile baby always taken seriously?
Babies who cannot yet roll, crawl or cruise rarely bruise by accident. NICE guidance on child maltreatment (CG89) says bruising in a child who is not independently mobile should raise suspicion of maltreatment. Most areas have a protocol requiring any bruise or unexplained mark in a non-mobile baby to be referred for specialist paediatric assessment and discussed with children's social care.
These protocols apply to every baby, which means you do not have to judge whether a particular family seems caring. Child safeguarding practice reviews have described cases where small bruises in infants were accepted as accidental before the baby was seriously harmed.
How do you raise a safeguarding concern about a child?
You are not expected to investigate or to be certain. Your job is to make sure the right people know so they can act. Follow your local procedures, which usually look like this.
- Make the child safe: If a child is in immediate danger, call 999. Give any treatment needed. If you think a child would be at risk going home, do not let them leave without urgent discussion with a senior colleague and children's social care.
- Listen: If a child tells you something, stay calm, take them seriously and tell them they were right to tell you. Do not ask leading questions or press for detail.
- Do not promise secrecy: Explain in words they understand that you may need to tell people who can help keep them safe.
- Think about the parents: Usually you discuss concerns with parents and seek agreement to a referral. Do not do this if it could increase the risk, for example in suspected sexual abuse or fabricated or induced illness. Seek advice.
- Get advice: Speak to a senior colleague and your safeguarding team or named professional. If you cannot reach them and the concern is urgent, contact children's social care directly.
- Refer: Contact children's social care for the area where the child lives, usually by phone followed by the local written referral form.
- Record: Record your concern, what was said, discussions, the decision and your reasons.
- Follow up: If you do not hear the outcome, chase it. If you remain worried, use your local escalation or professional disagreement procedure.
After a referral, children's social care may decide no further action is needed, offer family support, or carry out an assessment. Where there is reasonable cause to suspect a child is suffering or likely to suffer significant harm, a strategy discussion with police and health can lead to a section 47 enquiry and, if needed, a child protection conference. Not every worry needs a child protection referral; your local threshold document explains which service to contact.
Consent, confidentiality and information sharing
Reviews into child deaths and serious harm have repeatedly found that professionals held pieces of information that were never put together. Government guidance is clear that data protection law is not a barrier to sharing information to keep children safe.
- Share with consent where possible, but you do not need consent if seeking it would put the child at risk, or where there is a lawful basis such as protecting a child from significant harm.
- Be open with the family about what you are sharing and why, unless that would increase risk.
- Share only what is necessary, proportionate, accurate, timely and secure.
- Record what you shared, with whom and why, including decisions not to share.
Young people aged 16 and 17 are presumed able to consent to their own treatment. Under-16s can consent if they have enough understanding and maturity (Gillick competence). Young people have the same right to confidentiality as adults, but it can be overridden where there is a risk of serious harm. Sexual activity involving a child under 13 should always be discussed with your safeguarding lead and referred, because a child under 13 cannot legally consent.
Worked example: a baby with a small bruise
Noah's father brings him in with a cold. While examining him, the advanced practitioner, Chloe, notices a small bruise on his upper arm. Noah cannot roll yet. His father says his toddler sister may have grabbed him. The father seems attentive and Noah is clean and well fed. Chloe feels awkward and does not want to upset a family who seem to be doing their best.
Small bruise L arm, sibling grabbed per dad. Well-cared-for baby. No concerns. Discharged.
1 cm bruise left upper arm, recorded on body map. Father's explanation: 'his sister might have grabbed him'. Noah is not yet rolling. Treated for URTI. Explained to father that any bruise in a baby who cannot move about is always checked by a children's doctor as standard. Discussed with the nurse in charge and safeguarding team; referred to paediatrics for specialist assessment and contacted children's social care in line with the local non-mobile infant bruising protocol. Father informed of referral.
Chloe did not have to decide whether abuse had happened. The protocol did that work. Explaining that this is standard for every baby helped the father accept it without feeling accused.
How should you document safeguarding concerns?
Safeguarding records may be read by social workers, police, courts and reviews. They need to make sense to someone who has never met the child.
- Date, time and sign every entry with your name and role.
- Record what you saw and what the child or carer said, in their own words where possible.
- Describe injuries precisely (site, size, shape, colour) and use body maps. Do not try to age bruises.
- Note who was present and who the child was with.
- Separate facts from your opinion, and give reasons for concern.
