4. Recognition and response |
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Contents
4.1 |
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4.2 |
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4.2.1 |
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4.2.3 |
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4.2.6 |
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4.2.10 |
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4.3 |
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4.3.6 |
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4.3.16 |
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4.3.19 |
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4.3.25 |
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4.4 |
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4.5 |
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4.5.3 |
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4.5.6 |
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4.5.9 |
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4.5.13 |
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4.5.17 |
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4.5.20 |
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4.5.27 |
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4.6 |
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4.7 |
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4.1 |
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4.1.1 |
Some children are in need because they are suffering, or likely to suffer, significant harm. The Children Act 1989 introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life in the best interests of children, and gives local authorities a duty to make enquiries to decide whether they should take action to safeguard or promote the welfare of a child who is suffering, or likely to suffer, significant harm. |
4.1.2 |
There are no absolute criteria on which to rely when judging what constitutes significant harm. Consideration of the severity of ill-treatment may include the degree and the extent of physical harm, the duration and frequency of abuse and neglect, the extent of premeditation, and the presence or degree of threat, coercion, sadism and bizarre or unusual elements. |
4.1.3 |
Each of these elements has been associated with more severe effects on the child, and / or relatively greater difficulty in helping the child overcome the adverse impact of the maltreatment. |
4.1.4 |
Sometimes, a single traumatic event may constitute significant harm (e.g. a violent assault, suffocation or poisoning). More often, significant harm is a compilation of significant events, both acute and longstanding, which interrupt, change or damage the child's physical and psychological development. |
4.1.5 |
Some children live in family and social circumstances where their health and development are neglected. For them, it is the corrosiveness of long-term neglect, emotional, physical or sexual abuse that causes impairment to the extent of constituting significant harm. |
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4.2 |
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Physical abuse |
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4.2.1 |
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 fabricates the symptoms of, or deliberately induces, illness in a child; see section 5.13. Fabricated or induced illness. |
4.2.2 |
See section 5. Children in specific circumstances who may be at risk of suffering physical abuse. |
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4.2.3 |
Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent effects on the child's emotional development, and may involve:
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4.2.4 |
Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone. |
4.2.5 |
See section 5. Children in specific circumstances who may be at risk of suffering emotional abuse. |
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4.2.6 |
Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (e.g. rape, buggery or oral sex) or non-penetrative acts. |
4.2.7 |
Sexual abuse includes abuse of children through sexual exploitation. Penetrative sex where one of the partners is under the age of 16 is illegal, although prosecution of similar age, consenting partners is not usual. However, where a child is under the age of 13 it is classified as rape under s5 Sexual Offences Act 2003. See section 5.25. ICT-based forms of abuse, section 5.42. Sexually active children and section 5.43. Sexually exploited children. |
4.2.8 |
Sexual abuse includes non-contact activities, such as involving children in looking at, or in the production of pornographic materials, watching sexual activities or encouraging children to behave in sexually inappropriate ways. |
4.2.9 |
See section 5. Children in specific circumstances who may be at risk of suffering sexual abuse. |
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4.2.10 |
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. |
4.2.11 |
Neglect may occur during pregnancy as a result of maternal substance abuse. |
4.2.12 |
Once a child is born, neglect may involve a parent failing to:
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4.2.13 |
It may also include neglect of, or unresponsiveness to, a child's basic emotional needs. |
4.2.14 |
See section 5. Children in specific circumstances who may be at risk of suffering neglect. |
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4.3 |
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4.3.1 |
The factors described below are frequently found in cases of child abuse or neglect. Their presence is not proof that abuse has occurred, but:
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4.3.2 |
The absence of such indicators does not mean that abuse or neglect has not occurred. |
4.3.3 |
In an abusive relationship the child may:
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4.3.4 |
The parent may:
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4.3.5 |
Professionals should be aware of the potential risk of harm to children when individuals (adults or children), previously known or suspected to have abused children, move into the household. See section 5.20. Harming others and section 13. Risk management of known offenders. |
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4.3.6 |
The following are often regarded as indicators of concern:
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4.3.7 |
Children can have accidental bruising, but the following must be considered as indicators of harm unless there is evidence or an adequate explanation provided. Only a paediatric view around such explanations will be sufficient to dispel concerns listed below:
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4.3.8 |
Bite marks can leave clear impressions of the teeth. Human bite marks are oval or crescent shaped. Those over 3cm in diameter are more likely to have been caused by an adult or older child. |
4.3.9 |
A medical opinion should be sought where there is any doubt over the origin of the bite. |
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4.3.10 |
It can be difficult to distinguish between accidental and non- accidental burns and scalds, and will always require experienced medical opinion. Any burn with a clear outline may be suspicious, e.g:
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4.3.11 |
