Recognising Abuse and Neglect

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Recognising Abuse and Neglect

REGULATIONS AND STANDARDS

The Fostering Services (England) Regulations 2011:
Regulation 11 - Independent fostering agencies—duty to secure welfare
Regulation 12 - Arrangements for the protection of children

Fostering Services: National Minimum Standards
STANDARD 4 - Safeguarding Children
STANDARD 29 - Notifications of Significant Events

SCOPE OF THIS CHAPTER

This chapter provides guidance on recognising abuse in children and young people, and explains what is meant by safeguarding and significant harm.

RELEVANT INFORMATION AND GUIDANCE

Local Multi-Agency Safeguarding Children Procedures

RELATED CHAPTER

For procedures regarding the reporting of child welfare concerns, see Safeguarding Children and Young People and Referring Safeguarding Concerns Procedure.

Safeguarding and Promoting the Welfare of Children
Recognising Concerns
Abuse
Neglect
Physical Abuse
Sexual Abuse
Emotional Abuse
Bullying (including Online/Cyberbullying)
Technology Assisted Abuse
Child on Child Sexual Violence and Sexual Harassment
Extra-Familial Harm

1. Safeguarding and Promoting the Welfare of Children

Safeguarding relates to the action taken to promote the welfare of children and protect them from harm. Safeguarding is everyone's responsibility.

Working Together to Safeguard Children defines Safeguarding and promoting the welfare of children as:

Providing help and support to meet the needs of children as soon as problems emerge;
Protecting children from maltreatment, whether that is within or outside the home, including online;
Preventing impairment of children's mental and physical health or development;
Ensuring that children grow up in circumstances consistent with the provision of safe and effective care;
Promoting the upbringing of children with their birth parents, or otherwise their family network thought a kinship care arrangement, whenever possible and where this is in the best interest or children;
Taking action to enable all children to have the best outcomes in line with the outcomes set out in the Children’s Social Care National Framework.

Significant Harm

The Children Act 1989 introduced the concept of 'Significant Harm' and 'the likelihood of Significant Harm' as the threshold that justifies compulsory intervention in family life in the best interests of children; the act places a duty on local authorities to make enquiries to decide whether they should take action to safeguard or promote the welfare of a child who is suffering, or is likely to suffer Significant Harm.

Harm is defined as the ill treatment or impairment of health and development. This definition was clarified in section 120 of the Adoption and Children Act 2002 (implemented on 31 January 2005) so that it may include, "... impairment suffered from seeing or hearing the ill treatment of another" (for example in the case of a child who witnesses domestic abuse).

Physical Abuse, Sexual Abuse, Emotional Abuse and Neglect are all categories of Significant Harm.

There are no absolute criteria on which to rely when judging what constitutes significant harm. Sometimes a single violent episode may constitute significant harm but more often it is an accumulation of significant events, both acute and longstanding, which interrupt, damage or change the child's development.

2. Recognising Concerns

Safeguarding and promoting the welfare of children and young people and, in particular protecting them from abuse and harm, is a shared responsibility and depends on effective joint working between all staff and foster carers along with all the relevant agencies and professionals.

Children should be supported by staff and foster carers to understand what abuse is, and to manage the impact of any abuse or neglect they have suffered.

Children must be listened to and enabled to report any abuse or neglect at the earliest opportunity. They should be given information about how to report abuse or any concerns about possible abuse among their peers. This should include being able to access in private, relevant websites or help lines such as Childline to seek advice and help.

All staff and foster carers have a responsibility to report any suspicions or concerns that a child has or may be mistreated or harmed.

Abuse or neglect is not always easy to identify, staff and foster carers are more than likely to have some information but not the whole picture.

The first indications that a child is being abused or neglected may be as a result of:

Remarks made by the child or their parents or friends;
Changes in a child's behaviour or demeanour which may indicate abuse or neglect;
By a series of events or indicators which, whilst not necessarily of concern in themselves, are of concern when considered together.

Initially, the situation may not seem serious but it should be remembered that intervening early can prevent minor abuse from becoming more serious.

Any allegation of harm or abuse must be addressed in line with the Safeguarding Children and Young People and Referring Safeguarding Concerns Procedure.

The registered person should ensure that all staff and foster carers have relevant training in safeguarding and children protection.

