Recognising Abuse and Neglect
Abuse can be physical, emotional, sexual, or neglectful, and often co-exists. [3] In optical practice, signs may be ocular (periorbital bruising, subconjunctival haemorrhage) or contextual (delay in seeking care, inconsistent histories). [2][3] Recognition is about patterns over time plus professional curiosity in the moment. [6][1]
Optical red flags and patterns
Repeated breakage of spectacles without a plausible mechanism, missed amblyopia treatment appointments, or untreated infections may indicate neglect. [3][6] Periorbital bruising in various stages of healing, injuries with neat object outlines, or unilateral facial injuries in a non-mobile child warrant immediate concern. [2][3]
Behaviour such as flinching when instruments approach, watching a particular adult for cues, or providing rehearsed answers suggests coercion. [3] Equally, a caregiver who resists examination, refuses to allow the child to speak, or changes explanations should heighten alertness. [1][6]
- Triangulate information: the child's account, caregiver explanation, and clinical findings should cohere; mismatch requires escalation. [6][1]
- Document exactly: record verbatim phrases, injury diagrams/body maps if used, and photographs only if local policy permits. [4][5]
- Consider differentials: cultural practices, medical conditions (for example, easy bruising), or neurodiversity can mimic abuse; when in doubt, seek senior advice and share information. [3][5]
Maintaining proportionality
Recognition does not mean proving abuse - that is the role of children's services and police. [6]
The clinical duty is to notice, record, and refer when risk is credible. [1][6] Open prompts such as "Can you tell me what happened?" help avoid investigative questioning. [3]
Explain to the child in age-appropriate terms what will happen next and that they are not in trouble. [4][3]
Safety comes before completeness of history; escalate first if immediate risk is suspected, then add details as feasible. [6]
References (numbered in text)
- 11. Protect and safeguard patients, colleagues and others from harm — Standards of practice for optometrists and dispensing opticians — General Optical Council Find (opens in a new tab)
- Characteristics of non-vitreoretinal ocular injury in child maltreatment: a systematic review — T Betts; S Ahmed; S Maguire; P Watts — Eye (Lond) 2017 Find (opens in a new tab)
- Child maltreatment: when to suspect maltreatment in under 18s (Clinical guideline CG89) — National Institute for Health and Care Excellence (NICE) (published 2009; updated 2017) Find (opens in a new tab)
- Keeping records — Protecting children and young people (Keeping records) — General Medical Council (GMC) Find (opens in a new tab)
- Medical photography of possible physical abuse in children — Royal College of Paediatrics and Child Health (RCPCH) (refreshed June 2019) Find (opens in a new tab)
- Working together to safeguard children: statutory guidance — Department for Education (2023) Find (opens in a new tab)
References are included to demonstrate that all the content in this course is rigorously evidence-based, and has been prepared using trusted and authoritative sources.
They also serve as starting points for further reading and deeper exploration at your own pace.
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