Aim Siblings sharing homes with abused children are thought to be at high risk of abuse. Studies have demonstrated occult fractures in the siblings of abused children. The RCPCH Child Protection Companion makes recommendations about the examination of siblings, timings of assessments and investigations to consider.

This audit aims to evaluate a large city’s Department of Community Paediatrics’ performance in assessing siblings of index cases of child abuse.

Method There are no prescriptive guidelines for the assessment of siblings of index child abuse cases. However, recommendations for sibling assessment from national and local bodies were used to create standards against which practice could be audited. The city’s child protection database was searched from 1/5/13 to 31/5/13. All index children suffering abuse were identified and sibling details documented. The database was re-searched for evidence of these siblings being examined and details were recorded about the timescale of assessment and details of investigations performed. Any clinical suspicions of abuse were recorded.

Results Only 27 of 70 siblings identified were examined (39%). Of those siblings examined abuse was suspected in 87%. 11 of 18 siblings of physically abused children (61%) were seen within 24 hours. Of the 6 siblings of physically abused children who were aged less than 24 months old, 2 were investigated with a skeletal survey and CT head and 4 had not been investigated. 8 of 9 siblings of sexually abused children were investigated for sexually transmitted infections; only 2 siblings having complete screening. Of the 43 siblings not examined, 2 were seen within the next month as index cases with evidence of abuse.

Conclusion We are not seeing enough siblings of abused children and therefore may be missing evidence of abuse. We need to improve the timeframe in which siblings of physically abused children are seen. We need to consider investigating young siblings of physically abused children for evidence of occult injuries and perform more comprehensive screening of sexually transmitted infections in siblings of sexually abused children.