3. Abuse

Abuse is a form of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm or by failing to act to prevent harm. Harm can include ill treatment that is not physical as well as the impact of witnessing ill treatment of others. This can be particularly relevant, for example, in relation to the impact on children of all forms of domestic abuse, including where they see, hear, or experience its effects. Children may be abused in a family or in an institutional or extra-familial contexts by those known to them or, more rarely, by others. Abuse can take place wholly online, or technology may be used to facilitate offline abuse. Children may be abused by an adult or adults or another child or children.

A person can abuse or neglect a child by inflicting harm or by failing to act to prevent harm. Children can be abused in a family or in an institution or community setting; by those known to them or, more rarely, by a stranger. They can be abused by an adult or adults or another child or children.

4. Neglect

Neglect is a form of Significant Harm which involves 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 or development.

Neglect may occur/involve:

During pregnancy as a result of maternal substance abuse;
Parent/carer failing to provide adequate food and clothing, shelter including exclusion from home or abandonment;
Failing to protect a child from physical and emotional harm or danger;
Failure to ensure adequate supervision including the use of inappropriate carers;
Failure to ensure access to appropriate medical care or treatment;
May also include neglect of, or unresponsiveness to a child's basic emotional needs.

Warning signs include:

Non-organic failure to thrive, i.e. where there is poor growth for which no medical cause is found, especially with a dramatic improvement in growth on a nutritious diet away from home;
A consistently unkempt, dirty appearance;
Unmet medical needs, e.g. failure to seek medical advice or attend appointments for illness, severe untreated nappy rash, missed immunisations where they have not been refused on other grounds;
Developmental delay without any other clear cause;
Lack of social responsiveness;
Self-stimulating behaviours such as head banging or rocking (note that some children with special needs may exhibit this behaviour due to their disability but this should also be evaluated for context);
Repeated failure by parents/carers to prevent injury;
Consistently inappropriately clothed for the weather;
Hazardous living conditions.

5. Physical Abuse

Physical abuse is a form of Significant Harm which may include hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child, including fabricating the symptoms of, or deliberately causing, ill health, to a child.

Harm maybe caused to children both by the abuse itself, and by the abuse taking place in a wider family or institutional context of conflict and aggression, including inappropriate or inexpert use of physical restraint. Physical abuse has been linked to aggressive behaviour in children, emotional and behavioural problems, and educational difficulties. Violence is pervasive and the physical abuse of children frequently coexists with domestic abuse. It may involve hitting, shaking, scolding, suffocating or poisoning and it may cause the following injuries:

Bruises

Symmetrically bruised eyes are rarely accidental, although they may occur where there is a fracture of the head or nose and blood seeps from the injury site to settle in the loose tissue around the eye. A single bruised eye may be the result of an accident or abuse. Careful consideration is required whenever there is an injury around the eye. It should be noted whether the lids are swollen and tender and if there is damage to the eye itself.

Bruising in or around the mouth (especially in small babies);
Grasp marks on legs and arms or chest of a small child;
Finger marks (e.g. you may see three or four small bruises on one side of the face and one on the other);
Symmetrical bruising (especially on the ears);
Bruising behind the ears;
Outline bruising (e.g. belt marks, hand prints);
Linear bruising (particularly on the buttocks or back);
Bruising on soft tissue with no obvious explanation, e.g. inner aspect of thigh;
Bruising of different ages.

The following are uncommon sites for accidental bruising:

Back of legs, buttocks, except occasionally along the bony protuberances of the spine
Mouth, cheeks, behind the ear;
Stomach, chest;
Under the arm;
Genital, rectal area;
Neck.

Babies or others who are not yet mobile, i.e. are developmentally unable to move on their own, should not get bruises or other injuries. If they have bruises or other injuries, these must be adequately explained before they are accepted as accidental.

Note

Seemingly trivial injuries should not be ignored. Abuse can and does sometimes escalate against a child if it goes unchecked. All injuries should be noted and collated in the child/ren's records.

Most falls or accidents produce one bruise on a single surface - usually on a bony area. A child who falls downstairs generally has only one or two bruises. Children usually fall forwards and therefore, bruising is most often found on the front of the body. In addition, there may be marks on their hands if they have tried to break their fall.

Bruising may be difficult to see on child who is black. Blue grey spots are natural pigmentation on the skin which may be mistaken for bruising. These purplish-blue skin markings are most commonly found on the backs of children.

Scars

Children may have scars, but notice should be taken if a child has large number of scars of different ages (especially if coupled with current bruising), unusual shaped scars (e.g. round ones from possible cigarette burns) or of large scars that are from burns or lacerations that did not receive medical treatment.

