3.1 Recognition of Abuse and Neglect
This policy is currently under review
- The Concept of Significant Harm(Jump to)
- Categories of Abuse and Neglect(Jump to)
- Risk Indicators(Jump to)
- Recognising Physical Abuse(Jump to)
- Recognising Emotional Abuse(Jump to)
- Recognising Sexual Abuse(Jump to)
- Recognising Neglect(Jump to)
The Concept of Significant Harm
The Children Act 1989 provides the legal framework for defining the situations in which a local authority has a duty to make enquiries about what, if any, action to take to safeguard or promote a child's welfare.
Section 47 of the Act requires that if a local authority has 'reasonable cause to suspect that a child who lives or is found in their area is suffering or is likely to suffer Significant Harm, the authority shall make, or cause to be made, such enquiries as they consider necessary…'
In Section 31 Children Act 1989 as amended by the Adoption and Children Act 2002:
There are no absolute criteria on which to rely to determine what constitutes Significant Harm. It is often a compilation of significant events, both acute and longstanding, which impact on the child's physical and psychological development. Children's Social Care must consider all the circumstances when determining whether a referral about abuse and / or neglect to a child satisfies the criteria for a section 47 Enquiry - for further details, please see Section 47 Enquiries Procedure.
Categories of Abuse and Neglect
Abuse and neglect are forms of maltreatment of a child. Somebody may cause or neglect a child by inflicting harm, or failing to act to prevent harm. Children may be abused in a family, or in an institutional or community setting; by those known to them or, more rarely by a stranger. They may be abused by an adult or adults or another child or children.
Working Together to Safeguard Children 2018 includes definitions of the four broad categories of abuse which are used for the purposes of recognition:
These categories overlap and an abused child does frequently suffer more than one type of abuse. This chapter provides definitions of these categories and information to help identify potential abuse and neglect and the required response.
Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child.
It may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces illness in a child. This unusual and potentially dangerous form of abuse is described as fabricated or induced illness in a child (see Fabricated or Induced Illness Procedure).
See also Recognising Physical Abuse
Emotional abuse involves the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child's emotional development.
It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or 'making fun' of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children.
These may include interactions that are beyond the child's developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying causing children frequently to feel frightened or in danger, or the exploitation or corruption of children.
Some level of Emotional Abuse is involved in all types of maltreatment of a child, though it may occur alone.
Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetration (for example rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse. Sexual abuse can take place online, and technology can be used to facilitate offline abuse. Sexual Abuse is not solely perpetrated by adult males. Women can also commit acts of Sexual Abuse, as can their children.
The Sexual Offences Act 2003 introduced a range of new sexual offences designed to address all inappropriate activity with children.
Child Sexual Abuse includes:
In law children under 16 years of age cannot consent to any sexual activity occurring, although in practice young people may be involved in sexual contact to which, as individuals, they may have agreed. Children under 13 years cannot in law under any circumstances consent to sexual activity and specific offences, including rape, exist for child victims under this age (see Sexually Active Children Procedure).
Neglect is the persistent failure to meet a child's basic physical and/or psychological needs, likely to result in the serious impairment of the child's health and development.
It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.
Severe neglect of young children is associated with major impairment of growth and intellectual development. Persistent neglect can lead to serious impairment of health and development, long-term difficulties with social functioning, relationships and educational progress. Neglect can also result, in extreme cases, in death.
The factors described in this section are frequently found in cases of child abuse. Their presence is not proof that abuse has occurred, but:
In an abusive relationship the child may:
The parent or carer may:
Consideration must be given to the impact on the care of the child of any issues / problems affecting parenting e.g. domestic abuse which may include physical violence; coercive and controlling behaviour, substance misuse, mental health problems, learning disabilities, childhood experiences of severe neglect or abuse; including sexual abuse. Consideration should be given to whether the parent is able to understand and predict risk and subsequently make appropriate decisions to protect their child from harm
Staff should be aware of the potential risk to children when individuals, previously known or suspected to have abused children, move into or have substantial access in the household (see Risk Management of Known Offenders and Those who Pose a Risk).
Staff should be aware of the potential risk to children of witnessing, or being injured as a result of domestic abuse when a new partner is introduced into the family home, or has substantial access to the children and is known as a perpetrator of domestic abuse. Individuals who have been in an abusive relationship are more likely to enter into other unhealthy or abusive relationship. If concerns are raised an application under Clare’s Law should be made as either a ‘right to know’ made by professionals or a ‘right to ask’, made by individuals, so the parent can understand any risks posed by their new partner to make an informed choice about the relationship.
It should be recognised that those who pose a risk to children often will not be honest with others. Staff should be mindful of this. Of particular note are carers who present a risk due to either fabricating or inducing illnesses within the children they are responsible for - see Fabricated or Induced Illness Procedure.
