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Section 2: Signs and Indicators of Child Abuse and Neglect

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Any person, who knows or suspects that a child is being or has been harmed or is at risk of significant harm, has a duty to refer his or her concern to Children's Social Care and/or the Police.

It is not your role to investigate or assess whether or not abuse had occured - you have a responsibility to pass on your concerns to those who can investigate them, so that action to protect the child can be taken if necessary.

There is sometimes a danger of applying a ‘rule of optimism’, whereby adults like to think that the child is or will be OK really, or that it won’t happen again.

However, it is known that when an adult has abused a child on one occasion, it is very likely that such behaviour will be repeated – abusers rarely stop harming children without intervention or treatment.

We now look at the physical and behavioural signs that should alert you to the possibility that a child is being abused.  All forms of abuse are emotionally damaging to a child, and we should always be alert to signs and symptoms indicating emotional abuse.

All children are different, developing in different ways and at different rates.  However, a basic knowledge of normal child development can be useful in identifying some areas of concern.  Information on developmental milestones for children aged 0-5 can be found at:

http://www.yor-ok.org.uk/Safer%20Children%20York/SaferChildrenYork

PHYSICAL ABUSE:

Physical Signs:

All children have accidents and may have bruises from time to time.  The child or his or her parents will usually tell you how the injuries occurred and what happened.  However, if they do not tell you or do not give you an adequate explanation of what happened, you need to consider whether the injuries are a possible sign of physical abuse.  Sometimes a child can be physically abused without easily identifiable signs of injury, e.g. babies who have been shaken, so it is important to act on concerns so professional assessments can be made.

Injuries not adequately explained including:

  • Fractures, bruises, burns, bite marks, slap marks, implement marks e.g. belt mark.

Other signs of abuse include:

  • Grip marks - may indicate shaking
  • Slap marks - cheeks, buttocks, limbs (may leave a hand imprint)
  • Soft tissue marks
  • Long marks
  • Symmetrical bruising
  • Bruising in unusual places e.g. bruises on ears
  • Teeth / bite marks
  • Burns with outline, e.g. outline of an iron
  • Cigarette burns
  • Fractures or other injuries
  • Injuries which haven’t been treated properly and there is delay in seeking medical attention
  • Any injury to a child who isn’t mobile e.g. baby under 1 year, disabled child

Behavioural Signs:

  • Child appears frightened of others e.g. parent(s) or carer(s)
  • Child doesn’t want to go home, or runs away
  • Child flinches when approached or when someone stretches a hand towards them
  • Child reluctant to get undressed e.g. for games or sport activity
  • Child very passive or very aggressive
  • Frozen watchfulness - child sits very still watching what’s going on (waiting for the next hit)
  • Equally could appear overly “happy” and “eager to please”

 

SEXUAL ABUSE:

Physical Signs:

  • Repeated, inappropriate, masturbation
  • Presence of sexually transmitted disease
  • Young children with age inappropriate sexual knowledge, e.g. penetration, ejaculation, oral sex
  • Explicit sexual drawings
  • Pain, soreness or itching in the genital or anal areas or mouth
  • Recurrent genital or urinary infections.
  • Pregnancy

Behavioural Signs:

  • Disclosure from a child (to another child or an adult)
  • Young children acting out sexual behaviours, e.g. simulating intercourse, grabbing genitalia etc
  • Young children displaying sexually inappropriate knowledge or behaviour
  • Persistent bedwetting, nightmares and sleep problems
  • Anorexia, bulimia, self harm or excessive ‘comforting’ eating
  • Fear of a specific person
  • Running away from home
  • Substance abuse
  • Child having unexplained gifts, including money
  • Children having ‘secrets’ that an adult says they are not allowed to tell
  • Secrecy around internet use and webcams etc.

NEGLECT:

Physical Signs:

  • Looks excessively thin or ill
  • Well below average weight and height, failure to thrive,
  • Recent unexplained weight loss.
  • Complains of hunger; lack of energy
  • Untreated conditions/injuries
  • Repeated accidents, especially burns
  • Left home alone inappropriately
  • Repeatedly unwashed, smelly or dressed inappropriately for the weather
  • Supervision/carers inappropriate (e.g 8 year old looking after other children)
  • Badly decayed teeth
  • Unhygienic and/or unsanitary living conditions

Behavioural Signs:

  • Poor level of concentration
  • Constantly hungry or ’stealing’ food from others/from bins
  • Not keeping Doctor or Hospital appointments
  • Frequently not at school or persistent lateness
  • Reluctant to go home from school
  • Delayed speech development

EMOTIONAL ABUSE:

Physical Signs:

  • Physical, mental and emotional developmental delay / late developer with no obvious medical reason
  • Sudden onset speech disorders, e.g suddenly developing a stammer

Behavioural Signs:

  • Acceptance of punishment which seems excessive
  • Over-reaction to mistakes
  • Continual self deprecation
  • Excessive fear of new situations
  • Inappropriate emotional response to painful stimuli
  • Excessive behaviours, e.g. rocking, head banging, pulling own hair out
  • Self harm and/or eating disorders
  • Compulsive stealing/scavenging
  • Excessively sad, depressed, withdrawn,
  • Low self esteem
  • Very poor relationship with parent/carer

Handling Disclosures of Abuse

Disclosure by a child who is suffering abuse or about a child by another child or adult:

If child abuse is disclosed to you, the disclosure must be taken seriously.

Receive:

  • Listen to what is being said without displaying shock or disbelief
  • Accept what is being said without judgement
  • Take it seriously

Reassure:

  • Reassure the child, but only so far as is honest and reliable. Don’t make promises that you can’t be sure to keep, e.g “I’ll stay with you” or “everything will be all right now”
  • Don’t promise confidentiality – you have a duty to report your concerns.
  • Tell the child that you will need to tell some people, but only those whose job it is to protect children
  • Acknowledge how difficult it must have been to talk
  • Never agree to keep secrets – be honest
  • Do reassure the child that he or she is right to tell

React:

  • Listen quietly, carefully and patiently
  • Do not investigate, interrogate or decide if the child is telling the truth
  • Don’t ask leading questions, e.g “What did he do next?” (This assumes he did).
  • Do ask open questions like “Is there anything else that you want to tell me?”
  • Do not criticise the alleged abuser; the child may love him/her and a reconciliation may be possible
  • Do not ask the child to repeat what they have told you to another member of staff. Explain what you have to do next and whom you have to talk to.

Record:

  • Make some very brief notes at the time and write them up in detail as soon as possible
  • Do not destroy your original notes in case they are required by Court
  • Record the date, time, place, words used by the child and how the child appeared to you – be specific. Record the actual words used, including any swear words or slang
  • Draw a diagram to indicate the position of any marks
  • Record statements and observable things, not your interpretations or assumptions – keep it factual
  • Do not assume anything – don’t speculate or jump to conclusions

Remember:

  • If a child discloses abuse to you, take it seriously
  • Seek advice from your supervisor, manager or designated child protection person about the child’s disclosure

Where an adult discloses to you their own history of abuse, you need to consider if there are children now who may be at risk of continuing abuse. This is a complex area and you will need to tell the adult that you must seek advice from your supervisor/manager, Children's Social Care and/or the Police.

Section 3 gives specific advice about how to make a referral.


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