Fractures

These should be suspected if there is pain, swelling and discolouration over a bone or joint. Fractures should be suspected if the child is not using a limb, especially in younger children. The most common non-accidental fractures are to the long bones in the arms and legs, and to the ribs. It is very rare for a child under one year to sustain a fracture accidentally. Fractures also cause pain and it is very difficult for a parent to be unaware that a child has been hurt.

Burns/Scalds

It can be very difficult to distinguish between accidental and non-accidental burns; however, burns or scalds with clear outlines are suspicious as are burns of uniform depth over a larger area.

Bites

These can leave clear impressions of the teeth. Human bites are oval or crescent shaped. If the impression of the bites is more than 3 cm across its width, they must have been caused by an adult or older child with permanent teeth.

Other injuries which may be deliberately caused

Poisoning;
Ingestion or other application of damaging substances, e.g. bleach;
Administration of drugs to children where they are not medically indicated or prescribed;
Female Genital Mutilation (FGM) and Breast Ironing is Physical Abuse and a criminal offence regardless of cultural or other reasons. (See Female Genital Mutilation Procedure).

Injuries may also be caused as a result of a parent fabricating or inducing illness in a child.

6. Sexual Abuse

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 assault by 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 often takes place online, and can be in many forms including grooming, sexting (including sharing explicit photos / images) and social media. Creating or sharing explicit images of a child is illegal, even if the person doing it is a child. A young person is breaking the law if they:

Take an explicit photo or video of themselves or a friend;
Share an explicit image or video of a child, even if it's shared between children of the same age;
Possess, download or store an explicit image or video of a child, even if the child gave their permission for it to be created.

However, if a young person is found creating or sharing images, the police can choose to record that a crime has been committed but that taking formal action is not in the public interest.

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 other children.

Sexual abuse can have a long-term impact on emotional, social and educational development and is linked to the development of mental health issues in later life.

Most child victims are sexually abused by someone they know - either a member of their family or someone well known to them or their family. It can be the most secretive and difficult type of abuse for children and young people to disclose.

Both boys and girls of all ages are abused and the abuse may carry on for many years before it comes to light.

Initially children and young people may not recognise themselves as victims of sexual abuse - a child may not understand what is happening and may not even understand that it is wrong especially as the perpetrator will seek to reduce the risk of disclosure by threatening them, telling them they will not be believed or holding them responsible for their own abuse.

Recognition of sexual abuse generally follows either a direct statement from the child (or very occasionally from the abuser), or more often, as a result of concerns about the child's behaviour, or because of physical symptoms or signs.

Indicators that a child has been sexually abused include:

Changes in behaviour, including becoming more aggressive, withdrawn, clingy;
Problems in school, difficulty concentrating, drop off in academic performance;
Sleep problems or regressed behaviours i.e. bed wetting / soiling when previously dry;
Frightened of or seeking to avoid spending time with a particular person;
Knowledge of sexual behaviour/language that seems inappropriate for their age;
Physical symptoms including pregnancy in adolescents where the identity of the father is vague or secret, STIs, discharge or unexplained bleeding;
Poor hygiene, which often leads to social isolation in school;
Injuries and bruises on parts of the body where other explanations are not available especially bruises, bite marks or other injuries to breasts, buttocks, lower abdomen or thighs; and
Injuries to the mouth, which may be noted by dental practitioners.

Child sexual exploitation is also a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology. See Safeguarding Children and Young People from Sexual Exploitation Procedure.

7. Emotional Abuse

Emotional abuse is a form of Significant Harm which 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 (including online/cyberbullying) causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. See Internet, Photographs and Mobile Phones Procedure.

Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.

It is not usually indicated by a specific incident, but is observed in the interaction with the child. One child may be scapegoated or treated completely differently to their siblings.