Scalds to the buttocks of a small child, particularly in the absence of burns to the feet, are indicative of dipping into a hot liquid or bath. |
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4.3.12 |
Fractures may cause pain, swelling and discolouration over a bone or joint, and loss of function in the limb or joint. |
4.3.13 |
Non-mobile children rarely sustain fractures. |
4.3.14 |
There are grounds for concern if:
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4.3.15 |
A large number of scars or scars of different sizes or ages, or on different parts of the body, may suggest abuse. |
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4.3.16 |
Emotional abuse may be difficult to recognise, as the signs are usually behavioural rather than physical. |
4.3.17 |
The indicators of emotional abuse are often also associated with other forms of abuse. Professionals should therefore be aware that emotional abuse might also indicate the presence of other kinds of abuse. |
4.3.18 |
The following may be indicators of emotional abuse:
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4.3.19 |
Sexual abuse can be very difficult to recognise and reporting sexual abuse can be an extremely traumatic experience for a child. Therefore both identification and disclosure rates are deceptively low. |
4.3.20 |
Boys and girls of all ages may be sexually abused and are frequently scared to say anything due to guilt and / or fear. According to a recent study - [Cawson et al’s 2000 study for the NSPCC] - three-quarters (72%) of sexually abused children did not tell anyone about the abuse at the time. Twenty-seven percent of the children told someone later, and around a third (31%) still had not told anyone about their experience/s by early adulthood. |
4.3.21 |
If a child makes an allegation of sexual abuse, it is very important that they are taken seriously. Allegations can often initially be indirect as the child tests the professional's response. There may be no physical signs and indications are likely to be emotional / behavioural. |
4.3.22 |
Behavioural indicators which may help professionals identify child sexual abuse include:
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4.3.23 |
Physical indicators associated with child sexual abuse include:
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4.3.24 |
Sex offenders have no common profile, and it is important for professionals to avoid attaching any significance to stereotypes around their background or behaviour. While media interest often focuses on 'stranger danger', research indicates that as much as 80 per cent of sexual offending occurs in the context of a known relationship, either family, acquaintance or colleague [Grubin. D (1998). Sex offending against children: understanding the risk. Police Research Series. Paper 99. Home Office] |
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4.3.25 |
It is rare that an isolated incident will lead to agencies becoming involved with a neglectful family. Evidence of neglect is built up over a period of time. Professionals should therefore compile a chronology and discuss concerns with any other agencies which may be involved with the family, to establish whether seemingly minor incidents are in fact part of a wider pattern of neglectful parenting. |
4.3.26 |
When working in areas where poverty and deprivation are commonplace professionals may become desensitised to some of the indicators of neglect. These include:
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4.3.27 |
Disabled children and young people can be particularly vulnerable to neglect (see section 5.11. Disabled children) due to the increased level of care they may require. |
4.3.28 |
Although neglect can be perpetrated consciously as an abusive act by a parent, it is rarely an act of deliberate cruelty. Neglect is usually defined as an omission of care by the child's parent, often due to one or more unmet needs of their own. These could include domestic violence (see section 5.12), mental health issues (see section 5.32), learning disabilities (see section 5.33), substance misuse (see section 5.34), or social isolation / exclusion (see section 5.1.1 to 5.1.4), this list is not exhaustive. While offering support and services to these parents, it is crucial that professionals maintain a clear focus on the needs of the child. |
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4.4 |
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4.4.1 |
In some circumstances, agencies or individuals are able to anticipate the likelihood of significant harm with regard to an expected baby (e.g. domestic violence, parental substance abuse or mental ill health). |
4.4.2 |
These concerns should be addressed as early as possible before the birth, so that a full assessment can be undertaken and support offered to enable the parent/s (wherever possible) to provide safe care. See section 6.8. Pre-birth referral and assessment and section 8.14. Pre-birth conference. |
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4.5 |
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4.5.1 |
Professionals in all agencies who come into contact with children, who work with adults who are parents or who gain knowledge about children through working with adults, should:
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4.5.2 |
The law empowers anyone who has actual care of a child to do all that is reasonable in the circumstances to safeguard their welfare. Accordingly, professionals in all agencies should take appropriate action wherever necessary to ensure that no child is left in immediate danger, e.g. a teacher, foster carer, childminder or any professional should take all reasonable steps to offer a child immediate protection (including from an aggressive parent). |
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4.5.3 |
All agencies should have single / internal agency child protection procedures which are compliant with these London Child Protection Procedures and approved by the Local Safeguarding Children Board. Single / internal agency procedures must provide instruction to professionals in:
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4.5.4 |
Professionals in all agencies should be sufficiently knowledgeable and competent to contact local LA children's social care or the police about their concerns directly and to complete the appropriate referral form. |
4.5.5 |
A formal referral to LA children's social care, the police or accident and emergency services (for any urgent medical treatment) must not be delayed by the need for consultation with management or the nominated safeguarding children adviser, or completion of a common assessment. |
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4.5.6 |
All professionals in agencies with contact with children and members of their families must make a referral to LA children's social care if there are signs that a child or an unborn baby:
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4.5.7 |
The timing of such referrals should reflect the level of perceived risk of harm, not longer than within one working day of identification or disclosure of harm or risk of harm. |
4.5.8 |
In urgent situations, out of office hours, the referral should be made to the LA children's social care emergency duty team / out of hours team, see inside front cover for local contact details. |
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4.5.9 |
