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Child Abuse – Signs, Symptoms & Indicators

It is absolutely crucial that all staff working with children and young people are aware of child abuse and that they consider their own role in protecting children.  Managers will have the added responsibility of supporting their staff as well as reporting incidents of abuse.

Today we are more aware of abuse than ever before and have a very clear understanding of what constitutes abuse and what can be classed as effective behaviour control. For example, in the past beating a child was considered acceptable as a means of teaching a child right from wrong, today most of us would be horrified at this kind of treatment.

What is abuse?

Abuse could happen to any child in any family set-up. Evidence suggests that most abuse is carried out by people known to the child, including members of their own family, friends and sometimes even teachers and carers such as childminders and early year’s practitioners.

It should never be assumed that a child, who is from an affluent background, is less likely to be abused than a child from a poorer family, as this is simply not the case.

There are four main types of abuse:

  • Physical abuse
  • Sexual abuse
  • Emotional abuse
  • Neglect

There are several reasons why an adult may resort to abusing a child. These may include:

  • The lack of a bond between the parent and child
  • The failure of the parent to respond to their child
  • The failure of the child to respond to their parent
  • An inability by the parent to accept the parenting role
  • Separation of the child and parent
  • Stress and other factors which may contribute to a lack of interest in the child such as poor housing, unemployment etc.
  • Parents who have been victims of abuse themselves.
Emotional abuse

Physical child abuse

Physical abuse is the intentional infliction of an injury on a child by an adult or the failure to prevent the infliction of injuries by another adult. Physical abuse may take the form of:

  • Hitting
  • Shaking
  • Burning
  • Biting
  • Using excessive force when feeding
  • Giving drugs or alcohol

It is important to remember that all children will experience some form of accidental injury throughout their childhood years and they may well experience cuts, bruises, bumps and even broken bones.

The differences between genuine accidents and deliberate acts of physical abuse are:

  • The location of the injury
  • The frequency of the injury

The location of the injury

Accidental injuries to children usually occur on the following parts of the body:

  • Forehead.
  • Chin.
  • Nose.
  • Knees.
  • Elbows.
  • Forearms.
  • Spine.
  • Hips.
  • Shin.

The following areas are common sites for non-accidental injuries:

  • Lips and mouth.
  • Eyes.
  • Ears.
  • Cheeks.
  • Skull.
  • Chest.
  • Stomach.
  • Buttocks.
  • Back of legs.
  • Upper and inner arms.
  • Genital areas.
  • Rectal areas.
  • Soles of the feet.
  • Neck.

It is very rare for a child to sustain an accidental injury to the neck. Equally, a torn Frenulum (the tongue attachment) should be viewed with suspicion. Haemorrhages to the earlobes are also rarely accidental as are two black eyes, particularly if there are no other apparent injuries to the head or face. You should always be concerned if a child’s injuries appear to be of an unusual shape or give a clear indication that the child has been hit with an instrument such as a belt.

The frequency of the injury

Physical injuries are sometimes accidentally common in children, and a child who appears to have a history of age-appropriate injuries should not automatically raise suspicion of child abuse. Suspicion should, however, be raised if a child appears to suffer from:

  • Varying injuries sustained over a period of time – for example bruises of differing colours would imply that a child has been subjected to injury over a period of time.
  • Illnesses which cannot be accounted for such as recurring stomach pains or headaches.
  • Appearing to succumb to more than an average number of accidents for which there is no explanation for the injury.
Child with bruising

Bruising

One of the most common physical injuries sustained by children is bruising.  Most mobile children will have some kind of bruising at some point the crucial thing to remember is that bruising is strongly related to mobility.  It is very unusual for a baby who is not yet crawling and therefore has no independent mobility to sustain bruising.  As bruising is very common in young children it is important to know when we, as managers, need to be concerned.  So when do we need to be concerned?

  • Bruises sustained through abuse are often located on the ‘soft’ parts of the body for example the cheeks, abdomen, back and buttocks.
  • Cluster bruises are a common feature in abused children and these are often located on the upper arm, outside of the thigh or on the body.
  • A child who has had to defend themselves may have bruising on the forearm, face, ears, abdomen, hip, upper arm, back of the leg, hands or feet
  • Often bruises sustained through abuse will carry the imprint of the implement used or the hand
  • Bruises which show signs of petechiae (this is when dots of blood appear under the skin) are more commonly found in children who have been abused than in those injured naturally.

Although there have been many theories regarding how to ‘age a bruise’ the NSPCC report that the accuracy of observers who estimate the age of a bruise visually ‘is no better than 50%.’  Evidence therefore shows that we cannot accurately age a bruise from an assessment of colour however it is possible to observe the frequency of the bruising and whether any patterns are apparent.