Parental behaviours associated with Emotional Abuse

The following may identify parental behaviours which, if persistent, may be emotionally abusive. What is inappropriate will often depend on the child's developmental stage:

A persistently negative view of the child, particularly as inherently bad, often combined with "deserved" harsh punishment;
Inconsistent and unpredictable responses particularly where there is threat to or rejection of the child;
Expectations which are inappropriate for the developmental stage of the child, either too high or too low, over protective or under protective;
A lack of emotional availability or responsiveness to the child;
No respect for personal boundaries of the child; not seeing the child as an individual;
Promoting mis-socialisation or poor social adaptation;
Contradictory, confusing or misleading messages in communicating with the child which seriously distort reality for the child or promote confusion;
Serious physical or psychiatric illness of a parent including periods of hospitalisation;
Induction of a child into bizarre parental beliefs;
Breakdown in parental relationship with chronic, bitter conflict over contact or residence (this would also include situations where there is domestic abuse);
Major emotional rejection of the child and parental inability to perceive their needs with any objectivity;
Major and repeated familial change, e.g. separations, reconstitution of families;
Parental drug and/or alcohol misuse;
Entrenched offending behaviour which may be criminal and which might also lead to a term of imprisonment.

Behavioural signs in children

Behaviour in a child which may indicate emotional abuse includes:

Very low self esteem, often with an inability to accept praise or to trust;
Lack of any sense of fun, over-serious or apathetic;
Excessive clingy or attention seeking behaviour;
Over-anxiety, either watchful and constantly checking or over-anxious to please;
Developmental delay, especially in speech;
Substantial failure to reach potential in learning, linked with lack of confidence, poor concentration and lack of pride in achievement;
Self harming; compulsive rituals; stereotypical repetitive behaviour;
Unusual pattern of response to others showing emotions.

8. Bullying (including Online/Cyberbullying)

Also see Countering Bullying Procedure and Internet, Photographs and Mobile Phones Procedure.

Severe or persistent bullying can result in Significant Harm, which is why the registered person must ensure that procedures for dealing with allegations of bullying are in place, and that foster carers have the skills required to intervene, protect and address bullying behaviours effectively.

Bullying is defined as 'behaviour by an individual or group, usually repeated over time, which intentionally hurts another individual or group either physically or emotionally' (DfE definition). Repeated bullying usually has a significant emotional component, where the anticipation and fear of being bullied seriously affects the behaviour of the victim.

It can be inflicted on a child by another child or an adult. Bullying can take many forms (for instance, cyberbullying or online bullying via text messages or the internet), and is often motivated by prejudice against particular groups, for example on grounds of race, religion, gender, sexual orientation. It might be motivated by actual differences between children, or perceived differences.

It can take many forms, but the three main types are:

Physical - for example, hitting, kicking, pushing, theft;
Verbal - for example, threats, name calling, racist or sexual/homophobic remarks;
Emotional - for example, isolating an individual from activities/games and the social acceptance of their peer group.

An Ofsted thematic review (Review of Sexual Abuse in Schools and Colleges (Ofsted)) identified substantial levels of sexual harassment for both girls (90%) and boys (nearly 50%) – usually in unsupervised settings. Sexual harassment and sexual violence exist on a continuum and may overlap. Where the latter occurs, there could be a criminal offence committed (see also: Section 6, Sexual Abuse).

Cyberbullying is bullying that takes place using technology. Whether on social media sites, through a mobile phone, or gaming sites, the effects can be devastating for the young person involved. There are ways to help prevent a child from being cyberbullied and to help them cope and stop the bullying if it does happen. It is another form of bullying which can happen at all times of the day, with a potentially bigger audience. By its very nature, cyberbullying tends to involve a number of online bystanders and can quickly spiral out of control. Children and young people who bully others online do not need to be physically stronger and their methods can often be hidden and subtle.

Bullying often starts with apparently trivial events such as teasing and name calling which nevertheless rely on an abuse of power. Such abuses of power, if left unchallenged, can lead to more serious forms of abuse, such as domestic abuse, racial attacks, sexual offences and self-harm or suicide.

Bullying is a type of behaviour which needs to be defined by the impact on the child being bullied rather than by the intention of the perpetrator.

Staff and foster carers must ensure that children in their care who attend the same schools, work together with educational establishments where bullying occurs between children they both have responsibility for.

9. Technology Assisted Abuse

Technology is a significant component in many safeguarding and wellbeing issues. Children are at risk of abuse and other risks online as well as face to face. In many cases abuse and other risks will take place concurrently both online and offline.

Children can also abuse other children online, this can take the form of abusive, harassing, and misogynistic/misandrist messages, the non-consensual sharing of indecent images, especially around chat groups, and the sharing of abusive images and pornography, to those who do not want to receive such content. Children can also be groomed online and through social media by people coercing or manipulating them to sexually or criminally exploit them or seeking to radicalise them.

See Internet, Photographs and Mobile Phones.

