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    Safeguarding disabled children guidance

    Introduction

    This guidance is for all professionals engaged in the care and support of children and young people with complex needs and disabilities. It was formulated by the Gateshead Safeguarding Partnership and is designed to be universally applicable across all partner agencies. 

    The guidance has been updated to reflect changes in statutory guidance and incorporates insights from both national and local reviews. It is relevant for those working in a wide range of sectors including children's social care, health, education, schools, early years, youth services, the youth justice system, the police, as well as the independent and voluntary sectors.  

    It aims to raise awareness of best practice principles and of the additional safeguarding risks that affect children with complex needs and disabilities.  

    A child is defined as: a child and young person aged up until 18 years .

    The definition for Complex Need and Disability as adopted by Gateshead Safeguarding Partnership is as follows: 

     'A child/young person with two or more needs affecting their physical, mental, social, or financial wellbeing. Such needs typically interact with and exacerbate one another, resulting in a significant and enduring impact on their life, often leading to the need for specialist support from education, health and/or social care'.  

    The definition for disability is: 'a physical or mental impairment resulting in a substantial and long term negative effect on ability to carry out normal daily activities.' The definition of substantial is: 'more than minor or trivial, for example, it takes much longer than it usually would to complete a daily task such as getting dressed. Long term means 12 months or more,' (Equality Act, 2010).

    A child first

    Children with complex needs and disabilities are children first and foremost. This means that they should be afforded the same opportunities, rights and protections as all other children and young people. Children with disabilities are too often seen in the context of the things that they 'can't' do. Practitioners across all agencies should ensure that their intervention with children with disabilities is child focussed, that it highlights the child's strengths and that support plans, irrespective of context, promote the child's right to achieve their full potential. 

    Whilst disabled children experience much the same types of abuse as other children, research suggests that disabled children are 3 to 4 times more likely to be abused than non-disabled children. 

    Research has also shown that children with communication impairments, behavioural challenges, learning disabilities and sensory impairments are particularly vulnerable. 

    Children with a disability are children first and foremost, and deserving of the same rights and protection as other children. Ensuring disabled children's wellbeing is everybody's responsibility and it is critical that all practitioners are aware of the potential vulnerability of disabled children and to recognise and respond to safeguarding concerns. 

    Increased vulnerability

    Disabled children and young people can be more vulnerable to being harmed through abuse compared to their non-disabled peers. Safeguarding these children requires a heightened awareness of their unique vulnerabilities, individuality, and specific needs. It is crucial to consider the child within the context of their family and the community supports and services. 

    There are several reasons why disabled children might be particularly vulnerable to abuse: 

    • isolation: limited contact with others can increase vulnerability
    • intimate care: the need for intimate care from multiple carers can raise the risk of exposure to abusive behaviour and complicate the establishment and maintenance of physical boundaries
    • impaired resistance: some children may have a reduced capacity to resist or avoid abuse
    • communication barriers: difficulties in communication can hinder a child's ability to tell someone about what is happening to them, especially if there is limited or support around their communication needs
    • lack of awareness regarding abuse: disabled children may not be aware of what is safe or harmful and may not be able to define abuse
    • challenge of seeking support: some disabled children do not have access to support through the internet, phone, or social networks. This challenge is exacerbated for children with no or limited verbal communication skills and vision impairments, as services intended for children to reach out for support or make sense of their experiences are often in printed format or on websites that are not accessible to them
    • fear of complaining: concerns about losing services can inhibit raising an issue
    • bullying and intimidation: disabled children might be more prone to bullying and intimidation and may be more accepting of such treatment due to a lack of recognition of these issues
    • peer abuse: they may be more susceptible to harm and abuse from their peers
    • attitudinal barriers: discriminatory attitudes can lead to a focus on the disability rather than seeing the child as a whole and recognising their voice

    Challenges and assumptions: 

    • it is often assumed that disabled children cannot express their views, or service providers find it difficult to gather their opinions
    • effective service providers use creative methods to obtain the views of disabled children, including those who communicate non-verbally

    Professional misinterpretations: 

    • indicators like speech delay, distressed behaviour, or unexplained markings are sometimes not recognised as potential signs of abuse or neglect, leading to missed intervention opportunities

    Professionals may not consider a child's lived experience beyond their diagnostic label, which could impact upon a professional's curiosity and considering harm and abuse.  

