Recognising safeguarding concerns through medical work

Recognising when an injury you're assessing might involve non-accidental harm is a clinical skill — partly pattern recognition, partly listening, partly trusting your instincts. This article lists the indicators. The threshold for action is reasonable grounds for concern, not certainty.

• Pattern of injuries — repeated bruising in unusual sites, injuries inconsistent with the explanation given, "frequent flyer" patterns across the season.
• Injury pattern inconsistent with mechanism — bruising pattern, fracture type, or location doesn't match the family or child's account of how it happened.
• Bruising in protected sites — upper arms, inner thighs, torso, neck, ears, behind the knees. These sites are rarely bruised in normal play.
• Bilateral or symmetrical bruising — gripping or restraint patterns.
• Burns, bite marks, or unusual wound shapes.
• Delay in seeking treatment — meaningful gap between when the injury happened and when it was reported, particularly for injuries that would normally prompt immediate care.
• Injuries at different stages of healing without explanation.

• Child's account differs from the parent's in a meaningful way — particularly if the child appears coached or anxious about what they say.
• Affect — withdrawn, fearful, evasive, hyper-vigilant, or unusually compliant in a way that doesn't fit the situation.
• Reluctance to be alone with a specific adult in the football environment.
• Disclosure — the child or another adult tells you something has happened. A direct disclosure always warrants escalation, even if you're sceptical.
• Marked change in the child's normal demeanour over time.

These warrant escalation even without a child injury:

• Boundary violations by a coach, staff member, or volunteer — inappropriate physical contact, private contact outside team channels, gifting.
• Grooming-like behaviour — singling out a child for special attention, secrets, isolation from other children or staff.
• Inappropriate communication — a coach DM'ing a child outside app-monitored channels, requests for private photos, sexualised language.
• Observed inappropriate touch or comments — even one observed instance.

You don't need:

• Certainty about what happened.
• A theory about who's responsible.
• Corroborating evidence.
• The family's agreement.

You only need a reasonable concern that the child's safety might be at risk.

Many safeguarding professionals describe a "gut feel" — a sense that something is off that you can't immediately articulate. That feel is usually worth listening to. Your training and your clinical experience are giving you a signal even before your conscious mind has caught up. If you have it, document it (use neutral, descriptive language) and escalate.

Move to the escalation workflow. That article walks through the in-app and out-of-app steps to take, what the MPIO does next, and what you must not do.

We deliberately don't try to draw a line ("3 indicators = report, 2 = monitor"). Safeguarding is not a checklist. The list above helps you notice; the decision is always: am I worried about this child? If yes, escalate.

If you're reading this article before you've had a concern, that's the best time to read it. Familiarity with the indicators makes you faster and more confident when you need to act. Re-reading every season is a good habit.