10. Child on Child Sexual Violence and Sexual Harassment

Keeping Children Safe in Education Part five: Child on Child Sexual Violence and Sexual Harassment sets out how schools and colleges should respond to all signs, reports and concerns of child-on-child sexual violence and sexual harassment, including those that have happened outside of the school or college premises, and/or online.

Sexual violence and sexual harassment can occur between two or more children of any age and sex, from primary through to secondary stage and into college. It can occur also through a group of children sexually assaulting or sexually harassing a single child or group of children. Sexual violence and sexual harassment exist on a continuum and may overlap; they can occur online and face-to-face (both physically and verbally) and are never acceptable.

Sexual Violence

Child on child sexual violence refers to sexual offences under the Sexual Offences Act 2003 as described below:

Rape: A person (A) commits an offence of rape if: he intentionally penetrates the vagina, anus or mouth of another person (B) with his penis, B does not consent to the penetration and A does not reasonably believe that B consents.

Assault by Penetration: A person (A) commits an offence if: s/he intentionally penetrates the vagina or anus of another person (B) with a part of her/his body or anything else, the penetration is sexual, B does not consent to the penetration and A does not reasonably believe that B consents.

Sexual Assault: A person (A) commits an offence of sexual assault if: they intentionally touches another person (B), the touching is sexual, B does not consent to the touching and A does not reasonably believe that B consents.

NOTE: Schools and colleges should be aware that sexual assault covers a very wide range of behaviour so a single act of kissing someone without consent, or touching someone's bottom/breasts/genitalia without consent, can still constitute sexual assault.

Sexual Harassment

Child on child sexual harassment means 'unwanted conduct of a sexual nature' that can occur online and offline and both inside and outside of school/college. Sexual harassment is likely to: violate a child's dignity, and/or make them feel intimidated, degraded or humiliated and/or create a hostile, offensive or sexualised environment.

Sexual harassment can include:

Sexual comments, such as: telling sexual stories, making lewd comments, making sexual remarks about clothes and appearance and calling someone sexualised names;
Sexual 'jokes' or taunting;
Physical behaviour, such as: deliberately brushing against someone, interfering with someone's clothes. Schools and colleges should be considering when any of this crosses a line into sexual violence – it is important to talk to and consider the experience of the victim;
Displaying pictures, photos or drawings of a sexual nature;
Upskirting (this is a criminal offence); and

Online sexual harassment. This may be standalone, or part of a wider pattern of sexual harassment and/or sexual violence. It may include:

Consensual and non-consensual sharing of nude and semi-nude images and/or videos. Taking and sharing nude photographs of under 18s is a criminal offence. UKCIS Sharing nudes and semi-nudes: advice for education settings working with children and young people provides detailed advice for schools and colleges;
Sharing of unwanted explicit content;
Sexualised online bullying;
Unwanted sexual comments and messages, including, on social media;
Sexual exploitation; coercion and threats; and
Coercing others into sharing images of themselves or performing acts they're not comfortable with online.

It is essential that all victims are reassured that they are being taken seriously and that they will be supported and kept safe. A victim should never be given the impression that they are creating a problem by reporting sexual violence or sexual harassment. Nor should a victim ever be made to feel ashamed for making a report.

See also: Addressing Child-on-child Abuse: a Resource for Schools and Colleges (Farrer and Co.) which is intended to be used as a resource and reference document for practitioners.

11. Extra-Familial Harm

Children may be at risk of or experiencing physical, sexual, or emotional abuse and exploitation in contexts outside their families.

Extra-familial contexts include a range of environments outside the family home in which harm can occur. These can include peer groups, school, and community/public spaces, including known places in the community where there are concerns about risks to children (for example, parks, housing estates, shopping centres, takeaway restaurants, or transport hubs), as well as online, including social media or gaming platforms.

Working Together to Safeguard Children recognises that, whilst there is no legal definition for the term extra-familial harm, it is widely used to describe different forms of harm that occur outside the home. Children can be vulnerable to multiple forms of extra-familial harm from both adults and/or other children. Examples of extra-familial harm may include (but are not limited to): criminal exploitation (such as county lines and financial exploitation), serious violence, modern slavery and trafficking, online harm, sexual exploitation, child-on-child (nonfamilial) sexual abuse and other forms of harmful sexual behaviour displayed by children towards their peers, abuse, and/or coercive control, children may experience in their own intimate relationships (sometimes called teenage relationship abuse), and the influences of extremism which could lead to radicalisation.

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