Safeguarding disabled children guidance

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?".