Whenever a child reports that they are suffering or have suffered significant harm through abuse or neglect, or have caused or are causing physical or sexual harm to others, the initial response from all professionals should be limited to listening carefully to what the child says to:
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4.5.10 |
The child must not be pressed for information, led or cross-examined or given false assurances of absolute confidentiality, as this could prejudice police investigations, especially in cases of sexual abuse. |
4.5.11 |
If the child can understand the significance and consequences of making a referral to LA children's social care, they should be asked their view. |
4.5.12 |
However, it should be explained to the child that whilst their view will be taken into account, the professional has a responsibility to take whatever action is required to ensure the child's safety and the safety of other children. |
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4.5.13 |
Where practicable, concerns should be discussed with the parent and agreement sought for a referral to LA children's social care unless seeking agreement is likely to place the child at risk of significant harm through delay or the parent's actions or reactions. |
4.5.14 |
Where a professional decides not to seek parental permission before making a referral to LA children's social care, the decision must be recorded in the child's file with reasons, dated and signed and confirmed in the referral to LA children's social care. |
4.5.15 |
A child protection referral from a professional cannot be treated as anonymous, so the parent will ultimately become aware of the identity of the referrer. Where the parent refuses to give permission for the referral, unless it would cause undue delay, further advice should be sought from a manager or the nominated child protection adviser and the outcome fully recorded. |
4.5.16 |
If, having taken full account of the parents' wishes it is still considered that there is a need for referral:
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4.5.17 |
If the child is suffering from a serious injury, the professional must seek medical attention immediately from accident and emergency services and must inform LA children's social care, and the duty consultant paediatrician at the hospital. |
4.5.18 |
Where abuse is alleged, suspected or confirmed in a child admitted to hospital, the child must not be discharged until:
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4.5.19 |
Except in cases where emergency treatment is needed, LA children's social care and the police should initiate any medical examinations required as part of a child protection enquiry. |
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4.5.20 |
Referrals should be made to LA children's social care for the area where the child is living or is found. |
4.5.21 |
Where specific arrangements are made, or exist, for another borough to undertake an enquiry, the home LA children's social care will advise accordingly and ensure that the referral process outlined in section 6. Referral and assessment, is followed. |
4.5.22 |
If the child is known to have an allocated social worker, the referral should be made to them, or in their absence to the social worker's manager or a duty children's social worker. In all other circumstances referrals should be made to the duty officer. |
4.5.23 |
Where available, the following information should be provided with the referral (but absence of information must not delay referral):
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4.5.24 |
The referrer should confirm verbal and telephone referrals in writing, within 48 hours. |
4.5.25 |
Where a common assessment has been completed prior to referral, these details should also be conveyed at the point of referral. |
4.5.26 |
LA children's social care should acknowledge referrals within one working day of receipt. If this does not occur within three working days, the referrer should contact these services again. |
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4.5.27 |
The referrer should keep a formal record of:
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4.5.28 |
The referrer should keep a copy of the written referral, confirming the verbal and telephone referral. |
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4.6 |
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4.6.1 |
When a member of the public telephones or approaches any agency with concerns, about the welfare of a child or an unborn baby, the professional who receives the contact should always:
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4.6.2 |
The member of the public should also be given the number for their local LA children's social care and encouraged to contact them directly, see inside front cover for local contact details. The agency receiving the initial concern should always make a referral to LA children's social care and to the lead professional if there is one, in case the member of the public does not follow through (a common occurrence). |
4.6.3 |
If there is a risk that the member of the public will disengage without giving sufficient information to enable agencies to investigate concerns about a child, the NSPCC national 24 hour Child Protection Helpline (0808 800 5000) and ChildLine (0800 1111) can be offered as an alternative means of reporting concerns. See section 2. Roles and responsibilities, 2.25.12 NSPCC; |
4.6.4 |
Individuals may prefer not to give their name to LA children's social care or NSPCC. Alternatively they may disclose their identity, but not wish for it to be revealed to the parent/s of the child concerned. |
4.6.5 |
Wherever possible, professionals should respect the referrer's request for anonymity. However professionals should not give referrers any guarantees of confidentiality, as there are certain limited circumstances in which the identity of a referrer may have to be given (e.g. the court arena). |
4.6.6 |
Local publicity material should make the above position clear to potential referrers. |
4.6.7 |
LA children's social care should offer the referrer the opportunity of an interview. |
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4.7 |
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4.7.1 |
All agencies where professionals offer services to adults who may be parents or have close contact with children and / or to families, should have procedures and protocols in place for safeguarding and promoting the welfare of children. These should include arrangements for timely multi-disciplinary assessments with children's specialists in their own services and with other agencies, including LA children's social care and the police. |
4.7.2 |
Adult services and professionals working with adults need to be competent in identifying the client or patient's role as a parent. They need to be able to consider the impact of the adult's condition or behaviour on:
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4.7.3 |
Where a professional working with adults has concerns about the parent's capacity to care for the child and considers that the child is likely to be harmed or is being harmed, they should immediately refer the child to the police or LA children's social care, in accordance with their agency's child protection procedures. |
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