• Ruth Gilbert, Alison Kemp, June Thoburn, Peter Sidebotham, Lorraine Radford, Danya Glaser, and Harriet L Macmillan.
• Centre for Evidence-based Child Health and MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK.
• Lancet. 2009 Jan 10; 373 (9658): 167-80.

AbstractProfessionals in child health, primary care, mental health, schools, social services, and law-enforcement services all contribute to the recognition of and response to child maltreatment. In all sectors, children suspected of being maltreated are under-reported to child-protection agencies. Lack of awareness of the signs of child maltreatment and processes for reporting to child-protection agencies, and a perception that reporting might do more harm than good, are among the reasons for not reporting. Strategies to improve recognition, mainly used in paediatric practice, include training, use of questionnaires for asking children and parents about maltreatment, and evidence-based guidelines for who should be assessed by child-protection specialists. Internationally, studies suggest that policies emphasising substantiation of maltreatment without concomitant attention to welfare needs lead to less service provision for maltreated children than do those in systems for which child maltreatment is part of a broad child and family welfare response.

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