What is abuse

Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child. (Working Together to Safeguard Children 2018) p103

Whilst some injuries may appear insignificant in themselves, repeated minor injuries, especially in very young children, may be symptomatic of physical abuse.

It can sometimes be difficult to recognise whether an injury has been caused accidentally or non-accidentally, but it is vital that all concerned with children are alert to the possibility that an injury may not be accidental and seek appropriate expert advice.

Physical abuse can lead directly to neurological damage, physical injuries, disability or – at the extreme – death. Harm may be 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.

Physical abuse is when children are hurt or injured by others, for example by hitting, shaking squeezing or biting.

Some things to look for are:

• Unexplained injuries, bruises or marks
• Fear, watchfulness, over anxiety to please
• Small, round burns or bite marks
• Frequent absences from school 

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 (including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children. (Working Together to Safeguard Children 2018) p104

Children of both genders and 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.

Some behavioural indicators associated with this form of abuse are:

• Inappropriate sexualised conduct
• Sexual knowledge inappropriate for the child’s age
• Sexually explicit behaviour, play or conversation, inappropriate to the child’s age
• Continual and inappropriate or excessive masturbation
• Self-harm (including eating disorder), self-mutilation and suicide attempts
• Running away from home
• Poor concentration and learning problems
• Loss of self-esteem, sadness or depression
• Involvement in prostitution or indiscriminate choice of sexual partners
• An anxious unwillingness to remove clothes - e.g. for sports events (but this may be related to cultural norms or physical difficulties)

Some physical indicators associated with this form of abuse are:

• Pain or itching of genital area
• Recurrent pain on passing urine or faeces
• Blood on underclothes
• Pregnancy in a younger girl where the identity of the father is not disclosed and/or there is secrecy or vagueness about the identity of the father
• Physical symptoms such as injuries to the genital or anal area, bruising to buttocks, abdomen and thighs, sexually transmitted disease, presence of semen on vagina, anus, external genitalia or clothing.

Emotional abuse is 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 cyberbullying), 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. (Working Together to Safeguard Children 2018) p104

Emotional abuse is when children are persistently denied love and affection. Children will suffer if they are always shouted at, made to feel stupid, rejected, used as scapegoats or live in a violent environment.

Emotional abuse may be difficult to recognise, as the signs are usually behavioural rather than physical. The manifestations of emotional abuse might also indicate the presence of other kinds of abuse.

Some things to look for are:

• Unexplained gifts or money
• Withdrawn, anxious behaviour, lack of self-confidence
• Self-harm and eating disorders
• Demanding or attention-seeking behaviour
• Unwillingness to communicate
• Repetitive, nervous behaviour such as rocking, hair twisting or scratching 
• Developmental delay
• Abnormal attachment between a child and parent/carer e.g. anxious, indiscriminate or no attachment
• A child's indiscriminate attachment or failure to attach
• Aggressive behaviour towards others
• A child scapegoated within the family
• Frozen watchfulness, particularly in pre-school children
• Low self-esteem and lack of confidence
• A child who is withdrawn or seen as a ‘loner’ and/or has difficulty relating to others

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 or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to: provide adequate food, clothing and shelter (including exclusion from home or abandonment), protect a child from physical and emotional harm or danger, ensure adequate supervision (including the use of inadequate care-givers), or ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs. (Working Together to Safeguard Children 2018) p105

Neglect is where a child’s basic need for food, warmth, protection, education and care, including health care are not met. The growth and development of a child may suffer when the child receives insufficient food, love, warmth, care and concern, praise, encouragement and stimulation.

Some things to look for are:

• The child’s clothes are often dirty, scruffy or unsuitable for the weather
• No one seeks medical help when child is ill or hurt
• The child is smelly and dirty
• The child is left alone or with unsuitable carers
• The child is thin, pale, lacking in energy
• Lots of accidents happen to the child
• The child is exposed to risks or dangers, such as dangers in the home or drugs or needles being left around
• Short stature and underweight
• Red/purple mottled skin, particularly on the hands and feet, seen in the winter due to cold
• Swollen limbs with sores that are slow to heal, usually associated with cold injury
• Recurrent diarrhoea
• Abnormal voracious appetite at school or nursery
• Dry, sparse hair
• A child seen to be listless, apathetic and unresponsive with no apparent medical cause
• Unresponsiveness
• Indiscrimination in relationships with adults (may be attention seeking)

A clear distinction needs to be made between organic and non-organic failure to thrive.  This will always require a medical diagnosis.  Non-organic failure to thrive is the term used when a child does not put on weight and/or grow and there is no underlying medical cause for this.