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Types of Child Abuse

Different Types of Child Abuse...

Child abuse covers a spectrum of behaviour, from less to more abusive.

Early recognition of the indicators may prevent the unacceptable behaviour moving from less to more abusive.
Types of Child Abuse

Protecting children from abuse is a responsibility shared by everyone.

A first step in protecting children from abuse involves facing up to the fact that it happens at all and understanding the nature and types of abuse.

Types of Child Abuse #1: Physical Abuse And Injury

Physical abuse involves someone deliberately harming or hurting a child.

It covers a range of unacceptable behaviour, including what may be described as physical punishment.

It can involve hitting, shaking, squeezing, burning, attempted suffocation, drowning, giving a child poisonous substances, inappropriate drugs or alcohol.

It includes the use of excessive force when carrying out tasks like feeding or nappy changing.

Indicators of Physical Abuse

Bruises

Seventy per cent of abused children suffer soft tissue injury, such as bruises, lacerations or weals.

The position of the bruising is important: bruises on cheeks, bruised eyes without other injuries, bruises on front and back shoulders are less likely to occur accidentally, as are diffuse bruising, pinpoint haemorrhages and finger-tip bruises.

Bruises occuring frequently or re-bruising in the same position as old or faded bruising may also be indicators of abuse.

The pattern of bruises may also be an indicator: bruises reflecting the cause, for example finger-tip, fist- or hand-shaped bruising. Bruises incurred accidentally do not form a pattern.

It is very important that mongolian spots are not confused with bruises as a type of child abuse. They should not arouse suspicion of abuse.

Mongolian spots are smooth, bluish grey to purple skin patches, often quite large, consisting of an excess pigmented cells (melanocytes).

They are sometimes seen across the base of the spine (sacrum) or buttocks of infants or young children of Asia, Southern European and African descent. They disappear at school age.

Diagnosis of types of child abuse is by health care professionals: it is rarely made on the basis of physical indicators alone and may depend on prompt referral to appropriate professionals.

Burns

Around 10 per cent of abused children suffer burns, but only 2 per cent of these are burnt non-accidentally.

Examples are cigarette burns, especially when clear and round and more than one, and burns reflecting the instrument used, for example by placing a heated metal object on the skin.

The pattern and position of scalds can be significant, for example a 3 year old child with scalds on their feet that are spread like socks. This would imply that the child was placed in hot water and probably held there.

Fractures

In diagnosing non-accidental injury the following would be significant to a doctor...

  • the age of the child - immobile babies seldom sustain accidental fractures
  • x-rays revealing previous healed fractures of differing ages
  • the presence of other injuries
  • the explanation given by child or carer.

Head, Brain And Eye Injuries

Head, brain or eye injuries may indicate that a child has been swung, shaken, received a blow or been hit against a hard surface.

The result may be a small fracture or bleeding into the brain (subdural haematoma).

A small outward sign of head injury accompanied by irritability, drowsiness, headache, vomiting or head enlargement should be treated with urgency, as the outcomes can include brain damage, blindness, coma and death.

Other Marks

Other indicators of abuse may be bites, outlines of weapons, bizarre markings, nail marks, scratches, abrasions, a torn frenulum.

Damage in a young child ususlly results from something being forcibly pushed into the mouth, such as spoon, bottle or dummy.

It hardly ever occurs in ordinary accidents. This damage may be associated with facial bruising.

Additional Indicators of Physical Abuse

Physical indicators alone may be insufficient to diagnose types of child abuse. They should, therefore, always be considered alongside other factors.

The presence of the following additional indicators increases the likelihood that injuries were sustained non-accidentally; they should be recorded alongside the physical indicators.

Some of these additional indicators highlight the need to keep accurate, up-to-date records...

  • an explanation by the parent or carer that is inadequate, unsatisfactory or vague, inconsistent with the nature of the injury, considering the age or stage of development of the child
  • an unexplained delay in seeking medical attention, or seeking treatment only when prompted by others
  • a series of minor injuries to a child which may in themselves have satisfactory explanations
  • a history of child abuse or neglect of this or other children in the family.

Behavioural Indicators

In seeking to recognise physical abuse, the following behaviour in an injured child will be significant.

This behaviour should be recorded in order to consider it alongside physical and additional indicators, but it cannot be said to prove the existence of abuse...

  • fear and apprehension - professionals working with abused children have described a particular attitude or facial expression adopted by abused children and labelled it frozen awareness or frozen watchfulness. This describes a child who is constantly looking around, alert and aware (vigilant), while remaining physically inactive (passive), demonstrating a lack of trust in adults
  • inappropriately clinging to, or cowering from, the carer
  • unusually withdrawn or aggressive behaviour (a change in behaviour may be particularly significant)
  • the child's behaviour in role-play situations, including their explanation of how the injury occured.

Types of Child Abuse #2: Neglect

Neglect involves persistently failing to meet the basic essential needs of children, and/or failing to safeguard their health, safety and well-being.

Neglect involves acts of omission, that is not doing those things that should be done, such as protecting children from harm.

This contrasts with other types of child abuse that involve acts of commission, that is doing those things that should not be done, for example beating children.

To understand neglect you need to know about children's basic essential needs and their rights.

Physical Neglect

Physical neglect involves not meeting children's need for adequate food, clothing, warmth, medical care, hygiene, sleep, rest, fresh air and exercise.

It also includes failing to protect, for example leaving young children alone and unsupervised.

Emotional Neglect

Emotional neglect includes refusing or failing to give children adequate love, affection, security, stability, praise, encouragement, recognition and reasonal guidelines for behaviour.

