Child abuse – types of abuse

Child abuse and neglect is a phrase that covers all ill treatment of a child, from serious physical and sexual assault to cases where the standard of care is inadequate and does not support the child’s health or development.

The Government has defined four categories of abuse.

• Physical abuse; for example hitting, shaking, throwing, poisoning, burning or scalding, drowning and suffocating. It also includes situations in which a carer causes or feigns the symptoms of ill health in a child.
• Emotional abuse; which is the persistent emotional ill treatment of a child that causes severe and persistent adverse effects on the child’s emotional development. This may include making the child feel they are unloved or inadequate, imposing developmentally inappropriate expectations on the child, causing the child to feel continually frightened or in danger, or the exploitation or corruption of children.
• Sexual abuse; which involves forcing or enticing a child or young person to take part in sexual activities. This may involve physical contact and penetrative and non-penetrative acts. It may also include non-contact activities such as encouraging the child to look at pornographic material or encouraging the child to act in a sexually inappropriate way.
• Neglect; in which the carer persistently fails to meet a child’s basic physical or psychological needs. This may include failing to provide adequate food, shelter and clothing, failing to protect the child from physical harm or danger, or failing to ensure access to appropriate medical care. It may also include failure to meet a child’s basic emotional needs.
  

Website with information on child abuse

The Department of Health’s Child Protection Guidance for senior nurses, health visitors, midwives and their managers: What to do if you're worried a child is being abused, 2003, has been developed to assist practitioners to safeguard and promote the welfare of children.
www.dh.gov.uk/PublicationsAndStatistics

Children of drug-abusing parents

A large number of drug and alcohol misusers are responsible for the care of children. Drug and alcohol does not necessarily lead to problems in childcare or in the neglect or abuse of a child. However, it may affect the welfare of a child under the care of a drug misuser and it is important to consider this possibility. According to the Children Act 2004, it is the duty of the local authority to safeguard and protect the welfare of children in their area who are in need and, so far as is consistent with that duty, to promote the upbringing of such children by their families, by providing a range of services appropriate to those children’s needs.

In some cases it may be necessary to take action where it is suspected the child of a drug misuser is likely to suffer significant harm. In these cases, the local authority will set up a child protection case conference in which the facts will be determined and a decision made on any further action.

Assessment of the child in these cases is important to establish the child’s physical safety, psychological trauma due to the parent’s behaviour, the impact on the child’s health and development. The latter will be determined through liaison with GPs, health visitors or school nurses. Assessment will also cover any problems with schooling (for example with attendance) and, where the child is old enough, the child’s perception and concerns about their parent’s substance misuse.

Where the case involves an unborn child, care of the pregnant woman is vital. She should be encouraged to engage in antenatal care and appropriate treatment for the substance misuse. Prescribing of substitutes for opiate drugs can be effective, with a reduced risk of harm to the unborn baby than uncontrolled drug misuse. In such cases, care should be conducted with obstetric supervision. It is not always necessary to hold a child protection case conference for pregnant women, but it can be necessary where there are particular concerns over concurrent health or social problems, poor compliance with antenatal care or where there is a lack of use of drug services by the woman.

Websites with information on children of drug-abusing parents

The document Good practice guidance for working with children and families affected by substance misuse is available on the Scottish Executive website.
www.scotland.gov.uk

The National Treatment Agency for Substance Misuse (NTA) has published Models of care for the treatment of drug misusers in which there is information on dealing with families in which a parent is a drug or alcohol misuser.

Bereavement care

In the UK, a child is bereaved of a parent every 30 minutes. The literature on evaluating adult bereavement interventions is becoming increasingly comprehensive. Until recently, it was thought that children did not grieve. However, research now shows that children also grieve following the death of a significant person in their lives. In fact they experience much the same as bereaved adults. A child’s level of understanding about death varies as they develop. Therefore it may be difficult to determine and understand what they are feeling, especially in children under five years.

Advice on caring for a bereaved child on the Treetops website states that:

• it should be acknowledged that the child is grieving and may be suffering intensely
• the child should be reassured that it is normal to be experiencing strong feelings, and that the feelings may last a long time
• the child should be reassured that they are in no way responsible for the death
• the child should be given plenty of affection to show how much they are loved.