- Record discussions, advice received, referrals and actions. If you decide not to refer, record why.
Support for you and keeping your training current
Child safeguarding can be distressing. Talk to your safeguarding team, use supervision and access staff wellbeing support. If you are involved in a review or a concern about your own practice, seek advice from your trade union or defence organisation.
The intercollegiate document on safeguarding children and young people sets training levels by role, from level 1 for all staff to level 3 for clinicians who work with children and families. Check what your organisation requires.
Our Safeguarding Children and Young People course covers the legal framework, recognising abuse and exploitation, responding to disclosures, referral pathways, consent and information sharing, with a case study and reflection. It supports, but does not replace, the safeguarding training your employer requires.
Frequently asked questions
What are the four main types of child abuse?
UK guidance describes four main categories: physical abuse, emotional abuse, sexual abuse and neglect. Children often experience more than one at the same time. Health professionals should also recognise child sexual and criminal exploitation, online harm, radicalisation, female genital mutilation and the impact of domestic abuse in the home.
Do I need proof before making a child safeguarding referral?
No. You need a reasonable concern, not proof. Your role is to recognise and refer, not to investigate. Children's social care, working with police and health, decides what enquiries are needed. Discuss with your safeguarding team, and if a child may be in immediate danger, call 999.
Should I tell the parents before making a referral?
Usually yes. You should normally discuss concerns with parents and seek their agreement, unless doing so might put the child at greater risk, for example in suspected sexual abuse, fabricated or induced illness, or where a family may flee. If you are unsure, seek advice from your safeguarding team before speaking to the parents.
What should I do if a child discloses abuse to me?
Stay calm, listen and take them seriously. Reassure them they were right to tell you. Do not ask leading questions or promise to keep it secret; explain you may need to tell people who can help. Make sure they are safe, speak to your safeguarding lead promptly, refer as needed and write down what they said in their own words.
Why is a bruise on a baby a safeguarding concern?
Babies who are not yet independently mobile rarely bruise accidentally. NICE guidance says bruising in a non-mobile child should raise suspicion of maltreatment, and most areas have a protocol requiring specialist paediatric assessment and discussion with children's social care. The protocol applies to every baby, whatever the explanation.
What is Gillick competence?
Gillick competence describes when a young person under 16 has enough understanding and maturity to consent to their own treatment. The Fraser guidelines are related criteria used for contraceptive advice and treatment without parental involvement. Gillick-competent young people have a right to confidentiality, which can be overridden where there is a risk of serious harm.
What does 'was not brought' mean?
It is a phrase many NHS organisations use instead of 'did not attend' when a child misses an appointment. It recognises that children rely on adults to bring them. Repeated missed appointments can indicate neglect, especially for children with health needs, so they should be followed up rather than the child simply being discharged.
Related courses
Safeguarding Children and Young People
This course explains how healthcare professionals in England recognise and respond to concerns that a child or young person may be suffering, or at…
Adult Advanced Life Support (UK Guidelines)
This course explains the recognition and management of adult in-hospital cardiac arrest, based on the current Resuscitation Council UK adult advanced…
Paediatric Life Support (UK Guidelines)
This course teaches the recognition of the seriously ill or injured child and the management of paediatric cardiorespiratory arrest, based on current…
Sources and further reading
- Working Together to Safeguard Children (2026). Department for Education.
- Children Act 1989 and Children Act 2004. legislation.gov.uk.
- Child maltreatment: when to suspect maltreatment in under 18s (CG89). National Institute for Health and Care Excellence.
- Protecting children and young people: the responsibilities of all doctors. General Medical Council.
- Safeguarding children and young people: roles and competencies for healthcare staff (intercollegiate document). Royal College of Paediatrics and Child Health.
- Information sharing: advice for practitioners providing safeguarding services. Department for Education.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
Safeguarding Adults: Types of Abuse and How to Make a Referral
Safeguarding adults explained for UK health staff: the ten types of abuse, signs to look for, consent and capacity, and how to raise a safeguarding concern.
How to Write a Reflective Account for NMC Revalidation (With Examples)
How to write a reflective account for NMC revalidation: what the form asks, how many you need, a weak vs strong example, and how to link each one to the Code.
Medication Error Reflection: A Worked Example for Nurses
A medication error reflection example for nurses: what to do first, how to structure your reflection, a weak vs strong version, and how to show real learning.