    Service provision insights: 

    • some services and professionals can engage with children considering their lived experiences and communication needs, but this may be less likely when resources are limited
    • professionals do not always prioritise children's perspectives, feelings, and opinions, missing opportunities to adapt communication by involving specialists who understand the child's communication needs
    • delays in providing equipment sometimes leave children without a way to express themselves or move about, and the safeguarding implications of this are not always considered
    • practitioners may not always investigate why a child is not brought to appointments or offer the necessary support to help children access education, health, or social care provision

    Service responsibilities: 

    • ensure all disabled children can participate in decisions about: 
      • the activities they engage in 
      • how these activities are conducted 
      • the management of services and activities 

    Indicators

    Physical abuse 

    Physical abuse is when someone hurts or harms a child or young person on purpose.

    Types of physical abuse 

    • hitting, slapping, punching, kicking, hair-pulling, biting, pushing, scratching, throwing  
    • rough handling 
    • shaking
    • scalding and burning 
    • physical punishments 
    • inappropriate or unlawful use of restraint 
    • drowning

    It's important to remember that physical abuse is any way of intentionally causing physical harm to a child or young person. It also includes making up the symptoms of an illness or causing a child to become unwell.

    Possible indicators of physical abuse 

    Injuries caused by accidents are not uncommon in children, becoming less common as the child develops and grows. This means that recognising the signs of physical abuse in children can be especially difficult and leave practitioners unsure of what may be abusive. 

    The following is a guide to injuries that are more likely to be accidental or abusive. However, it is not absolute, and it is important that those working with children consider the child's stage of development, any pattern of injuries and the account given by the child, parents, carers or others of how the injury was sustained. 

    Typically accidental injuries  

    Accidental injuries typically involve bony prominences - the bones that are close to the surface and so more likely to become injured through falls, slips and trips. This can include: 

    • forehead 
    • knees 
    • elbows 
    • palms of hands 
    • nose  

    The injuries will match the account given by the child and parent/carer and be in-keeping with the child's level of development and activity. 

    Typically abusive injuries  

    Abusive injuries, however, tend to involve softer tissue and be in areas that are harder to damage through slips, trips, falls and other accidents. This may include: 

    • upper 
    • arm 
    • forearm (defensive injuries)  
    • chest and abdomen 
    • facial injuries (cheeks, black eyes, mouth) 
    • ears, side of face or neck and top of shoulders (triangle of safety) 
    • back and side of trunk

    Abusive injuries may be seen on both sides of the body and match other patterns of activity. They may not match the explanation given by the child or parent/carer and there may also be signs that injuries are being untreated, or at least a delay in seeking treatment. 

    Sexual abuse 

    When a child or young person is sexually abused, they're forced, tricked or manipulated into sexual activities. They might not understand that what's happening is abuse or that it's wrong for the abuser to do this to them. They might be afraid to tell someone or behave as though this is normal for them to experience, both are valid for the child to be displaying. Sexual abuse can happen anywhere - and it can happen in person or online.

    It's never a child's fault they were sexually abused - it's important to make sure children know this.