Just as adults do, children may react to the death of a person in different ways. Therefore each bereaved child should be cared for on an individual basis.

Websites with information on bereavement care

The National Children’s Bureau (NCB) promotes the voices, interests and well-being of all children and young people across every aspect of their lives. It has a section on bereavement care aimed at healthcare professionals and carers of bereaved children.
www.ncb.org.uk

Winston’s Wish provides support for bereaved children and young people up to the age of 18 and their parents or carers. Its services include a national helpline for anyone caring for a bereaved child, group and individual work with bereaved children and their families, and support programmes for schools. It also provides training and consultancy for professionals.
www.winstonswish.org.uk

The BBC Lifestyle web pages contain information on caring for bereaved children.
www.bbc.co.uk/health

Cruse Bereavement Care is the leading charity in the UK specialising in bereavement. It currently has 178 branches and over 6,300 volunteers throughout the UK. Over 100,000 people contact Cruse each year for help and information. Its website contains a section on helping bereaved children.
www.crusebereavementcare.org.uk

RD4U is a website designed for young people by young people. It is part of Cruse Bereavement Care's Youth Involvement Project and is available to support people after the death of someone close.
www.rd4u.org.uk

Treetops is a support programme for small groups of children who have experienced a sudden death in the family, where children and parents can meet others who have had a similar experience. It provides opportunities to share stories, express feelings and worries and explore fears and hopes for the future. It has information on its website about caring for bereaved children.
www.bereavedchild.org

ChildLine is the UK's free, 24-hour helpline for children in distress or danger. Trained volunteer counsellors comfort, advise and protect children and young people who may feel they have nowhere else to turn. It operates from 11 counselling centres around the UK. Its website has information on child protection, care of children and counselling. The website has a report on child bereavement.
www.childline.org.uk

Children in prison (mother and baby units)

Mother and baby units are available in four prisons in the UK for women with a child aged under either nine months or 18 months, depending on the prison. Each case for admission is assessed on an individual basis by a multidisciplinary team, and the decision is made in the best interest of the child.

There are conflicting views about whether babies and children should be in prison. Some argue that prisons should be able to accommodate older children because of the important role a mother plays in a child’s emotional development. Other parties argue that prisons are unsuitable places for children and that a child will form a bond with another adult to whom he or she becomes attached. To date, the prison service has taken the view that whilst prison is an unsuitable place for a child, a baby will benefit from being with its mother. However, older children need space to move around as well as interaction with other children and therefore they are best cared for out of prison.

A recent study on the psychiatric needs of women in prison-based mother and baby units concluded that they tend to have more stable backgrounds than the rest of the female prison population. However it also found that as many as 30% of mothers in mother and baby units in prison suffer from undiagnosed depression. Without treatment this impacts on the mother’s ability to function effectively and may have resulting adverse effects on the child’s development.

All the mother and baby units in women’s prisons have written child protection procedures in place.

Websites with information on children in prison

Her Majesty’s Prison Service has a website that contains a section on female prisoners.
www.hmprisonservice.gov.uk

The Home Office website has a report from its Research and Planning Unit on the effects that being in prison mother and baby units has on children.
www.homeoffice.gov.uk

The Royal College of Midwives has a positioning paper on caring for pregnant women in prison.
www.rcm.org.uk

The on-line NHS Magazine has published an article on pregnant women in prisons and the care they should receive.
www.nhs.uk/nhsmagazine

Self harm

The term ‘self harm’, also called ‘self injury’, is used to describe a person’s deliberate actions to hurt themselves, for instance:

Children can be affected either because they are harming themselves or because someone they are close to, such as a parent, sibling or carer, is doing so.

A child should be able to talk to a health professional such as his or her GP or school nurse if they are affected by self harm. They have the same rights to confidentiality as an adult, however information should be disclosed to an appropriate agency if it is felt that:

• the child may be suicidal
• the child may harm themselves more than they mean to
• the child may cause permanent physical damage to their body
• the child is being mentally, ph