First UK-wide clinical guidelines for paediatric non-fatal strangulation launched to transform the clinical response
First UK-wide clinical guidelines for paediatric non-fatal strangulation launched to transform the clinical response
> Download the Guidelines here
> Download the Information Leaflet here
The Institute for Addressing Strangulation (IFAS) has recently published the UK’s first Guidelines for clinical management of paediatric (under 16) non-fatal strangulation, closing a significant gap in clinical practice and providing dedicated guidance for healthcare professionals for the first time.
Building on IFAS’s previously published adult clinical guidelines for emergency and acute care settings, the new guidance responds to the clear need for dedicated recommendations for paediatric patients. Until now, clinicians caring for children following suspected or confirmed non-fatal strangulation had no dedicated UK guidance and often had to rely on protocols developed for adults. The new guidelines have been developed by a UK-wide Intercollegiate Working Group convened by IFAS, bringing together more than 60 senior clinicians, Royal Colleges, professional bodies and frontline professionals from across the UK to develop evidence-informed, consensus-based recommendations.
The guidance arrives against a backdrop of increasing concern. Home Office data shows recorded non-fatal strangulation and suffocation offences against under-18s in England and Wales increased from 2,130 in 2022–23 to 4,888 in 2024–25 (IFAS Police Report Data, 2023–2025). Evidence also shows that hanging/strangulation is the most common method of suicide among children and young people in England, accounting for 69% of deaths in 2019–20 (National Child Mortality Database Programme, 2021).
The guidelines provide practical recommendations covering clinical assessment, imaging, safeguarding, mental health, admission and discharge planning, while recognising that children who have experienced strangulation may present with little or no visible injury despite the potential for significant harm.
Alongside the clinical guidelines, IFAS has also published a new information leaflet for children, young people and their families following a medical assessment for non-fatal strangulation. The leaflet has been developed to help children, young people and their families better understand non-fatal strangulation, what to expect following a medical assessment, and where they can access further support and information.
Dr Catherine Hayhurst, Consultant in Emergency Medicine, Co-Chair Quality in Emergency Care Committee, Royal College of Emergency Medicine (RCEM), said:
“RCEM is pleased that a review of the evidence has shown that there is no need to routinely do a CT angiogram in young people given the radiation exposure. This update of the guidance continues to have an emphasis on safeguarding and also highlights mental health issues for patients presenting with non-fatal strangulation.”
Professor Cath White, Medical Director, IFAS, said:
“There simply wasn’t a UK guideline for managing non-fatal strangulation in children, so clinicians were doing their best with guidance written for adults. We brought together more than 60 clinicians from across the UK – including Royal Colleges, specialist organisations and frontline professionals – to build something better. We listened, challenged one another and developed guidance that addresses a real need. These are the first UK guidelines, but they won’t be the last. As the evidence grows, we’ll continue to learn and refine them to ensure children receive the best possible care.”
Bernie Ryan OBE, Chief Executive of IFAS, said:
“Our adult clinical guidelines helped establish a more consistent response to non-fatal strangulation across the UK. Children deserve that same standard of evidence-based clinical and trauma-informed care. These new guidelines, together with the new information leaflet developed in partnership with SafeLives Changemakers, survivors and Beyond Equality, are the result of extraordinary collaboration across the healthcare community and represent an important step forward in improving outcomes for children and young people.”
About IFAS
The Institute for Addressing Strangulation (IFAS) is the UK’s leading authority on non-fatal strangulation, established in October 2022 with Home Office funding. IFAS works across research, training, policy and survivor engagement, alongside partners in government, healthcare, criminal justice, and specialist services, to improve the UK’s understanding and response to strangulation. Since 2022, IFAS and its partners have trained more than 22,000 frontline professionals, including through its partnership with SafeLives.