    Types of sexual abuse  

    • sexual abuse may take place either in person or online or offline. It may be perpetrated by family or non-family members, males or females, older adults or by other young people 
    • forcing or enticing a child or young person to take part in sexual activities, which may or may not involve violence 
    • penetrative acts 
    • non-penetrative acts (kissing, masturbation, rubbing or inappropriate touching) 
    • sexual photography or forced use of pornography or witnessing sexual acts 
    • non-contact (looking at or producing pornography or sexual images, watching sexual activities, grooming, in preparation for abuse)

    Possible indicators of sexual abuse  

    • bruising, particularly to the thighs, buttocks and upper arms and marks on the neck 
    • bleeding, pain or itching in the genital area 
    • difficulty walking or sitting 
    • sudden change in behaviour or school performance 
    • displays of affection that are sexual or not age-appropriate 
    • use of sexually explicit language that is not age appropriate 
    • alluding to a secret that cannot be revealed 
    • bedwetting or incontinence 
    • infections, unexplained genital discharge or sexually transmitted diseases 
    • unexplained gifts or money 
    • self harming 
    • poor concentration, withdrawal, sleep disturbance
    • reluctance to be alone with a particular person  

    Knowing the signs of sexual abuse can help give a voice to children and can get support for that child earlier on. Sometimes children won't understand that what's happening to them is wrong.

    Emotional abuse

    Emotional abuse is any type of abuse that involves the continual emotional mistreatment of a child. It's sometimes called psychological abuse. Emotional abuse can involve deliberately trying to scare, humiliate, isolate or ignore a child.

    Emotional abuse is often a part of other kinds of abuse which means it can be difficult to spot the signs or tell the difference, though it can also happen on its own.

    Types of emotional abuse

    • some level of emotional abuse is present in all types of abuse or neglect, though it may also appear alone. It is the persistent mistreatment of a child that has a severe and negative impact on their emotional development. Emotional abuse may also be perpetrated by other young people through serious bullying and cyber-bullying
    • overprotection - preventing someone accessing educational and social opportunities and seeing friends 
    • intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse 
    • threats of harm or abandonment 
    • placing inappropriate expectations on children 
    • witnessing or hearing the abuse of ill treatment of others (including domestic violence) 

    Possible indictors of emotional abuse 

    • concerning interaction between parents or carers and the child (e.g. overly critical or lack of affection) 
    • lack of self-confidence or self esteem 
    • sudden speech disorders 
    • self-harm or eating disorders 
    • lack of empathy shown to others (including cruelty to animals)  
    • drug, alcohol or other substance misuse 
    • change of appetite, weight loss/gain 
    • signs of distress, tearfulness, anger

    Neglect 

    Neglect is the ongoing failure to meet a child's basic needs. A child might be left hungry or dirty, or without proper clothing, shelter, supervision or health care. This can put children and young people in danger. And it can also have long term effects on their physical and mental wellbeing.

    Types of neglect  

    • neglect is found to be a factor in 60 per cent of child deaths that are investigated through Serious Case Reviews. However, even though it is often suspected by those who work with children, it is under-reported. Neglect is a persistent failure to meet basic needs (physical or emotional) and it leads to serious harm to the health or development of a child
    • failing to provide adequate shelter, clothing or food  
    • failing to protect a child from harm or danger 
    • failing to ensure that a child is supervised appropriately  
    • failing to access medical care or treatment for a child when it is needed  

    Possible indicators of neglect 

    • excessive hunger 
    • inadequate or insufficient clothing 
    • poor personal or dental hygiene 
    • untreated medical issues 
    • changes in weight or being excessively under or overweight 
    • low self-esteem, attachment issues, depression or self-harm 
    • poor relationships with peers 
    • self soothing behaviours that may not be age appropriate (e.g. thumb sucking, hair twisting or rocking) 
    • changes to school performance or attendance 

    "Disguised compliance" 

    Put simply this relates to a parent or care giver who can present in one way and then act very differently.  

    There are multiple reasons as to why a parent or care giver may not be honest with a professional. 

    This relates to both carers for children living in a family home or carers and professionals who work alongside children. We need to consider both.  

    In working with children there may be well established relationships and it can be a challenge to recognise harm because of this, or to entertain the idea that harm may be happening.  

    Relationships can delay parents, carers or professionals reporting suspected harm.  