Intellectual Neglect

Intellectual neglect includes refusing or failing to give children adequate stimulation, new experiences, appropriate responsibility, encouragement and opportunity for appropriate independence.

Indicators of Neglect

The following signs and symptoms may be observed and should be recorded accurately and dated...

  • constant hunger, voracious appetite, large abdomen, emaciation, stunted growth, obesity, failure to thrive
  • inadequate, inappropriate clothing for the weather, very dirty, seldom laundered clothing
  • constant ill-health, untreated medical conditions, for example extensive persistent nappy rash, repeated stomach upsets, chronic diarrhoea
  • unkempt appearance, poor personal hygiene, dull matted hair, wrinkled skin, skin folds
  • constant tiredness or lethargy
  • repeated accidental injury
  • frequent lateness or non-attendance at school
  • low self-esteem
  • compulsive stealing or scavenging
  • learning difficulties
  • aggression or withdrawal
  • poor social relationships.

It is important to remember that behavioural indicators may be due to causes other than neglect. For this reason, you need to be aware of the background of children in your care.

Diagnosis will not be on the basis of behavioural indicators alone. Possible medical conditions that may account for the physical indicators observed will need to be ruled out.

Types of Child Abuse #3: Emotional Abuse

Failing (omitting) to meet the needs of children in any area of their development, i.e. neglecting children, will cause emotional damage. In addition, it is possible to committ acts of emotional abuse.

This occurs when children are harmed by constant threats, verbal attacks, taunting and/or shouting.

Emotional abuse includes the adverse effect on children's behaviour and emotional development as a result of their parent or carer's behaviour, including their neglect and/or rejection of the child.

This category is only used in circumstances where it is the only or main form of abuse. Children may fail to thrive as a result of emotional neglect or abuse, as well as of physical neglect.

Children who are neglected are more likely to be victims of other types of child abuse, such as emotional, sexual or physical abuse.

Types of Child Abuse #4: Sexual Abuse

Sexual abuse is the involvement of dependent, developmentally immature children and adolescents in sexual activities that they do not fully comprehend and are unable to give informed consent to, or that violet the social taboos of family roles.

An example of a social taboo of family roles might be incest.

Victims of sexual abuse include children who have been the subject of unlawful sexual activity or whose parents or carers have failed to protect them from unlawful sexual activity, and children abused by other children.

Sexual abuse covers a range of abusive behaviour not neccessarily involving direct physical contact.

It often starts at the lower end of the spectrum, for example exposure and self-masturbation by the abuser, and continues through actual body contact such as fondling, to some form of penetration.

Who Are The Victims of Sexual Abuse?

Child sexual abuse is a universal phenomenon. It is found in all cultures and socio-economic groups.

It happens to all children in all kinds of families and communities. It is untrue that it is only found in isolated rural communities.

Both boys and girls experience sexual abuse. As far as we know, many more girls are abused than boys.

There have been reported incidents of children as young as 4 months old being sexually abused.

Both men and women sexually abuse children. It is becoming clear that the majority of children who are sexually abused know the identity of the abuser.

They are either a member of their family, a family friend or a person the child knows in a position of trust, for example a teacher or a carer.

How Widespread Is Sexual Abuse?

The prevalence of sexual abuse is largely known as it is under-reported and we are dependent on estimates.

In a study of college students, 19 per cent of women and 9 per cent of men reported having been sexually abused as a child.

Out of 3,000 respondents to a survey by a teenage magazine, 36 per cent said they had been subjected to a sexually abusive experience as a child.

Indicators of Sexual Abuse

Early recognition of the indicators of sexual abuse may prevent progression, by the abuser, from less to more abusive acts.

If sexual abuse is not recognised in the early stages, it may persist undiscovered for many years.

Physical Indicators

The following are physical indicators of sexual abuse...

  • bruises or scratches to the genital and anal areas, chest or abdomen bites
  • blood stains on underwear
  • sexually-transmitted diseases
  • semen on skin, clothes or in the vagina or anus
  • internal small cuts (lesions) in the vagina or anus
  • abnormal swelling out (dilation) of the vagina or anus
  • itchiness or discomfort in the genital or anal areas.

In addition, there are signs that are specific to either boys or girls...

In boys...

  • pain on urination
  • penile swelling
  • penile discharge.

In girls...

  • vaginal discharge
  • urethral inflammation, urinary tract infections
  • lymph gland inflammation
  • pregnancy.

Behavioural Indicators

There may be no obvious physical indicators of sexual abuse, so particular attention should be paid to behavioural indicators.

The following should be recorded accurately and discussed with the designated person in your establishment or a senior member of staff...

  • what the child says or reveals through play with dolls with sexual characteristics, genitals, etc.
  • over-sexualised behaviour that is inappropriate for the age of the child; being obsessed with sexual matters; playing out sexual acts in too knowledgeable a way, with dolls or other children; producing drawings of sex organs such as erect penises; excessive mastaburtion
  • sudden inexplicable changes in behaviour, becoming aggressive or withdrawn
  • showing behaviour appropriate to an earlier stage of development
  • showing eating or sleeping problems
  • showing signs of social relationships being affected, for example becoming inappropriately clingy to carers; showing extreme fear of, or refusing to see, certain adults for no apparent reason; ceasing to enjoy activities with other children
  • saying repeatedly that they are bad, dirty or wicked (having a poor self-image)
  • acting in a way that they think will please and prevent the adult from hurting them (placatory), or in an inappropriately adult way (pseudomature behaviour).

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