Practitioners should, in particular, be alert to the potential need for early help for a child who:
Recognising Physical Abuse
This section provides information about the sites and characteristics of physical injuries that may be observed in abused children. It is intended primarily to assist staff in the recognition of bruises, burns and bites which should be referred to Children's Social Care and / or require medical assessment.
Further useful information can be found on the RCPCH website, about a series of systematic reviews defining the evidence base for the recognition and investigation of physical child abuse and neglect.
The following are bruises/injuries/burns that should prompt a thorough assessment:
See 'Bruising' below for more information on brusing.
Babies and young children can also sustain serious head injuries as a result of abusive head trauma. Physical signs include reduced conscious levels, vomiting, irritability, apnoea (a pause/temporary stopping or of breathing) or irregular breathing.
The following are often regarded as indicators of concern:
Acute Life Threatening Event
Most acute life threatening events have a medical or physiological basis, although a precise explanation is not always found. Some have unnatural causes and assessment should always include consideration of these through careful history taking, examination and investigation similar to the list for unexplained deaths.
Child protection checks must be initiated for the child and any siblings. Any suspicions must be reported immediately to the duty social worker.
Children can have accidental bruising, but the following must be considered as highly suspicious of a non-accidental injury unless there is an adequate explanation provided and experienced medical opinion sought:
Bruises are difficult to age accurately because they change colour at differing rates.
A medical opinion from a forensic dentist / odontologist should be sought where there is any doubt over the origin of the bite.
Burns and Scalds
It can be difficult to distinguish between accidental and non- accidental burns and scalds, and will always require experienced medical opinion. Any burn with a clear outline may be suspicious e.g:
Scalds to the buttocks of a small child, particularly in the absence of burns to the feet, are indicative of dipping into a hot liquid or bath.
Fractures may cause pain, swelling and discolouration over a bone or joint.
Non-mobile children rarely sustain fractures.
There are grounds for concern if:
A large number of scars or scars of different sizes or ages, or on different parts of the body, may suggest abuse.
Shaken Baby Syndrome
Shaking and/or inflicting an impact injury on a baby often results in no visible external injury. Nevertheless, significant internal injuries may be caused, e.g. intra-cranial bleeding, brain injury, small fractures to the ends of the long bones, other fractures (such as ribs and neck) and retinal haemorrhages. Signs and symptoms can be non-specific, which may result in a delay in seeking advice.
The infant can present with:
In suspected cases it is essential that a full paediatric assessment is carried out including an ophthalmological examination, blood tests and CT/MRI scans/skeletal survey (according to the RCR/RCPCH guidance).
Self-Harming and Siblings
Caution must be used when interpreting an explanation by parents/carers that an injury or series of injuries was self-inflicted or caused by a sibling. This is especially important in young or disabled children not able to offer a reliable explanation themselves.
Due consideration must be given to the possibility that the injury may:
In these circumstances a referral to Children's Social Care should be made in accordance with the Making a Referral Procedure
Recognising Emotional Abuse
Emotional Abuse may be difficult to recognise, as the signs are usually behavioural rather than physical.
Indicators of Emotional Abuse are also often associated with other forms of abuse.
Recognition of Emotional Abuse is usually based on observations over time and the following offer some associated indicators:
Parent / Carer and Child Relationship Factors
Child Presentation Concerns
Parent / Carer Related Issues
Recognising Sexual Abuse
Please also see:
Children of all ages may be sexually abused and are frequently scared to say anything due to guilt and/or fear. This is particularly difficult for a child to talk about and full account should be taken of the cultural sensitivities of any individual child / family.
Recognition can be difficult, unless the child discloses and is believed. There may be no physical signs and indications are likely to be emotional / behavioural.
Evidence of neglect is built up over a period of time and can cover different aspects of parenting.
Evidence of neglect is built up over a period of time and can cover different aspects of parenting.
Child Related Indicators
Indicators in the Care Provided
Obesity in children is an increasingly common problem in the general population and differentiating when there is a Safeguarding issue can be difficult and complex. Neglect can result in poor supervision of food intake, or an inappropriate diet being offered to the child with resultant excessive weight gain. A sedentary lifestyle with limited opportunity for physical activity, when combined with an inappropriate diet, can result in excessive weight gain.
It is important to take into account:
Excessive calorie intake is the cause of most childhood obesity. In a very small proportion of obese children there is an underlying medical cause. The parent/carer is responsible for monitoring their child's diet and seeking appropriate advice/support if the child or adolescent is overweight or obese. The management of obesity in children therefore requires parental engagement to enable and support their child to adopt healthy eating patterns, participate in age appropriate levels of physical activity and attend medical and dietetic appointments as necessary. Parental failure to engage with an appropriate management plan in a child who is severely obese and/or is developing serious complications of obesity should be considered a safeguarding issue.