    Behaviours may include: 

    A parent or carer can disguise or hide signs of abuse or neglect for pre-arranged home visits by professionals 

    In addition to the universal indicators of abuse/neglect, the following abusive behaviours must be considered: 

    • force feeding
    • unjustified or excessive physical restraint
    • rough handling
    • extreme behaviour modification including the deprivation of food medication, or clothing
    • misuse of medication, sedation, heavy tranquillisation
    • invasive procedures against the child's will
    • neglect of personal care needs
    • deliberate failure to follow medically recommended regimes
    • non-compliance with programmes or regimes
    • failure to address ill-fitting equipment e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting
    • misappropriation/misuse of a child's finances
    • being denied access to education, play and leisure opportunities

    Remember that evidence of good quality care or treatment does not always mean there are no safeguarding issues. 

    Those who perpetrate abuse (both within and outside the child's home) may also be perceived as quality caregivers with good relationships with children, families and professionals. Their ability to engage successfully with children may be a necessity in securing the trust, privacy and opportunity which enables abuse to take place. This applies as much to disabled children, as to non-disabled children. 

    It is crucial when considering whether a disabled child or young person has been or is at risk of abuse and/or neglect that the disability does not mask or deter appropriate investigation of child protection concerns. There should be no distinction made in acting on concerns where a child is disabled. 

    When working with a disabled child/young person always ask: 

    "Would I be making the same decision if the child was not disabled?".  

    Barriers to communicating abuse

    The voice of children should be at the centre of all safeguarding, and none less so for children with additional needs, including complex needs and disabilities. In all instances, children and young people should be given the opportunity to communicate their opinions, feelings and wishes and to be involved in decision making regarding their care. A child's additional needs should not be a barrier to capturing their voice. Children, including infants, can display their emotions and well-being through a range of communication methods, including their demeanour and behaviour. 

    There are many barriers to children telling adults about abuse, some common reasons relate to embarrassment, shame, guilt and distrust, a lack of understanding about what has happened or fearing consequences of disclosure.  

    For children with complex needs and disabilities, particularly those with speech and communication needs, it may be especially difficult to make a disclosure about their abuse experience(s) and/or for them to be understood by professionals.  

    A variety of methods will need to be drawn upon to support communication, including BSL, Makaton, PECS, drawing and non-verbal communication. Careful observation will usually assist in understanding what is being communicated.  

    It is important not to underestimate the child's ability to communicate or make assumptions that they will be unable to do so 

    It is important to remember that speech, language and communication needs may not mean the child understands less. Practitioners should not assume that the child cannot understand, even if they cannot communicate their feelings and thoughts through speech. 

    Things to consider

    • do you have recent information about how best to communicate with the child? 
    • have you liaised with those who know the child best and have you a developed plan about how best to involve the child? 
    • have you completed research on how the child communicates so you will be able to effectively interact using their preferred methods? 
    • are you able to provide the child with a range of opportunities to build a relationship with you so that they are able to effectively communicate? 
    • how will you help the child to communicate about their health and wellbeing and how they are feeling? 
    • how will you ensure that you communicate with the child and not talk over them to a parent/carer to get the child's views? 

    Specialist staff (SaLT) or equipment (e.g. AAC) may be required and will need to be provided in a timely manner. 

    Observation

    Observation can be used to notice and understand children and young people's behaviours and reactions to certain situations, activities or events. Observation is best used over time, at different times of the day and week, as any number of factors may be impacting on how a child or young person may present at a certain time. 

    Behaviour needs to viewed as a form of communication with professional curiosity being used to try and understand the reasons for this behaviour. 

    Misunderstandings of indicators of abuse or neglect may occur, if professionals attribute the actions and behaviours to the child's disability. 

    Protection and action to be taken

    It should be remembered that children with disabilities are children first and foremost, and have the same rights to protection as any other child. People caring for and working with disabled children need to be alert to the signs and symptoms of abuse. 

    Where there are concerns about the safety and wellbeing of a child with disabilities a referral should be made in accordance with Gateshead procedures. 

    Children with disabilities should not be left in situations where there is a high level of neglect or other forms of abuse. A practitioner may be of the view that the parent, carer or service "is doing their best" because the situation is complex. This is not a child centred or safe way of considering a situation. Parents, services and carers will need to be challenged in the same way as those of non-disabled children and offered support to bring about changes so as to create greater safety.  

