Child abuse and neglect

‘Significant harm’ means that someone is:

• punishing a child too much
• hitting or shaking a child
• constantly criticising, threatening or rejecting a child
• sexually interfering with or assaulting a child
• not looking after a child – not giving them enough to eat, ignoring them, not playing or talking with them or not making sure that they are safe.

Children are usually abused by someone in their immediate family circle. This can include parents, brothers or sisters, babysitters or other familiar adults. It is quite unusual for strangers to be involved.

Children may present with a variety of difficulties and behaviours depending on where, when and the type of abuse they have experienced.

It can be hard to detect long-standing abuse by an adult the child is close to. It is often very difficult for the child to tell anyone about it, as the abuser may have threatened to hurt them if they tell anybody. A child may not say anything because they think it is their fault, that no one will believe them or think they will be teased or punished. The child may even love the abusing adult. They want the abuse to stop, but they don't want the adult to go to prison or for the family to break up.

Physically abused children may:

• be watchful, cautious or wary of adults
• be unable to play and be spontaneous
• be aggressive or abusive
• bully other children or are being bullied themselves
• be unable to concentrate, underachieve at school and avoid activities that involve removal of clothes, e.g. sports
• have temper tantrums and behave thoughtlessly
• lie, steal, truant from school and get into trouble with the police
• find it difficult to trust other people and make friends.

Sexually abused children may:

• suddenly behave differently when the abuse starts
• think badly of themselves
• not look after themselves
• use sexual talk or ideas in their play that you would usually see only in someone much older
• withdraw into themselves or be secretive
• under-achieve at school
• start wetting or soiling themselves
• be unable to sleep
• behave in an inappropriately seductive or flirtatious way
• be fearful, frightened of physical contact
• become depressed and take an overdose or harm themselves
• run away, become promiscuous or take to prostitution
• drink too much or start using drugs
• develop an eating disorder, such as anorexia or bulimia.

Emotionally abused or neglected children may:

• be slow to learn to walk and talk
• be very passive and unable to be spontaneous
• have feeding problems and grow slowly
• find it hard to develop close relationships
• be over-friendly with strangers
• get on badly with other children of the same age
• be unable to play imaginatively
• think badly of themselves
• be easily distracted and do badly at school.

First and foremost, the child must be protected from further abuse. If you suspect that a child is being abused, you may be able to help them to talk about it.

Social Services will need to be involved to find out:

• what has happened
• if it is likely to happen again
• what steps are needed to protect the child.

Your local Social Services Child Protection Adviser will be able to offer more detailed advice. It is helpful to speak to them even if you are not sure. Remember, all of us need to protect the child from further harm.

Child Protection

After investigation, Social Services may be satisfied that the problems have been sorted out, and that the parents can now care for and protect the child properly. If so, they will remain involved only if the family wants their help. If Social Services are concerned that a child is being harmed, they will arrange a child protection case conference. The parents and professionals who know the child will be invited. A plan will be made to help the child and family and ensure that there is no further harm.

When a child has been abused within the family, the person involved is sometimes able to own up to what they have done and want help. They can then be helped to look after their child better.

Occasionally, the child may have to be taken away from the abusing adult because the risks of physical and emotional harm are great. This can be for a short time, until things become safer, or may be permanent.

Specialist treatment

Many children need specialist treatment because of the abuse they have endured. Some receive help from family centres run by Social Services.

If they are worried, depressed or being very difficult, the child and family might need help from the local child and adolescent mental health services (CAMHS).

These specialists may work with the whole family or with children and adolescents alone. Sometimes they work with teenagers in groups. Individual therapy can be especially helpful for children who have been sexually abused, or who have experienced severe trauma.

Children who have suffered serious abuse or neglect can be difficult to care for, and the services can offer help and advice to parents and carers.

"It started when I was about 8 and my and I sister went to stay with my aunt and uncle. My sister, aunt and cousins went out, but I didn’t feel well so I stayed behind. My uncle said he had a game that would make me feel better. He said it was a special game that we could play with my cousin’s Barbie doll. In the game, Barbie got married and then went on her Honeymoon – he said on a Honeymoon people do special things and he could show me what they were, but I mustn’t tell anyone because I’d get into serious trouble.

Barnardo's - Works with families and children in many ways, including counselling, fostering and adoption, support for young carers, training and disability inclusion.

ChildLine - Provides a free and confidential service for children. Helpline 0800 1111.

NSPCC (National Society for the Prevention of Cruelty to Children) - Has a number of useful publications. If you are worried about a child, call the NSPCC Helpline on 0808 800 5000.

The Hideout - A website offering support and advice to children whose lives are affected by domestic abuse.

References

• Rutter’s Child and Adolescent Psychiatry, Fifth Edition (2008). Publisher: Wiley-Blackwell.
• HM Government (UK). Working together to safeguard children: a guide to inter-agency working to safeguard and promote the welfare of children. March 2010. 
• Gilbert R, Spatz Widom C, Browne K, et al.,(2009). Burden and consequences of child maltreatment in high income countries. Lancet; 373:68-81.
• Understanding the behavioral and emotional consequences of child abuse. Amaya-Jackson L (2008). Committee on Child Abuse and Neglect and Section on Adoption and Foster Care, Pediatrics. 2008 Sep; 122(3):667-73.

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.

This resource reflects the best possible evidence at the time of writing.