The Biology Tutor

Appendix A

Examples of abuse or neglect

Statutory guidance offers four defined areas of abuse:

1. Physical abuse
   Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child.
   
   
2. Emotional abuse
   Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyber bullying) causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.
   
   
3. Sexual abuse
   Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children. Child Sexual Exploitation is a form of child sexual abuse. It occurs when an individual or group takes advantage of an imbalance of power to coerce, manipulator deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.
   
   
4. Neglect
   Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:
   • Provide adequate food, clothing, and shelter (including exclusion from home or abandonment)
   • Protect a child from physical and emotional harm or danger
   • Ensure adequate supervision (including the use of inadequate caregivers); or
   • Ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional need.
   
   
5. Bullying (in some circumstances bullying can be considered as emotional, physical or sexual abuse)
   Bullying may be defined as deliberately hurtful behaviour, usually repeated over a period of time, where it is difficult for those bullied to defend themselves. It can take many forms, but the three main types are physical (e.g. hitting, kicking, theft), verbal (e.g. racist or homophobic remarks, threats, name calling) and emotional (e.g. isolating an individual from the activities and social acceptance of their peer group). The damage inflicted by bullying (including bullying via the internet) can frequently be underestimated. It can cause considerable distress to children, to the extent that it affects their health and development or, at the extreme, causes them significant harm (including self-harm).
   
   The NSPCC outlines that:
   • Peer-on-Peer abuse includes bullying, sexual violence and sexual harassment, physical abuse, sexting and so-called initiation ceremonies.
   • Female genital mutilation (FGM) is the partial or total removal of the external female genitalia for nonmedical reasons. It's also known as female circumcision or cutting. Religious, social or cultural reasons are sometimes given for FGM. However, FGM is child abuse.

Appendix B

Potential Indicators of abuse or neglect

The following signs may be indicators or signs that abuse has taken place although some of these indicators can also be caused by other factors, e.g. a bereavement, family breakdown or illness. It is not the role of The Biology Tutor to decide if abuse or neglect has taken place rather this is a complex task undertaken by skilled professionals working together across agencies. However, if any of these signs are present then The Biology Tutor should share these concerns as outlined in the procedure. In deciding if something may be a concern it is always helpful to think about the child’s age, abilities and stage of development too. It is important to keep in mind that abuse may be committed against children by members of the child’s family or party, by other children or by staff.

Physical Abuse

Physical signs of abuse:

• Injuries which occur to the body in places which are not normally exposed to falls or games.
• Most children will collect cuts and bruises in their daily life, particularly on bony parts of their body like elbows, knees and shins. You should be more concerned by bruising which can almost only have been caused non-accidentally, is unexplained, or the explanation does not fit the injury, or where treatment is not being sought. Bruising may be more or less noticeable on children with different skin tones or from different racial groups and specialist advice may be needed
• Patterns of bruising that are suggestive of physical child abuse include:
  • bruising children who are not independently mobile
  • bruising in babies
  • bruises that are seen away from bony prominences
  • bruises to the face, back, stomach, arms, buttocks, ears and hands
  • multiple bruises in clusters or of uniform shape, or carrying the imprint of an implement used, hand marks or fingertips
• Unexplained bruising, marks or injuries on any part of the body
• Cigarette burns, bite marks, broken bones, scalds
• Injuries which have not received medical attention
• Repeated urinary infections or unexplained stomach pains

Changes in behaviour which may indicate physical abuse:

• Fear of parents being approached for an explanation
• Aggressive behaviour or severe temper outbursts
• Flinching when approached or touched
• Reluctance to get changed, for example, wearing long sleeves in hot weather
• Depression
• Withdrawn behaviour
• Running away from home

Emotional Abuse

The physical signs of emotional abuse may include:

• A failure to thrive or grow particularly if a child puts on weight in other circumstances, e.g. in hospital or away from their parents’ care
• Sudden speech disorders
• Persistent tiredness
• Development delay, either in terms of physical or emotional progress

Changes in behaviour that may indicate emotional abuse include:

• Neurotic behaviour e.g. sulking, hair twisting, rocking
• Obsessions or phobias
• Being unable to play
• Attention-seeking behaviour
• Fear of making mistakes
• Self-harm
• Fear of parent being approached regarding their behaviour

Sexual Abuse

The physical signs of sexual abuse may include:

• Pain or itching in the genital/anal area
• Bruising or bleeding near genital/anal areas
• Sexually transmitted disease
• Vaginal discharge or infection
• Stomach pains
• Discomfort when walking or sitting down
• Pregnancy

Changes in behaviour that may indicate sexual abuse include:

• Sudden or unexplained changes in behaviour e.g. becoming withdrawn or aggressive
• Fear of being left with a specific person or group of people
• Having nightmares
• Running away from home
• Sexual knowledge which is beyond his/her age or developmental level
• Sexual drawings or language
• Bedwetting
• Eating problems such as over-eating or anorexia
• Self-harm or mutilation, sometimes leading to suicide attempts
• Saying they have secrets they cannot tell anyone about
• Substance or drug abuse
• Having unexplained sources of money
• Not allowed to have friends (particularly in adolescence)
• Acting in a sexually explicit way with adults

Neglect

The physical signs of neglect may include:

• Constant hunger, or stealing food from other children
• Constantly dirty or smelly
• Loss of weight or being constantly underweight
• Inappropriate dress for the conditions
• Under nourishment, failure to grow, inadequate care

Changes in behaviour that can also indicate neglect include:

• Complaining of being tired all the time
• Untreated illnesses, not requesting medical assistance and/or failing to attend medical appointments
• Having few friends
• Being left alone, being unsupervised or being supervised by an unsuitable adult or young person

FGM

Physical signs of FGM
A child or woman who has had female genital mutilation (FGM) may:

• have difficulty walking, standing or sitting
• spend longer in the bathroom or toilet
• appear withdrawn, anxious or depressed
• display unusual behaviour after an absence from school or college
• be particularly reluctant to have routine medical examinations
• ask for help but may not be explicit about the problem due to embarrassment or fear

A child at immediate risk of FGM may ask you directly for help. But even if they don’t know what's going to happen, there may be other signs. You may become aware of:

• a relative or ‘cutter’ visiting from abroad
• a special occasion or ceremony to 'become a woman' or prepare for marriage
• a female relative being cut – a sister, cousin, or an older female relative such as a mother or aunt
• a family arranging a long holiday or visit to family overseas during the summer holidays
• unexpected, repeated or prolonged absence from school
• a girl struggling to keep up in school and the quality of her academic work declining
• a child running away from or planning to leave home

Additional vulnerabilities

It is also important to be mindful that some children are particularly vulnerable to abuse because of their age or their living circumstances or characteristics. Disabled children are a greater risk of abuse that non-disabled children. Children living in homes where there are adverse parental circumstances may also be more at risk, in particular children living in homes where there is domestic violence, substance misuse and/or severe parental mental illness. Children from particularly isolated or new communities may also be at increased risk of abuse as well as those children who show challenging behaviour.