    There are likely to be greater number of services and practitioners involved than for a non-disabled child and therefore joined up communication and information sharing during an assessment of a child is essential. Continued communication amongst professionals should mean incidents don't get missed or explained away and everyone remains curious and open to looking at information from different perspectives.  

    Particular attention should be paid to the communications needs of a child so as to gain as  clear of an understanding as possible of a child's perception of events and their views wishes and feelings. 

    Safeguards for disabled children are essentially the same as all other children: 

    • make it common practice to enable disabled children to make their wishes and feelings known in respect of their care and treatment
    • ensure that disabled children receive appropriate personal, health and social education (including sex education)
    • make sure that all disabled children know how to raise concerns and give them access to a range of adults with whom they can communicate. This could mean using interpreters and Speech and Language support using the child's preferred method of communication; it may mean visiting a number of times
    • recognise and utilise key sources of support including staff in schools, friends and family members where appropriate
    • develop the safe support services that families want, and a culture of openness and joint working with parents and carers on the part of services 

    Ensure that guidance on good practice is in place and being followed in relation to: 

    • intimate care
    • working with children of the opposite sex
    • managing behaviour that challenges families and services
    • issues around consent to treatment
    • anti-bullying and inclusion strategies sexuality and safe sexual behaviour among young people
    • monitoring and challenging placement arrangements for young people living away from home.

    Organisational culture and 'custom and practice' can contribute to institutional abuse or harm. Do not underestimate the power of tradition or how poor practice can become pervasive in influencing staff to behave inappropriately. 

    Unreflective practice and risk aversive approaches from staff members can significantly reduce the quality of life for young people. Such cultures can also become ideal contexts for determined abusers to manipulate both children and adults. 

    Good quality services readily seek the views of young people, parents and other professionals in reviewing their practice.  

    Staff must refer any concerns about the behaviour of a staff member, volunteer, taxi driver, etc. which may constitute Significant Harm/gross misconduct towards a child in their care to their designated safeguarding lead. 

    Capacity and consent

    If children are competent and able to give consent for themselves, you should seek consent directly from them.

    You should aim to be involving the people who have parental responsibility for a child in decision-making from the start unless this in itself would be a safeguarding risk. You will need to explain this to the child.

    Where a child is worried about sharing information with their parent or carer, or is telling you that you cannot, it is important to explore why and when you are able, allow them some space to consider the situation. Dependent on the age of the child you may make the decision to involve a parent or carer, whilst acknowledging the child's worry about this.

    These decisions can be tricky, and you need to keep in mind that you cannot breach a child's right to confidentiality. You do not need to make these decisions on your own - you can seek some management and legal advice to help make the decision.   

    You should never automatically assume that a child with learning disabilities is not competent to make their own decisions; many children will be competent if information is presented in an appropriate way and they are supported through the decision-making process: Think about the tools that will support them and support you. Think about advocacy and how this could help a child give their views.  

    In England and Wales, the starting point in assessing whether a young person is able to make decisions about all aspects of their care and treatment is the Mental Capacity Act 2005.

    The Mental Capacity Act starts with the premise that:  

    All individuals over the age of sixteen have the capacity to make decisions for themselves, unless they can be shown to lack capacity.  

    The Acts sets out a single clear test for assessing whether a person lacks capacity to make a decision at a particular time. 

    The Code of Practice outlines a two-stage test of capacity: 

    • does the person have an impairment of the mind or brain
    • if so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made

    In assessing an individual's ability to make a decision the following areas need to be explored: 

    • does the person have a general understanding of what decision they need to make and why they need to make it? 
    • does the person have a general understanding of the likely consequences of making, or not making, this decision? 
    • is the person able to understand, retain, use and weigh up the information relevant to this decision? 
    • can the person communicate their decision? (by talking, using sign language or by any other means). 

