Warning Signs of Abuse

Safeguarding assessment integrates presentation, behaviour, and history. No single sign is diagnostic; patterns and context guide action. Optical professionals combine clinical observation with structured questioning and clear documentation.^[1][6]

Physical abuse

• Indicators: periorbital bruises in various healing stages, patterned marks, retinal/subconjunctival haemorrhage without adequate trauma explanation.^[4][5][3]
• Context: frequent "accidents", delay in presentation, inconsistent accounts, or caregiver minimisation.^[1][2]
• Optical actions: record precise locations and sizes, and the child/caregiver accounts; escalate when explanations do not fit findings.^[6][1]

Emotional abuse

• Indicators may include withdrawal, hypervigilance, fearfulness around a particular adult, or persistent belittling of the child's symptoms by a caregiver.
• Context can involve unrealistic expectations, humiliating remarks, or conditional affection that is reported or observed.
• Optical actions include documenting behaviour and interactions, validating the child's feelings, and seeking advice where patterns suggest persistent harm.^[1][6]

Sexual abuse and exploitation

• Indicators: age-inappropriate sexual knowledge or behaviour, STIs disclosed, gifts/expensive items inconsistent with family means, controlling older "friends".^[1]
• Context: online contact, grooming, or coercion; unexplained absences from school.^[2][1]
• Optical actions: avoid detailed questioning; capture disclosures verbatim; escalate immediately according to local pathways.^[2][6]

Neglect

• Indicators cover unmet health needs (such as untreated infection), persistent lack of spectacles/repairs, and missed appointments for amblyopia or ocular disease.
• Context is typically chronic patterns rather than one-off lapses.
• Optical actions include recording chronology, offering adjustments, and escalating when needs remain unmet or risk of harm persists.^[1][6]

In all categories, clinical judgement considers differentials (medical conditions, cultural practices, neurodiversity).^[1][3]

When uncertainty remains but risk cannot be excluded, consult the safeguarding lead and children's services without delay.^[2][6]

References (numbered in text) Why we include references

1. Child maltreatment: when to suspect maltreatment in under 18s — National Institute for Health and Care Excellence (NICE) Find (opens in a new tab)
2. Working together to safeguard children 2023 — Department for Education Find (opens in a new tab)
3. Retinal findings: systematic review — Child Protection Evidence, Royal College of Paediatrics and Child Health (RCPCH) Find (opens in a new tab)
4. S. A. Maguire, P. O. Watts, A. D. Shaw, S. Holden, R. Taylor, W. J. Watkins, et al., Retinal haemorrhages and related findings in abusive and non-abusive head trauma: a systematic review. Eye (2013) Find (opens in a new tab)
5. Abusive Head Trauma and the Eye in Infancy — The Royal College of Ophthalmologists Find (opens in a new tab)
6. Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff — Royal College of Nursing (2019) Find (opens in a new tab)