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Child Abuse and Neglect


Children who have experienced abuse or neglect may not always present with obvious symptoms of trauma. What will be important for the medical team to consider is:

  1. Was there a delay in presentation?
  2. Is the injury / fracture type inconsistent with the account of what happened?
  3. Is there radiological evidence of old / healing fractures?
  4. Has the person presented to that ED / orthopaedic service with previous unexplained injuries or fractures?
  5. In the case of a child or young person, is there a history of other siblings with unusual injuries?
  6. Is this child’s life at risk due to their unmanaged medical condition?

Types of injuries which are often associated with intentional harm or neglect include:

  • Fractures and sentinel injuries (i.e. facial bruising) in pre-mobile infants.
  • Long bone fractures in children under 3 years.
  • Head trauma and related injuries (particularly in children under 2 years old. Presenting features may range from severe neurological compromise (coma) to symptoms such as seizures, lethargy, irritability, vomiting, poor feeding, and increasing head circumference).
  • Unmet medical needs or morbid obesity.


The NSW Health Suspected Child Abuse and Neglect (SCAN) Medical Protocol provides a standard template for medical staff to record a forensically oriented medical assessment of a child or young person, to enable an informed opinion about the probability that injuries have been caused intentionally.

If the situation were to present out-of-hours, the hospital on-call Social Worker or a Child Protection Unit should be contacted. If this is not available at your institution, the child may require overnight admission to ensure adequate assessment of the safety of the child is made in daylight hours.

  • The Sydney Children’s Hospitals Network Westmead Campus Ph: 02 9845 0000.
  • The Sydney Children’s Hospitals Network Randwick Campus Ph: 02 9382 1111.
  • John Hunter Children’s Hospital Ph: 02 4921 3000.

Child Abuse & Sexual Assault Clinical Advice Line (CASACAL)

The Child Abuse & Sexual Assault Clinical Advice Line (CASACAL) is a 24/7 medical and forensic telephone advice line. CASACAL provides advice on medical and forensic examinations, medical care (and documentation) for children and young people (up to their 16th birthday) who are suspected victims of sexual assault, physical abuse and neglect. Advice can be provided in both urgent and non-urgent situations. CASACAL is staffed by specialist child protection paediatric consultants at a NSW Health Child Protection Unit/Service. You can call CASACAL after following your local advice and escalation pathways, and the service is available to those working in inter-jurisdictional or Private Public Partnership arrangements.

CASACAL can be contacted on 1800 244 531 (1800 CHILD1).

Fact Sheet about CASACAL is available here.

Mandatory Reporting for NSW Health Staff

NSW Health, including ED staff, are mandatory reporters of suspected risk of significant harm to children, young people and “classes” of children and young people[1] , and are required to report these matters.

If you suspect abuse or neglect (past or recent), please follow the steps below:

  1. Complete the Mandatory Reporters Guide (MRG) which only takes a couple of minutes and will help guide your next steps.
  2. Contact the Health Child Wellbeing Unit (CWU) on 1300 480 420 (Monday–Friday; 8:30am – 5:00pm) if directed by the MRG, or you are not sure what to do.


  1. Contact the Child Protection Helpline (24 hours / 7 days) as directed by the MRG on ‍132 111 and/or if you suspect a child or young person is at imminent risk of significant harm. Alternatively, if the child is at risk of significant harm but the threat is not imminent or urgent, you can complete a report via an online eReport which must be completed within 24 hours of presentation.
  2. Document your concerns / interventions in the client file.

[1] Note that in some Rural LHDs Assessment Centers are also available for consultation.

© Agency for Clinical Innovation 2023