Signs and symptoms of abuse and neglect
There are many lists a of the indicators of abuse and neglect. None of them are exhaustive and none of them are definitive- all require the exercise of professional judgment. This list is intended to be a guide only.
· Bruising – particularly to soft tissue. They may also correspond with a mark the child has after they have made an allegation of physical abuse. These can include bruised ear or eye, belt or strap marks, slap or grab marks.
· Burns – may be neglectful or deliberate action, such as cigarette burns.
· Adult bite marks.
· Broken bones.
· Injuries caused by parent failing to protect.
· Parent threatening violence to a child.
· Inappropriate physical chastisement.
· Parents whose delusion includes harming the child.
· Baby being shaken.
Emotional abuse can be very hard to assess because there may be no direct allegation made by the child and often it will be necessary to observe parental behaviours towards the child.
Parental behaviours may include:
· Marked age inappropriate expectations of the child.
· Persistent rejection, negative attributes to the child and very low emotional warmth.
· Child may be scapegoated.
· High criticism and low warmth expressed to the child.
· Extreme discipline may be used or threatened and a justification of harsh punishment.
· Child is frightened by the parents and threats may be made to control the child-including domestic violence.
· Child is not allowed to socialise and have friends, play and have fun.
· Positive emotions such as pride, joy, enthusiasm, and love are rarely expressed by the parents, which impacts on the child’s ability to feel these.
Impact on child:
· Severe emotional problems.
· Inability to make friends, play and have fun.
· Excessive timidity or withdrawal.
· Excessive sadness.
· Indiscriminate attachment.
· Cognitive development – ability to concentrate, develop memory, etc
· Non organic failure to thrive.
· Disclosure – direct or indirect, accidental or purposeful.
· Physical injuries or bruising to genitals, inner thighs etc
· Persistent vaginal or urinary tract infection or discharge.
· Sexually Transmitted Infections.
The problem here lies in the fact that there is often no physical indicator of sexual abuse. Where this is the case and child sexual abuse is suspected, professionals need to focus more on behaviour of the child and understand more about what the dynamics of the family are and the child’s life is like. Reaching a view about whether the child is being sexually abused or not is complex without a disclosure. Child sexual abuse is different than other kinds of abuse because it takes place in a world of secrecy and the child is silenced by the perpetrator. Behaviours include:
· Inappropriate sexual knowledge.
· Sexual preoccupation and compulsive behaviour – eg. Masturbation.
· Sexually explicit language and drawings.
· Challenging behaviours – self mutilation, arson, running away, withdrawn, aggression and tantrums, eating problems, bed wetting or soiling.
· Depression and being withdrawn.
· Headaches, stomach aches.
· Changes in school attendance and performance.
Most behavioural problems, which might indicate sexual abuse, could also be explained by other difficulties in a child’s life.
· Medical treatment not sought when child requires it.
· Child poor school attendance.
· Child left unsupervised or inappropriately looking after other children.
· Child persistently hungry, persistently dirty, smelly or inadequately dressed.
· Unremitting low level of care provided by parent, resulting in child not only suffering above but poor stimulation and cognitive support, leading to low expectation of themselves as parents and then in turn of their child.
· Child may show indiscriminate affection or is withdrawn or frightened.
· The pathway of development is likely to be the same for all children but the way their needs are met is where there will be difference. Families will bring to their parenting their own beliefs and values, traditions and expectations, religion and ways of life, which will influence how they bring up their children. Mostly these differences are environmental and not an intrinsic difference within the child in terms of their needs or what they need from their parents.
· Cultural differences will be part of all assessments and will help us understand how.
· That family live their life and what the child’s lived experience is. Families do not need to parent in the same way to live within the legislative expectations of Britain but the action they take to enforce their parenting expectations may be unacceptable, not the cultural belief.
What to do:
The multi agency assessment needs to take account of all of the child’s circumstances, including that of their siblings. The assessment needs to bring information together in relation to all their circumstances. This includes:
· Identifying their needs and being clear which needs are met and which are unmet and why.
· What is known about the parental behaviour, their ability to provide the necessary parenting requirements and what they do well and what they are failing to do.
· What is known about the circumstances in the family, both environmental or whether there is any DV, drug use, mental health problems or learning difficulty, which may impact on the parents ability to parent.
· Being clear exactly what you are worried about, how long you have been worried and exactly why you are worried.
· Always gather whatever is possible from the child’s testimony – what do they share about their life and their lived experience at home and what do the siblings share. What kinds of conversations are possible with the child to clarify your concerns?
Taking action and referring:
Always know who your child protection lead is and discuss the situation with them. The situation may require immediate referral to children’s social care or may require some time to assess the situation for yourselves and build up your picture.
The child protection lead will advise you on this and will know how to make a referral to children’s social care.
Children’s social care operates high thresholds and therefore it can sometimes be hard to get them to accept a referral. The child has to be suffering or likely to suffer significant harm or have serious impairment of health and development. It is always better to really gather your assessment together first – using earlier prompts- unless the child has an injury or another allegation that requires immediate referral. This way you can present your concerns in a clear way that identify exactly what you are worried about, what is making you so worried and why a social worker needs to be involved and become part of the team working with the child and family.
Once a referral is made to children’s social care, if a child is suffering or likely to suffer significant harm they will carry out a child protection investigation, following the London Child Protection procedures. The procedures encourage schools and other professional referrers to inform parents of the referral, unless there is reason not to – for example placing the child in greater danger – so a judgement is required. It is good practice to inform them, because it supports the professional relationship with the parents.