    Before coming to a decision that a young person lacks capacity, appropriate steps must be taken to try and enable the young person to make the decision themselves. In circumstances when a young person lacks capacity, practitioners will be able to make decisions in relation to a young person's care and treatment, if such decisions are in the young person's best interests. 

    When assessing the young person's best interests, the person providing care or treatment must consult those involved in the young person's care and anyone interested in their welfare, if it is practicable and appropriate to do so. This may include the young person's parents. As discussed above, care should be taken not to unlawfully breach the young person's right to confidentiality. 

    When disagreements about the treatment, care or welfare of a young person aged sixteen or seventeen arise, the case may be heard in either the Court of Protection or the Family Courts, depending on the specifics of the case. A legal advisor will guide you here.  

    Everyone working with or caring for any young person from the age of 16 whose capacity may be in doubt must comply with the Mental Capacity Act.

    The CQC have published a 'myth-buster' to clarify the principles, laws and guidelines used when assessing children's ability to make decisions about their treatment, as well as the differences between Gillick competence and Fraser guidelines.

    The NSPCC have published Gillick competency and Fraser guidelines to help people who work with children to balance the need to listen to children's wishes with the responsibility to keep them safe.

    Competence:  

    • Gillick - the principles of Gillick Competency apply to young people under 16. It is about determining a child's ability to consent. 
    • Fraser - used in specific cases where deciding whether a child can consent to sexual or contraceptive health advice and treatment.  

    Safeguarding duties allow professionals to override an individual's refusal of consent to share information or intervene if there is a risk of serious harm, abuse, or neglect, particularly regarding children.

    Issues

    • a disabled child's dependency on parents and carers for practical assistance in daily living, including intimate personal care, increases their risk of exposure to abusive behaviour 
    • carers are relied upon (whether family or paid carers) as a source of information about disabled children and to interpret and explain behaviour or symptoms
    • presence of a disability can add strain to a parent-child relationship as some parents may struggle to accept their child's diagnoses. This could lead to delayed access to emotional support (Source: RNIB - What do we know about the impact of sight loss on relationships? 2024) 
    • professional staff can potentially feel out of their depth in terms of knowledge of a disabled child's impairment, where the familiar developmental milestones may not apply
    • lack of understanding and training about safeguarding disabled children can result in professionals not recognising the signs of abuse or neglect. This is all the more worrying given that research indicates that the identification of the abuse of disabled children is most likely to come from observations of physical signs, behaviour or mood changes 
    • disabled children should not be left in situations where there is a high level of neglect or other forms of abuse, because a professional feels the parent, carer or service is 'doing their best'
    • worries about carers of disabled children will be shared with carers in the same way as carers of non-disabled children
    • where there are communication impairments or learning difficulties, particular attention should be paid to the communications needs of the child to ascertain the child's perception of events and his or her wishes and feelings
    • limited personal safety programmes and personal, social and sex education for disabled young people results in them being less aware about abusive behaviour and less able to communicate about abuse. (Source: The Children's Society: 2009) 
    • children's social care and the Police should be aware of non- verbal communication systems and should contact suitable interpreters and facilitators
    • agencies must not make assumptions about the inability of a disabled child to give credible evidence, or to withstand the rigours of the Court process
    • as more short break services are commissioned it is essential that sufficient staff are trained to ensure they are competent to deliver safe care in areas such as ventilation and tube feeding. (Source: The Children's Society: 2009 ) 
    • children and young people with vision impairment are more likely than children without vision impairment to live in families that experience social and economic disadvantage. Over 50% have at least one other SEND. (RNIB) 
    • each child should be assessed carefully and supported where relevant to participate in the criminal justice system when this is in their interests as set out in Achieving Best Evidence in Criminal Proceedings: Guidance on Vulnerable and Intimidated Witnesses (Home Office 2011) which includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing disabled children
    • participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated. The use of specialist advocates should be considered

    Resources for practitioners

    Gateshead resources

    Gateshead's advocacy offer for children and young people 

    Gateshead Safeguarding Children Partnership

    National resources