Appendix One (Child Protection)

Appendix one

Recognising signs of child abuse

Signs of Abuse in Children:

The following non-specific signs may indicate something is wrong:

ª Significant change in behaviour

ª Extreme anger or sadness

ª Aggressive and attention-seeking behaviour

ª Suspicious bruises with unsatisfactory explanations

ª Lack of self-esteem

ª Self-injury

ª Depression

ª Age inappropriate sexual behaviour

ª Child Sexual Exploitation.

Risk Indicators

The factors described in this section are frequently found in cases of child abuse. Their presence is not proof that abuse has occurred, but:

Must be regarded as indicators of the possibility of significant harm
Justifies the need for careful assessment and discussion with designated / named / lead person, manager, (or in the absence of all those individuals, an experienced colleague)
May require consultation with and / or referral to Children’s Services

The absence of such indicators does not mean that abuse or neglect has not occurred.

In an abusive relationship the child may:

Appear frightened of the parent/s
Act in a way that is inappropriate to her/his age and development (though full account needs to be taken of different patterns of development and different ethnic groups)

The parent or carer may:

Persistently avoid child health promotion services and treatment of the child’s episodic illnesses
Have unrealistic expectations of the child
Frequently complain about/to the child and may fail to provide attention or praise (high criticism/low warmth environment)
Be absent or misusing substances
Persistently refuse to allow access on home visits
Be involved in domestic abuse

Staff should be aware of the potential risk to children when individuals, previously known or suspected to have abused children, move into the household.

Recognising Physical Abuse

The following are often regarded as indicators of concern:

v An explanation which is inconsistent with an injury

v Several different explanations provided for an injury

v Unexplained delay in seeking treatment

v The parents/carers are uninterested or undisturbed by an accident or injury

v Parents are absent without good reason when their child is presented for treatment

v Repeated presentation of minor injuries (which may represent a “cry for help” and if ignored could lead to a more serious injury)

v Family use of different doctors and A&E departments

v Reluctance to give information or mention previous injuries

Bruising

Children can have accidental bruising, but the following must be considered as non-accidental unless there is evidence, or an adequate explanation provided:

v Any bruising to a pre-crawling or pre-walking baby

v Bruising in or around the mouth, particularly in small babies which may indicate force feeding

v Two simultaneous bruised eyes, without bruising to the forehead, (rarely accidental, though a single bruised eye can be accidental or abusive)

v Repeated or multiple bruising on the head or on sites unlikely to be injured accidentally

v Variation in colour possibly indicating injuries caused at different times

v The outline of an object used e.g. belt marks, handprints or a hairbrush

v Bruising or tears around, or behind, the earlobe/s indicating injury by pulling or twisting

v Bruising around the face

v Grasp marks on small children

v Bruising on the arms, buttocks and thighs may be an indicator of sexual abuse

Bite Marks

Bite marks can leave clear impressions of the teeth. Human bite marks are oval or crescent shaped. Those over 3 cm in diameter are more likely to have been caused by an adult or older child.

A medical opinion should be sought where there is any doubt over the origin of the bite.

Burns and Scalds

It can be difficult to distinguish between accidental and non-accidental burns and scalds and will always require experienced medical opinion. Any burn with a clear outline may be suspicious e.g.:

v Circular burns from cigarettes (but may be friction burns if along the bony protuberance of the spine)

v Linear burns from hot metal rods or electrical fire elements

v Burns of uniform depth over a large area

v Scalds that have a line indicating immersion or poured liquid (a child getting into hot water is his/her own accord will struggle to get out and cause splash marks)

v Old scars indicating previous burns/scalds which did not have appropriate treatment or adequate explanation

Scalds to the buttocks of a small child, particularly in the absence of burns to the feet, are indicative of dipping into a hot liquid or bath.

Fractures

Fractures may cause pain, swelling and discolouration over a bone or joint.

Non-mobile children rarely sustain fractures.

There are grounds for concern if:

v The history provided is vague, non-existent or inconsistent with the fracture type

v There are associated old fractures

v Medical attention is sought after a period of delay when the fracture has caused symptoms such as swelling, pain or loss of movement

v There is an unexplained fracture in the first year of life

Scars

A large number of scars or scars of different sizes or ages, or on different parts of the body, may suggest abuse.

Recognising Emotional Abuse

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.

The indicators of emotional abuse are often also associated with other forms of abuse.

