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National Collaborating Centre for Women's and Children's Health (UK). When To Suspect Child Maltreatment. London: RCOG Press; 2009 Jul. (NICE Clinical Guidelines, No. 89.)

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When To Suspect Child Maltreatment.

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8Parent–child interactions

The features of harmful parent/carer–child interaction are encapsulated in the definition of emotional abuse within Working Together to Safeguard Children1 (see Section 2.6 on definitions of child maltreatment). The definition is based on a thorough review of literature and clinical experience at the time that it was drawn up and updated for the 2006 version. The definition establishes that it is important to look at reported or evident troubling parent/carer–child interactions. The effects on the child of these interactions can be caused by other types of maltreatment, including emotional abuse.

GDG considerations

The GDG's opinion is that the UK government's definition of emotional abuse is well formulated and that direct observation of parent/carer–child interactions by healthcare professionals can provide significant pointers to more fundamental concerns that the nature of the relationship between parent/carer and child may be harmful. Therefore, the GDG believes that healthcare professionals should be alerted to how the general concerns in the definition of emotional abuse can translate into specific interactions between parents/carers and children. The GDG also believes that infants are particularly vulnerable to the effects of emotional neglect and has highlighted this.

The GDG discussed the issue of wetting (see Section 7.2.5 on wetting and soiling). In addition, the parent or carer's interaction with the child in cases of wetting is considered to be important and the GDG concluded that punishing a child for involuntary wetting when, for example, the parents had been advised that the symptom was involuntary would be a cause for concern.

A concerning parent–child or carer–child interaction that presents as an obstacle to recognising maltreatment is when the parent or carer does not allow the healthcare professional to talk to the child in the absence of the parent or carer. The GDG believes this behaviour to be concerning because it disempowers the child or young person.

There was consensus within the GDG about the recommendations in this section and thus the views of the Delphi panel were not sought.

Recommendations on parent–child interactions

Consider* emotional abuse if there is concern that parent– or carer–child interactions may be harmful. Examples include:

  • Negativity or hostility towards a child or young person.
  • Rejection or scapegoating of a child or young person.
  • Developmentally inappropriate expectations of or interactions with a child, including inappropriate threats or methods of disciplining.
  • Exposure to frightening or traumatic experiences, including domestic abuse.
  • Using the child for the fulfilment of the adult's needs (for example, children being used in marital disputes).
  • Failure to promote the child's appropriate socialisation (for example, involving children in unlawful activities, isolation, not providing stimulation or education).

Suspect* emotional abuse when persistent harmful parent– or carer–child interactions are observed or reported.

Consider* child maltreatment if parents or carers are seen or reported to punish a child for wetting despite professional advice that the symptom is involuntary.

Consider* emotional neglect if there is emotional unavailability and unresponsiveness from the parent or carer towards a child and in particular towards an infant.

Suspect* emotional neglect if there is persistent emotional unavailability and unresponsiveness from the parent or carer towards a child and in particular towards an infant.

Consider* child maltreatment if a parent or carer refuses to allow a child or young person to speak to a healthcare professional on their own when it is necessary for the assessment of the child or young person.


Refer to Chapter 3 for the definitions of ‘unsuitable explanation’, ‘consider’ and ‘suspect’, and for their associated actions.

See also Section 7.2.5 on wetting and soiling.

Copyright © 2009, National Collaborating Centre for Women's and Children's Health.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK []. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

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Bookshelf ID: NBK57173
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