How to spot child abuse

Would you know how to spot child abuse?

Little girl with ponytail, side view with hand over her ear. Spot the signs of Child Abuse
Spot the signs of Child Abuse

This is the third in a series of Let’s talk about Abuse. Today we’re going to look at Child Abuse but before we start:

Content/Trigger Warning: Please be advised, this article might mention trauma-related topics which could potentially be triggering.

First, let’s take a look at the following Child Abuse statistics for year ending March 2019 from the Office of National Statistics (ONS), 2019. If you’re not too interested in statistics, just scroll down the page.

  • The Crime Survey for England and Wales (CSEW) estimated that one in five adults aged 18 to 74 years experienced at least one form of child abuse, whether emotional abuse, physical abuse, sexual abuse, or witnessing domestic violence or abuse, before the age of 16 years (8.5 million people).
  • Many cases of child abuse remain hidden; around one in seven adults who called the National Association for People Abused in Childhood’s (NAPAC’s) helpline in the latest year had not told anyone about their abuse before.
  • In the year ending March 2019, Childline delivered 19,847 counselling sessions to children in the UK where abuse was the primary concern; around 1 in 20 of the sessions resulted in a referral to external agencies. So yes, let’s talk Child Abuse.

What is the UN convention on the rights of the child?

Lit up photo young child holding up broken chains
All children have the right to be treated
with dignity and fairness……

In 1989, governments across the world adopted the United Nations Convention on the Rights of the Child (UNCRC), recognising that all children have the right to be treated with dignity and fairness, to be protected, to develop to their full potential and to
participate.

Their rights, according to UNCRC, include that: Governments must do all they can to make sure every child can enjoy their rights; to life, to adequate standard of living and non-discrimination, from child mortality to combating disease and malnutrition, preventing violence and injury, ensuring rehabilitation and support for children with disabilities, or abolishing traditional practices that harm children such as early enforced marriage and female genital mutilation.

So, what is Child Abuse?

Head of baby lying on his back, with black eyes and blooding dripping from his nose
Shocking — One month old baby

The World Health Organization (WHO) describes child abuse as a single, or repeated act, or lack of appropriate action, occurring within any relationship where there’s an expectation of trust, which causes harm or distress.

Who are the abusers

Sometimes people who abuse children were themselves abused as children. A cycle of abuse might be difficult to break if it’s not dealt with effectively. It can be passed down through generations within a family.

Child abusers come from all walks of life and abuse could happen anywhere i.e. in the home, at school, at the local swimming pool or park. Child abusers can be anyone from parents, caregiver, close family members, family friends, teachers and/or coaches. In fact, an abuser could be anyone who has access to a child — whether through action or failing to act.

People who’ve experienced abandonment, witnessed family violence or experienced various forms of abuse during childhood are at greater risk of poor mental health, behavioural and interpersonal skills in later life.

Types of abuse

Child abuse is behaviour toward a child that is outside the ‘normal societal behaviours’. Four types of abuse are generally recognized:

Girl with long blond hair wearing blue denim jacket and jeans. Sitting, leaning against a wall and covering her face
Emotional abuse harms a child’s
mental and social development
  • Emotional abuse includes any act that results in the child suffering significant emotional deprivation or trauma. Emotional abuse harms a child’s mental and social development, and over time, can cause severe emotional harm.

Shouting at a child or at other parent in front of them is child abuse. Being threatening towards a child, saying things like “If you don’t behave, I’ll cut your rabbit in half”, or “If your gonna sulk I’ll smash up that bloody laptop” is child abuse.

Putting a child down or criticising them, particularly in front of people, shaming or making the child feel guilty is abuse. Letting children hear adult themed conversations, talking about divorce or separation or putting the other partner down in front of a child is also abuse.

Psychological abuse is often the hardest form of abuse to identify. However, if a child is abused in another way i,e, physically or sexually, psychological abuse might not be far behind.

‘My greatest wish is that my kids always know how much I love them, and that they walk through the rest of their life knowing I’ll always be there for them anyway I can.’