There are both physical and behavioural indicators attached to a child who is suffering from this type of abuse, and managers need to be aware of all the signs.  All children will, at some point, succumb to accidental injury through everyday play. Some children are more accident prone than others and some are simply clumsy! It is always a good idea to talk to children about their injuries – children who have had a genuine accident are usually forthright in their explanations and enjoy recalling the incident for avid listeners. Suspicion should be raised if the child is reluctant to talk about their accident or if they appear nervous or upset, as this may be a sign of an abused child having been warned by their abuser not to talk about their injuries, and they may feel confused or uncomfortable about what, if anything, they should say. In addition to the physical signs, an abused child who suffers from this type of abuse may also show behavioural indicators such as:

  • Aggression towards other children or when playing
  • Showing signs of not wanting to be with certain people
  • Appears shy and withdrawn
  • Appears to be in pain

Sexual child abuse

Sexual abuse is when an adult uses a child for their own sexual gratification.  Sexual abuse covers a wide range of acts such as:

  • Being exposed to sexually explicit photographs, videos or webcams..
  • Encouraging a child to take part in any form of sexual activity including stripping or masturbation.
  • Failure by the adult to take adequate measures to prevent a child from being exposed to sexual activity.
  • Genital or oral stimulation.
  • Indecent exposure
  • Meeting a child following sexual ‘grooming’ with the intention of carrying out abuse
  • Rape.
  • Sexual fondling of any part of the body, either clothed or unclothed.
  • Sexual intercourse.
  • Taking, making or permitting to take, distributing, showing or advertising indecent images of children.

The physical signs associated with sexual abuse will, of course, usually be confined to the genital areas and, unless the child is at an age where they need assistance when visiting the toilet, these signs may be difficult for managers to detect. However, it is important to be aware of the physical signs associated with sexual abuse and these include:

  • Bloodstains in underwear.
  • Difficulty in going to the toilet and showing distress when needing to pass urine or have a bowel movement.
  • Difficulty sitting down or moving about.
  • Frequent ‘accidents’ when the child wets or soils themselves.
  • Frequent infections of the genital areas.
  • Non accidental bruising or scratching particularly around the genital areas
  • Vaginal discharge.

Sexual abuse can be very difficult to detect particularly as many children do not appear to show many “outward” physical injuries. However, although the physical signs may not be apparent, the behavioural indicators should be much easier to detect, and these may include:

  • Appearing depressed or withdrawn.
  • Avoiding being alone with certain people.
  • Dropping hints or clues to try to tell you what is happening to them – this is known as a covert disclosure.
  • Exposing the genital area.
  • Losing interest in school and starting to perform badly in school work.
  • Masturbating in public.
  • Painting or drawing images of a sexual nature.
  • Resorting to immature comfort behaviour such as rocking or thumb sucking not usually associated with a child of that age.
  • Showing insecurity.
  • Showing unexpected fear of certain people.
  • Undressing themselves at inappropriate times.
  • Using imaginary play to act out behaviour of a sexual nature.
  • Using sexual behaviour not usually associated with a child of that age.
  • Using sexual language not usually associated with a child of that age.

Most sexual abuse is carried out by someone known to the child, and in many cases it occurs during normal, routine family activities such as during bath time or at bedtime, and therefore the child may be quite oblivious to what is happening, not always realising that anything unusual is occurring. However, other children, who will understand that what is happening is wrong, may be threatened into keeping the activity a secret; they may be told that they will break up the family or be taken into care if they disclose the secret. Many children are even made to believe that the abuse they are experiencing is a direct result of their own behaviour and that they have caused it to happen, adding guilt to an already very confused child’s mind.

The Sexual Offences Act 2003 provides a clear, modern framework to protect the public from sexual crimes with specific laws designed to protect children and families.  The Sexual Offences Act is the first major overhaul of sexual offences legislation for more than a century and a central aim of the Act is to give better protection to children and families and to put the needs of the victims first.  The act plugs previous loopholes on the law and sets clear limits and boundaries about behaviour with children and reflects what we know today about the patterns and impact of sexual abuse in childhood.

Emotional child abuse

Emotional abuse is when a child is refused love and affection. The adults caring for them may regularly threaten them, shout at them, ridicule or verbally abuse them.  The result of emotional abuse is a child lacking in self-confidence and feeling unworthy of love and affection. Children suffering from emotional abuse may find it difficult to form lasting relationships in later life as a result of the long-term effects of the abuse.

