Appendix I – Further Information About Abuse

The following list is not exhaustive. The abuse and neglect of children physically, emotionally and sexually can have various derogatory effects on children and be manifested in infinitely different ways. The following does, however, show some of the more common signs and indicate situations when more expert advice should be sought.

Neglect

Physical and emotional neglect:

Nutritional neglect that can lead to significant harm/ non-organic failure to thrive.  Failure to seek medical care or follow medical advice which endangers the child’s life or development.  Failure to protect a child from physical or social danger for example children being left at home alone or generally being inadequately supervised by an adult.  Lack of stimulation, social contact or education where development is severely impaired.  The demonstration of high levels of criticism and a low level of emotional warmth.  Failure to provide appropriate standards of personal hygiene, clothing and physical comfort in the home, which can lead to medical problems or illness.  Anxious or avoidant attachment behaviour sometimes demonstrated by infants who lack confidence to explore their surroundings and constantly clings to their care giver. Infants who roam around aimlessly and seem extremely wary of what is happening around them. Infants in a state of frozen watchfulness.

Physical Abuse

Careful consideration should be given to bruises around the eyes; symmetrical bruises are rarely accidental, although they can occur in head injuries.

A simple bruise could be the result of an accident or abuse.

Most accidental falls produce one or two bruises, usually to the front of a child, as they tend to fall forward, there may be marks on the hands where they have tried to break their fall.  It is relatively uncommon for accidental bruising to occur on the back of a child, or on the mouth, cheeks, behind the ears, on the stomach, chest, under the arms, or on the neck, genital or rectal area.

The following injuries are likely to be an indication of non-accidental injury.

Bruising in or around the mouth, especially in small babies. Grasp marks on limbs and chest of a small child. Finger mark bruising i.e. 3 or 4 small bruises on one side of the face and one on the other. Different aged bruising on the buttocks. Bites- human bites are oval and crescent shape. If the distance is more than 3 cm across they are likely to have been caused by an adult or child with permanent teeth. Burns and scolds with clear outlines or those with a uniform depth over a large area. Splash marks above a main burn. Small round burns that may be cigarette burns. Fractures- the most common fractures are to the long bones i.e. Arms, legs and ribs. It is very rare for a child under one year to sustain a fracture accidentally. Scars- children may have scars but notice should be given of an exceptionally large number of differing age scars, unusual shaped scars, or large scars from untreated burns or lacerations.

Some indicators of Physical Abuse

There is a delay in reporting the accident or getting treatment. There is a discrepancy between the history and the physical signs. More than one history/different stories are given about how the injury was sustained. There is a history of previous injuries to the same child or siblings.  Other signs of poor physical care are evident. The family is known to be under severe social stress.  Families where there is high criticism/ low warmth.

Sexual Abuse

Forms of sexual abuse vary from inappropriate touching to full penetration. Children may be involved in or exposed to pornographic material or watching sexual activity.

Signs and Symptoms of Sexual Abuse

Disclosure.  Genital soreness, injuries or discomfort.  Sexually transmitted disease, urinary or vaginal infection. Sexualised play or behaviour. Nightmares. Wetting/soiling.

Children and young people aged twelve years or above may additionally exhibit;

Depression. Eating disorders. Drug and/or alcohol abuse. Suicide attempts. Self mutilation. School/peer/relationship problems. Obsessional behaviour

Children or young people who have been sexually abused may go on to abuse others if they do not receive appropriate therapeutic help or treatment. Children may be sexually abused by adults, adolescents or other children.

Emotional Abuse

Emotional abuse occurs when a child’s need for love, security, praise and recognition is not met. Emotional abuse usually co-exists with other forms of abuse. Emotionally abusive behaviour towards a child may consist of a parent or carer:

Being verbally hostile. Exhibiting rejecting behaviour. Making continual threats. Preventing social contact. Making threats and using forms of punishment that may be psychologically damaging. Consistently undermining a child.  Scape goating a child. Conveying to a child that they are worthless, unloved and/or inadequate. Imposing developmentally inappropriate exceptions on a child.

Children who are suffering emotional abuse may exhibit the following, which must be considered in the context of the parent/child relationship:

Excessively clingy or attention seeking behaviour . Very low self esteem. Fearfulness or excessively withdrawn behaviour. Despondency. Constantly seeking to please. Lack of appropriate wariness with strangers/over readiness to relate to anyone. Excessive self criticism. Anxious attachment/insecurity. Eating disorders of various kinds. Various other mental health problems