Unknown

Signs a child might be emotionally abused might include:

  1. Withdrawal from friends and activities they used to enjoy
  2. Sudden loss of self-confidence, depression, anxiety, panic attacks, OCD or unusual fears
  3. Looking sad and lonely, different from how they’ve been in the past
  4. Changes in behavior — such as anger, aggression, hostility or hyperactivity and being spiteful, bullying others such as younger siblings, school friends and even parents
  5. Rebellious or defiant behavior, deliberately breaking all the normal family or school rules
  6. An apparent lack of supervision, possibly always out on the streets
  7. Running away
  8. Frequent absences from school or sudden changes in school performance
  9. Reluctance to leave school activities, as if he or she doesn’t want to go home
  10. Self-harm; pulling out their hair, cutting or scratching self, or suicide attempts
Young boy wearing blue jeans and white t-shirt. Sitting on the floor with his hand up defending himself as females hand that look like they're about to hit or slap
Young boy looks like mum’s angry,
– Image Shutterstock/Speedkingz
  • Physical abuse is when a parent, family friend, teacher or caregiver purposely causes physical injury to a child. There’s lots of signs of physical abuse, some of which are listed here:
  1. Bruises, black eyes, blisters, hair pulling, cuts and cigarette burns, scars or scratches
  2. Severe visible injuries like burns or welts, possibly hit with a belt or stick
  3. Broken arms, legs or hands, dislocated joints
  4. Internal injuries like stomach; perhaps being kicked and punched or brain damage
  5. Lifelong injury as in brain injury, death

Be aware if a child doesn’t want to leave, say a friend’s birthday party, to go home, or they’re afraid of adults, including other parents

ID 9388190 © Monkey Business Images | Dreamstime.com
  • Neglect includes any serious omission or act that constitutes a failure to provide the essential conditions for the healthy emotional and physical development of a child (within the bounds of cultural tradition). Some examples are:
  1. Leaving a child alone without appropriate supervision i.e. leaving a baby with a 6/7 year old sibling while parent goes off to a bar or party
  2. Not receiving comfort, affection, and appropriate stimulation from caregivers; no smiles, hugs or appropriate physical bonding. No emotional support such as ignoring their cries, their feelings or other emotional needs
  3. Not getting medical help when required or quite the opposite, Munchausen syndrome by proxy (a mental health problem where a caregiver makes up or causes an illness or injury in a child
  4. Infection because of lack of medication or poor hygiene which might result in scabies, head lice, diarrhea
  5. Not enrolling a child at school or not making sure a child attends school

Signs of neglect in children would include things like:

Whiteboard with someone writing in large blue letters - child neglect
Dreamstime.com
  • Nasty body odour, matted hair, dirty skin and/or nails
  • A child being ill-kempt, extremely dirty clothing or wearing clothing that’s way too small or too big
  • Untreated sores, scabs or severe nappy rash
  • If a baby isn’t meeting appropriate physical and developmental milestones without an underlying medical reasons
  • Being hungry and stealing food or what might appear as gluttony – eating really quickly and furtively
  • A child is always tired, late for school or not attending school
  • Feeling bad about themselves, not making friends
  • Being involved in serious accidents like falling down stairs, constantly bruised or broken bones

I have consciously left out Childhood Sexual Abuse in this article, as that’s a whole other post.

Knowing how to help a child who is being abused and how to respond if you think a child is suffering is very complex. So too is understanding why most children don’t disclose, but I’ll try to cover that in my next post childhood sexual abuse. Listed here are support services you might want to contact for advice and support if you know of a child being abused:

  • NAPAC because the damage caused by child abuse doesn’t always end in childhood. NAPAC offer support to adult survivors and training for those who support them. Call 0808 801 0331
  • NSPCC 0808 800 5000 to report concerns about a child
  • Childline call 0800 1111 for advice and support

Though it’s crucial to raise awareness of child abuse, researching and writing this article brought up many old thoughts and feelings. It’s been depressing at times, anxiety provoking, soul-destroying and shocking. I’m guessing that many of you will have had similar anxieties reading it. If so, I’m sorry for what you may have gone through and, please take a few moments to self-soothe and to take care of yourself.

Large red question mark with white man character leaning against it
Clipart.com

I hope you’ve found this post useful in some way. Do you think I’ve covered most angles, or do you need more? Would you ever report to the authorities if you saw signs of child abuse? I’m really interested to hear your opinions and I’m happy to answer any questions you might have.

You might be interested in the two other posts in this series, Let’s talk about Domestic Violence here or Let’s talk about the various forms of abuse here.

One last thought: if you’re having relationship problems, please – tell a friend, speak to your GP or find a therapist, but please don’t take it out on the children.

What causes mental illness?

While I can’t give you all the answers, take a look at this model which helps in identifying and treating mental illness.

The Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition, has defined depression as 5 or more of the following symptoms that are present for 2 or more weeks and cause significant emotional distress and/or impairment in functioning:

Getty.com
  1. depressed or sad mood
  2. short-tempered or easily annoyed
  3. loss of interest or enjoyment in hobbies or activities that was previously enjoyed
  4. feeling of worthlessness or guilt
  5. thoughts of death or suicide
  6. difficulty with concentrating or making decisions
  7. feeling tired or fatigue
  8. feeling restless or slow
  9. changes in appetite such as overeating or loss of appetite
  10. changes in weight such as weight loss or weight gain, and changes in sleep pattern.1 

According to the National Institute of Mental Health, depression occurs due to a combination of genetic, biological, environmental, and psychological factors.2

Genetic vulnerability refers to the inherited characteristics passed on from parents to children that make it more likely that a person will develop a mental illness or addiction.

Biological theory suggests that depression is caused by an imbalance of naturally occurring substances called neurotransmitters (Serotonin and norepinephrine) in the brain and spinal cord.

Depression is said to be almost twice as likely to affect women than men and tends to have different contributing causes in women than it does in men. Contributing factors include reproductive hormones (biological)

Psychological and environmental/social factors—such as lifestyle choices ie too much alcohol, past trauma, low self-esteem, substance abuse and loneliness can also play an enormous part in depression.

Treatment for depression consists of participation in psychotherapy, taking antidepressants, or a combination of both. However, many individuals don’t participate in psychotherapy or antidepressants due to factors such as side effects, lack of access/resource, or personal choice.

According to Agius et al 2010, the Stress Vulnerability Model is an extremely useful model for identifying and treating relapses of mental illness. We accept that humans carry genetic and other predisposition to mental illness. However, the question arises as to how stress impacts on a person in order to cause mental illness to develop. Furthermore there arises the issue as to what other effects such stress has on the human body beyond the human brain. 4.

The Stress Vulnerability Model explores the interrelationship between all these factors, and the genetic component which in large part constitutes the ‘vulnerability’ part of the model. Such problems occur in many Psychiatric illnesses, including Depression, PTSD, as well as Schizophrenia.

Vulnerability Factors predispose individuals to develop mental health problems e.g psychosis, clinical depression. Problems are triggered by stress. If vulnerability is high, low levels of environmental stress may trigger distress. Use and effectiveness of coping strategies goes some way to explain why some have problems and others don’t.

Let’s take a look at the model and I’ll share how my vulnerability lead to a psychotic depression:

Look along the bottom where it says Vulnerability – high to low. For me, because mental illness runs in the family (genetic) I have a predisposition to mental illness. I grew up with mum as single carer for four children, I was shy and had low self-esteem (psychological). We moved a lot, I went to more than ten schools and each time I was bullied because of my new accents (social/environmental), then there’s the childhood abuse (psychological), so — I have a high vulnerability to mental illness.

Now look at the left-hand side where it says stressful events: my ex had a baby with someone else, then the breakdown of my relationship, my ex was cheating, I experienced domestic violence, one of his girlfriend’s plagued me for eighteen months, I wasn’t sleeping, I felt suicidal, I was now a single parent and didn’t have any real coping mechanisms other than to bottle it all up. Therefore, you can add up all the stressful events and my arrow is very high, as in the diagram.

Follow that curve in the model and you’ll see how I have an extremely low stress threshold towards mental illness. Hence my psychotic depression, anxiety, panic attacks and anorexia.

While I still have a predisposition to mental illness, there’s been a huge reduction in my stressful events so I now have a higher threshold for stress.

So, back to the chart — Along the bottom line, I’m at the end, on the right ‘high vulnerability’. But along the left side, I’m presently low down on the scale as I have minimum stress at the moment (trace along the chart with your finger). So you’ll see, I’m currently in the mental health category, rather than mental ill-health.

Is this your empty toolbox? Photo by worthpoint.com

I still experience depression and anxiety but they tend to be reactive. I still take medication and I have an extensive toolbox of coping techniques that I can use, when necessary.

I found this model really helpful when working with patients and they liked how it might explain why they developed a mental illness. If you have a mental illness and you wonder why, try using the above chart to see if it’s helpful in determining the how or the why me?

Does this model fit with your ideas? Where would you sit on the graph? Do you think vulnerability needs more explanation? I’d really appreciate your thoughts.