The following may be indicators of emotional abuse:

Developmental delay
Abnormal attachment between a child and parent/carer e.g. anxious, indiscriminate or not attachment
Indiscriminate attachment or failure to attach
Aggressive behaviour towards others
Scapegoated within the family
Frozen watchfulness, particularly in pre-school children
Low self-esteem and Lack of confidence
Withdrawn or seen as a “loner” – difficulty relating to others

Recognising Signs of Sexual Abuse

Boys and girls 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:

v Inappropriate sexualised conduct

v Sexually explicit behaviour, play or conversation, inappropriate to the child’s age

v Continual and inappropriate or excessive masturbation

v Self-harm (including eating disorder), self-mutilation and suicide attempts

v Involvement in prostitution or indiscriminate choice of sexual partners

v 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:

v Pain or itching of genital area

v Blood on underclothes

v Pregnancy in a younger girl where the identity of the father is not disclosed

v 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

Sexual Abuse by Young People

The boundary between what is abusive and what is part of normal childhood or youthful experimentation can be blurred. The determination of whether behaviour is developmental, inappropriate or abusive will hinge around the related concepts of true consent, power imbalance and exploitation. This may include children and young people who exhibit a range of sexually problematic behaviour such as indecent exposure, obscene telephone calls, fetishism, bestiality and sexual abuse against adults, peers or children.

Developmental Sexual Activity encompasses those actions that are to be expected from children and young people as they move from infancy through to an adult understanding of their physical, emotional and behavioural relationships with each other. Such sexual activity is essentially information gathering and experience testing. It is characterised by mutuality and of the seeking of consent.

Inappropriate Sexual Behaviour can be inappropriate socially, in appropriate to development, or both. In considering whether behaviour fits into this category, it is important to consider what negative effects it has on any of the parties involved and what concerns it raises about a child or young person. It should be recognised that some actions may be motivated by information seeking, but still cause significant upset, confusion, worry, physical damage, etc. it may also be that the behaviour is “acting out” which may derive from other sexual situations to which the child or young person has been exposed.

If an act appears to have been inappropriate, there may still be a need for some form of behaviour management or intervention. For some children, educative inputs may be enough to address the behaviour.

Abusive sexual activity included any behaviour involving coercion, threats, aggression together with secrecy, or where one participant relies on an unequal power base.

Assessment

In order to more fully determine the nature of the incident the following factors should be given consideration. The presence of exploitation in terms of:

Equality – consider differentials of physical, cognitive and emotional development, power and control and authority, passive and assertive tendencies
Consent – agreement including all the following:

Understanding that is proposed based on age, maturity, development level, functioning and experience
Knowledge of society’s standards for what is being proposed
Awareness of potential consequences and alternatives
Assumption that agreements or disagreements will be respected equally
Voluntary decision
Mental competence

Coercion – the young perpetrator who abuses may use techniques like bribing, manipulation and emotional threats of secondary gains and losses that is loss of love, friendship, etc. Some may use physical force, brutality or the threat of these regardless of victim resistance.

In evaluating sexual behaviour of children and young people, the above information should be used only as a guide.

Recognising Neglect

Evidence of neglect is built up over a period of time and can cover different aspects of parenting. Indicators include:

Failure by parents or carers to meet the basic essential needs e.g. adequate food, clothes, warmth, hygiene and medical care
A child seen to be listless, apathetic and irresponsive with no apparent medical cause
Failure of child to grow within normal expected pattern, with accompanying weight loss
Child thrives away from home environment
Child frequently absent from school
Child left with adults who are intoxicated or violent
Child abandoned or left alone for excessive periods

Child Sexual Exploitation

The following list of indicators is not exhaustive or definitive, but it does highlight common signs which can assist professionals in identifying children or young people who may be victims of sexual exploitation.

Signs include:

underage sexual activity
inappropriate sexual or sexualised behaviour
sexually risky behaviour, 'swapping' sex
repeat sexually transmitted infections
in girls, repeat pregnancy, abortions, miscarriage
receiving unexplained gifts or gifts from unknown sources
having multiple mobile phones and worrying about losing contact via mobile
having unaffordable new things (clothes, mobile) or expensive habits (alcohol, drugs)
changes in the way they dress
going to hotels or other unusual locations to meet friends
seen at known places of concern
moving around the country, appearing in new towns or cities, not knowing where they are
getting in/out of different cars driven by unknown adults
having older boyfriends or girlfriends
contact with known perpetrators
involved in abusive relationships, intimidated and fearful of certain people or situations
hanging out with groups of older people, or anti-social groups, or with other vulnerable peers
associating with other young people involved in sexual exploitation
recruiting other young people to exploitative situations
truancy, exclusion, disengagement with school, opting out of education altogether
unexplained changes in behaviour or personality (chaotic, aggressive, sexual)
mood swings, volatile behaviour, emotional distress
self-harming, suicidal thoughts, suicide attempts, overdosing, eating disorders
drug or alcohol misuse
getting involved in crime
police involvement, police records
involved in gangs, gang fights, gang membership
injuries from physical assault, physical restraint, sexual assault.

Criminal Exploitation / County Lines

· Returning home late, staying out all night or going missing

· Being found in areas away from home

· Increasing drug use, or being found to have large amounts of drugs on them

· Being secretive about who they are talking to and where they are going

· Unexplained absences from school, college, training or work

· Unexplained money, phone(s), clothes or jewellery

· Increasingly disruptive or aggressive behaviour

· Using sexual, drug-related or violent language you wouldn’t expect them to know

· Coming home with injuries or looking particularly disheveled

Leigh Sacred Heart Catholic Primary School