Some children, who have suffered from emotional abuse, may resort to self-harm such as trying to cut or mutilate themselves in some way. However, usually there are very few physical signs of emotional abuse. The main indicators of this type of abuse are behavioural and these include:

  • Trying too hard to please other people in an attempt to feel accepted.
  • Being fearful of new people and situations.
  • Being unable to trust people.
  • Becoming anxious.
  • Becoming passive.
  • Becoming uncooperative and attention seeking, perhaps resorting to telling lies and becoming ‘clingy’ towards certain adults.
  • Developing speech impediments such as stuttering and stammering.
  • Finding it difficult to accept praise.
  • Lacking in self-esteem.
  • Developing poor social skills and finding it difficult to mix with other children of a similar age.
  • Regressing with toilet training.
  • Resorting to comfort-seeking behaviour such as thumb sucking or rocking.
  • Resorting to stealing.
  • Resorting to tantrums due to frustration and a lack of acceptance.
  • Showing aggression.
  • Suffering from an all round delay in their development.
  • Suffering from lack of concentration or lose interest in the things around them.
  • It is important to remember that emotionally abused children are also at risk from sexual abuse as they crave love and affection and may look for this from strangers.

Neglect

A child who does not receive the basic care they need to thrive is said to be suffering from neglect. Neglected children do not receive sufficient food, warmth and supervision, and are often denied basic medical treatment. Often children who are neglected are actually loved. However, their parents or carers may be suffering from personal problems or they may simply lack the necessary knowledge required to provide for their offspring. Neglected children may also have parents who are suffering from some form of mental illness or who are drug users. Neglected children will show both physical and emotional signs. Physical signs may include:

  • The child appearing unkempt, dirty and smelly.
  • The child being underweight.
  • The child not having adequate clothing suitable for the time of year.
  • The child suffering frequent injuries due to a lack of supervision or adequate safety devices.
  • The child suffering from minor infections and ailments on a regular basis which go untreated such as earaches, coughs and toothache.
  • The child appearing to be constantly hungry.
  • The child being tired due to lack of sleep or irregular sleeping habits.
  • The clothing the child does have may be dirty and unwashed and will often be ill fitting.

Neglected children may also show behavioural signs such as:

  • Talking about being left alone to fend for themselves or being in charge of younger siblings.
  • Acting responsible beyond their years, perhaps young children appear knowledgeable in cooking and caring for others which is not normally associated with a child of their age.
Child Neglect

Helping children and young people to protect themselves against abuse

Although adults can, and should, do many things to safeguard the children in their care, it is also necessary for children to learn how to protect themselves from abuse.  Children and young people should be taught how to protect themselves in a sensitive, age appropriate manner without resorting to scare tactics. Although much of the responsibility for protecting children lies on the shoulders of the adults caring for them, we must ensure that children learn some basic rules about how they can be responsible for their own safety, and how they can protect themselves from abuse and managers should be willing to organise suitable training for staff when necessary or invite the appropriate person into the setting to speak to the children.

Children and young people should be taught to understand that it is not always appropriate to be polite and courteous to adults. Although this advice will go against many things you have taught a child with regard to acceptable behaviour, it is necessary for children to understand that they have rights and, if an adult is showing unacceptable behaviour towards them, they do not have to accept it simply because they are children.

All too often children are led to believe that they must ‘do as an adult tells them’. This advice is a bit like being polite and courteous towards adults all of the time and should only really take effect if the child is being shown the same consideration by the adult. Children should be taught that they have the right to say ‘No’ to something which they are unsure of or if something is worrying or frightening them. Children and young people must be taught to understand that they can refuse to do anything which they are uncomfortable with.

Once again, when teaching children acceptable behaviour we often tell them not to answer back, argue, shout or kick up a fuss. When teaching children how to protect themselves from abuse the very opposite is true! Children who feel threatened should be taught to make as much noise as possible; they should be encouraged to scream, shout and kick out if necessary.

Children can be taught, successfully, how to protect themselves if the adults doing the teaching are prepared to do so in a calm and patient manner and by using age appropriate language and tactics. Adults need to listen to the children and help and encourage them to make the right decisions and choices. It is important to offer guidance and show respect towards the child in order to build on their confidence and self-esteem.

Children should be encouraged to learn about their bodies. Adults need to ensure that children are aware of who should be allowed to touch them, such as doctors, and the reasons behind this. Children should be encouraged to respect their own bodies and be confident in their knowledge of what is and is not appropriate behaviour. To enable a child to stay safe they should be taught:

  • How to respond to unwanted attention or inappropriate behaviour towards them.
  • What to do if they get lost when away from home or the childcare setting.
  • About the dangers of talking to people they do not know and how to respond if they are approached by a stranger.
  • That it is alright to tell someone if they are worried or concerned and that keeping a ‘secret’ is not always the right thing to do Children need to know that they should not feel guilty about breaking a confidence or telling a secret.
  • Who they can turn to if they need help and advice, and they need reassurance that this person will listen and respond accordingly.

