Recognising Physical Abuse, Non-Accidental Injury and Fabricated or Induced Illness

Consider physical abuse and non-accidental injury when an injury, symptom pattern or account does not match the child's age, development, presentation or circumstances. Level 3 practice is about recognising those inconsistencies, thinking about immediate safety, recording concerns clearly and seeking advice rather than investigating beyond your role.

In clinical pharmacy settings, physical abuse may present via:

• requests for pain relief
• wounds or dressings brought for review
• frequent urgent-care attendances
• delayed presentation after injury
• a child who appears frightened or unable to speak freely

You do not need to establish how an injury happened; you need to notice when explanation, behaviour and the wider pattern do not fit together safely.

Non-Accidental Injury Red Flags

Red flags include injuries inconsistent with age or development, changing or delayed explanations, repeated injuries or repeated requests for analgesia, fearful behaviour, and an adult who is hostile, controlling or more concerned with ending the interaction than the child's welfare.

Context is important. A single bruise may mean little on its own, but repeated injuries, fear, poor attendance and medicine-related patterns together may indicate significant harm.

Fabricated or Induced Illness Awareness

Fabricated or induced illness (FII) is abuse in which a carer exaggerates, fabricates or causes symptoms in a child. It can occur alongside genuine illness; the concern is an unusual or inconsistent picture driven by an adult's account that lacks objective support.

In pharmacy practice, FII may be suspected when there are:

• repeated urgent requests
• strong pressure for changes to treatment
• symptoms reported by a carer but not observed by staff
• inconsistent accounts across services

Do not confront the carer or attempt tests yourself. Record what was said, what you observed, what objective evidence exists, and seek senior and safeguarding advice promptly.

A child does not need to disclose abuse for an injury pattern, clinical mismatch, or highly inconsistent illness story to be safeguarding-significant.