NICE Updates Guidance on Child Maltreatment

Why the new definition of “Independently Mobile” matters and what it means for clinicians

On 3 December 2025, NICE updated its long standing guideline Child maltreatment: when to suspect maltreatment in under 18s (CG89), introducing a key clarification that has immediate implications for frontline clinicians assessing injuries such as bruises, lacerations and abrasions. 

The updated Guidance adds – for the first time – a formal definition of “independently mobile”, a term that underpins several key recommendations that inform when clinicians should consider or suspect maltreatment. ¹

What might sound like a small linguistic tweak, seeks to address a problem that has impacted clinicians, Trusts, and local safeguarding partnerships for more than a decade. Namely, what amounts to “independent mobility”. The result being inconsistency across the board and material variations in thresholds for escalation, referral and even child protection investigations. NICE itself having acknowledged that the absence of a definition had “led to variation in how people were interpreting the term, [and] in turn… affected how child maltreatment was being classified and addressed.” ²

Why was a definition needed?

Safeguarding cases involving infants and pre mobile children often hinge on whether an injury—especially bruising—could plausibly have arisen accidentally. Evidence shows that accidental bruising is rare in infants who are not independently mobile. Yet without a shared understanding of what mobility entails, clinicians were applying different thresholds in similar cases. For example, evidence gathered by NICE highlights that in some regions any bruise in a “non mobile” or “pre-mobile” infant automatically triggered a formal child protection investigation, while others only recommended a paediatric review. 

The consequences of this inconsistency is not purely academic: it has been reported that professionals who have seen infants in the weeks leading up to abusive head trauma or serious injury sometimes underestimated the significance of the presence of bruising or minor injuries in infants who are not independently mobile. Elsewhere, families have experienced unnecessary interventions because benign injuries were overinterpreted through an overly cautious mobility threshold. ³

What is NICE’s new definition?

A child is now considered “independently mobile” if they can do any of the following: crawl, bottom shuffle, pull to stand using furniture, stand unaided, cruise (moving from place to place holding an object), climb, walk using a push along walker, or walk unaided. 

This functional definition hopes to remove the guesswork around borderline cases (e.g., infants who can sit and roll but cannot yet crawl). 

What is the practical significance for healthcare professionals?

This clarification matters because recommendations 1.1.2, 1.1.5 and 1.1.6 in CG89 directly link levels of child maltreatment concerns to whether a child is independently mobile when injuries such as bruises, abrasions or thermal injuries are observed. With the new definition, we can expect clinicians to:

• have a consistent basis for interpreting injuries in very young children.
• have more confidence when deciding whether or not to escalate through safeguarding pathways.

For healthcare professionals whose decisions can be heavily scrutinised in disciplinary, regulatory or coronial settings with reference to national guidelines, the update highlights the importance of:

• accurate articulation of clinical reasoning (e.g., describing specific independent movements rather than simply writing “mobile/non mobile”). The definition arguably having restricted the scope of what constitutes ‘reasonable’ clinical judgement.   
• linking escalation decisions explicitly to CG89 and local safeguarding protocols. NICE explicitly notes that defining the term will “support professionals… to have difficult conversations” and improve decision making. ⁴
• demonstrating alignment with national guidance, particularly when responding to criticisms around missed or over interpreted injuries.

By introducing a nationally recognised benchmark, the hope is that this will assist healthcare professionals in defending cases where their threshold decision was reasonable within the clarified framework or — conversely — may raise questions about decisions made without clear documentation.

Furthermore, the updated guidance:

• illustrates the increasing scrutiny on safeguarding thresholds amidst a backdrop of national concern about missed opportunities to identify early abuse. 
• signals NICE’s intent to close interpretative gaps that have caused practical problems for years. 
• acts as a reminder for clinicians of the need to stay engaged with evolving safeguarding guidance and to ensure their decision making processes and, in turn, documentation reflect these changes.

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1. Child-Protection-Evidence-Chapter-Bruising_Update_final.pdf
2. Child maltreatment: when to suspect maltreatment in under 16s (NICE CG89) | NHSGGC
3. Bruising and Injuries in Non-Mobile Infant Multiagency Procedure - Tees Safeguarding Children Partnerships' Procedures
4. Child maltreatment: when to suspect maltreatment in under 16s (NICE CG89) | NHSGGC