Managers can play an active part in protecting children from abuse by:

  • Listening to what the children have to say.
  • Being aware of the signs and symptoms of abuse and neglect.
  • Understanding their setting’s procedures and being confident in their knowledge to act on suspicions of abuse should the need arise.
  • Ensuring that any assistants or co-workers they work with have no criminal convictions relating to children and taking all reasonable steps to ensure that any employees they take on are suitable to be in contact with children.
  • Understanding the rights of children.
  • Providing activities and opportunities to promote self awareness.
  • Carrying out routine observations.
Disabled Child

Abuse of children with disabilities

Disabled children can be very vulnerable to abuse largely because they are not always capable of communicating adequately and therefore disclosing their suffering. Sadly paedophiles and other predators see this as a way of concealing their actions and therefore they prey on the most vulnerable of children.

Often children with learning disabilities appear much younger than their actual age and their disability may make them less aware of what is and is not viewed as acceptable behaviour in public.

Although sometimes it is often difficult to know whether a disabled child has suffered from abuse, this does not mean that the possibility can be overlooked, and you should never dismiss any worrying signs as simply being an inevitable consequence of their disability. If you have any concerns, but are uncertain about the signs, always ask yourself how you would feel and react if the child in question did not have a disability which could be used to explain their behaviour.

The fact that disabled children may require more personal physical care and that they may, at times, have been subjected to continual intrusive medical procedures, makes them even more vulnerable to abuse. They may find it difficult to differentiate between medical treatment and abusive exploitation, and they may end up believing that all intrusive attention is normal and necessary.

Disabled children who have difficulty communicating may find it impossible to disclose what they are experiencing, and, of course, those suffering from a high level of disability may be completely helpless and unable to resist their abuser.

As the carer of a disabled child or young person, it is paramount that you keep a close eye on everything they say and do. You need to be sure that the medical attention they receive is appropriate and never be afraid to ask questions about medical procedures you are unsure of. Depending on the severity of the child’s disabilities you will need to encourage them to take as much responsibility as possible for their own care and explain to them who is and is not responsible for helping them with their intimate needs so that they know that only one or two people are in a position to assist them in this way. Remember, all children and young people have a right to privacy and respect.

Disabled children are open to abuse in a variety of ways such as:

  • Confinement.
  • Discrimination.
  • Force feeding.
  • Isolation.
  • Lack of privacy.
  • Physical restraint.
  • Sedation.
  • Segregation.
  • Sexual abuse.

It is often much more difficult to spot the signs of abuse in disabled children and young people as sometimes, parents and carers, tend to put down any changes in behavioural patterns or mood swings to the disability. However, those who are involved in the care of a disabled child will get to know them well over a period of time and should be just as aware of any patterns of change in their behaviour as they would in any able bodied child. As a manager supporting staff caring for a disabled child your suspicions should be immediately aroused if the child shows:

  • Any unexpected fear towards an individual or appears reluctant to be near them.
  • Signs of any unexplained or repeated injuries such as bruises, cuts and grazes.
  • Signs of eating problems.
  • Signs of sleeping problems.
  • Signs of inappropriate sexual behaviour or awareness of sexual activity.
  • Signs of self harming.
  • Signs of unusual aggressive behaviour.
  • Segregation.
  • Signs of unusual withdrawn behaviour.

There are certain things that managers of settings caring for disabled children can do to protect them such as:

  • Listening to the child and taking on board everything they tell you- never dismiss their feelings.
  • Talking to the child. Making sure that they are happy with the care and medical treatment they are receiving and always taking their own wishes and feelings into account. A disabled child is no less needy of love and reassurance than any other child and they have the right to privacy and for their feelings and opinions to be taken into account.
  • Using props and other resources to enable the child to communicate successfully with you if they have a speech problem. If necessary managers and staff should learn sign language to enable them to communicate with disabled children, and the use of pictures and other resources can be invaluable.
  • Disabled children are probably more in need of love and affection than other children as they are often prone to depression and feelings of inadequacy. Encourage the child to feel good about themselves and, instead of dwelling on the things they have difficulty doing, try focusing on the things they are good at and offer lots of praise and encouragement to boost their confidence and enable them to feel proud of their achievements.

Managers must ensure that all staff have undergone the basic training in safeguarding and it may also be necessary for them to arrange additional training for those members of staff who require it.  Managers and deputy managers should undergo in-depth safeguarding training and ideally be in a position to provide in house training for the whole team.

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