Monday 7 October 2013

Spotting the Warning Signs of Abuse/Neglect in Children

Victoria Climbie. Daniel Pelka. Baby Peter. Hamzah Khan. Keanu Williams.

These are all names that we know so well and have heard talked about so often in the news. These are all names of children who have been failed by their parents or carers in the most unimaginable way. I'm sure those of us who are parents hug our children a little tighter when we hear the details reported of how these poor children suffered at the hands of those who were supposed to protect them.

This weekend yet another case has emerged of another mother causing "wilful neglect" to three of her children including a four month old baby girl who died. Every time we hear these stories, we are met with assurances that serious lessons has been learnt and that the authority want to make sure this awful thing never happens again. Yet it keeps on happening.....

Time after time we hear about how the warning signs were missed, or people spotted something but didn't report it, or they had doubts about the validity of their concerns. We hear how one agency didn't talk to another agency. We hear how the parents/carers managed to talk the person around and sew seeds of doubt in their mind that abuse or neglect was actually happening.

Sometimes, like in the Hamzah and Climbe cases, these children disappear under the radar and perhaps failed by technology, the child's name disappears from the view of a GP's system or School register rather than a real person asking questions about why the child is no longer detected. Other times, the abuse is happening in full view of others, like in the Pelka case where the teachers were told by the parents that the child had an eating disorder, and they ignored the signs of the child stealing from a lunch box or eating scraps out of the bin.

It is easy do wonder how these warning signs could have been ignored when we have the full picture, but often, one person - except for the person abusing or neglecting the child may not have the whole picture.

So what is abuse? How do we know a child is being abused?

Well of course there are the physical signs - a child with bruising from being punched or kicked, perhaps burns, a child who is scared in the company of adults, or who divulges something. a child who perhaps plays up for attention, or who is very withdrawn to the world - and a multitude of others.

However, often those neglecting or abusing a child may do their very best to keep their secret hidden, and so the signs may not be as noticeable if you only had one piece of the puzzle.

There are also the contributing factors - it is hard to overlook that most children suffering from abuse or neglect come from groups of people living on the edge of society - those for whom English is not their first language, those who claim benefits or are on low incomes, people with a history of substance or alcohol abuse, those with mental health issues, a history of violence or depression. Those who have grown-up in environments with one or more these contributing factors are more likely to abuse or neglect their child as they may be unaware of what it is to bring up a child in a stable environment, This is a huge sweeping generalisation and of course abuse and neglect happens in many different places, but the evidence suggests that more often than not, these pre-disposed factors exist.

So those working in jobs who come into contact with children or vulnerable adults will have their own safeguarding procedures in place and should be more adept at spotting signs of abuse, but what about the general public?

Are we in a position to spot and report signs of abuse? There are systems in place such as calling the NSPCC or reporting via Social Services, but would small every day occurrences we witness trigger this process?

Are there warning signs which we are missing, or which seem so insignificant that on their own, they would not be a factor for abuse or neglect?

I'm sure we all have opinions about the way that other parents we know parent their children, and we may have witnessed children being parented or treated in a way that we don't agree with, but where do we draw the line? If we see parents or carers making choices that we think would be tantamount to some kind of abuse or neglect, is it our place to mention our concerns? Should we be making judgments about other people which could have life changing consequences?

Are there small signs that we have witnessed that we brushed off as bad behaviour - like stealing food from another child's lunch box? I have seen children do this - and brushed it off as bad behaviour. Recently I was involved in an event which involved serving food to children. One child came back for three helpings and was desperately still begging for more food saying that they were starving. Was this a sign that they are not fed at home - or simply a child not knowing their limits?

What about bruises? If we notice a bruise on a child, is this a sign of neglect or abuse - or are they just a little over zealous in the playground? My youngest is always covered in bruises as she is a real rough and tumble little girl. I can well believe that someone may imagine she were being abused if they didn't know her and the way that she likes to throw herself around.

A child not speaking properly, a child who never has their coat or jumper on, or who walks around in shoes full of holes. Perhaps a child who never does their reading homework or school homework, or a child who treats other children badly. Are any of these signs of neglect? Does a child who can't speak properly have a speech impediment - or did their parents never teach them? Does the child with no coat/jumper and holey shoes continually lose and ruin their own clothes to the point the parent refuses to replace them? Can the parents not afford to replace items, or do they just not bother about whether their children are warm? Do the parents work full time with no time to help with school homework and reading - or are they just not that interested? Perhaps they can't actually read or write themselves so can't help even if they wanted to. Is the school bully crying out for attention, or are they simply copying behaviour that an adult has inflicted upon them?

What about a child with low self-esteem, who never speaks to adults? Often children who are being abused or neglected are frightened into silence - is this a sign, or is the child just very shy?

There seem to be so many situations where the truth could swing one way or another. For us as adults, it's easy to write what we witness off as the lesser excuse - especially if we always want to see the best in people. Are any of the signs mentioned above warning signs - or just the behaviour of typical children?

Parents or Carers who neglect or abuse their children typically either do it will fully or unwillfully

Whilst it is easy to consider the abuser or neglecter as evil, what if the person caring for the child doesn't actually realise that their behaviour is tantamount to abuse or neglect? Are they technically neglecting or abusing them if they don't know any different? Those who have been abused themselves may just project the behaviour onto their children that they were subjected to as a child as pass it off as "normal". It may be that the abuser/neglecter is so consumed with their own problems - whether it be domestic issues, mental health problems, financial issues or depression that they are not in a fit state to take care of their children. What about these situations for us as adults? Would we be urged to report these instances of abuse or neglect, or hope that if we kept quiet, things might improve for the adult and the child as the adult wasn't willingly trying to hurt the child.

Sometimes there are those in life who may simply not have the life skills to be good parents. Recently I witnessed some treatment of a child which I didn't agree with. The child who was much older than baby age was eating spoon fed baby food and drinking bottled milk, and coke . The child didn't eat solid foods, or drink from a cup, and was not toilet trained. They also couldn't talk. They were essentially being kept and treated as a baby - much like Hamzah Khan was. They were not played with or spoken to - they were more being helicopter parented to try and get them to stay in one place - without once directly addressing the child or paying them attention. I don't believe that those looking after the child were deliberately mistreating them. In their view, they thought that this was how a child of this child's age should be looked after. Is it my place to report my concerns about this behaviour just because I don't agree with how the child was being looked after? Was this behaviour abuse or neglect of the child's welfare?

What if we expressed our concerns and a child was taken away from their parents or carer? The psychological impact of this stress can have an impact and repercussions on children and their carers for life. Do we want to cause this amount of stress and damage on a whim? But what if we didn't report concerns and six months later the child was dead?

In my day job teaching antenatal courses, I teach a little bit about caring for a baby and how to care for a baby in the first year. I sometimes witness behaviour at reunions which I have concerns about, and whilst it is definitely not my place to judge or tell parents how they should and shouldn't be caring for their baby, what if these are the first seeds of neglect being sewn?

What if the passing glimpses of things that we witness are all pieces of the puzzle which could be forming a bigger picture? What if those small things that we brush off, are in fact the warning signs which are being ignored? Professionally, unless it was a real safeguarding issue, I would not be obliged to report behaviour I witnessed, but what about about my concerns? Should there be a confidential system in place to raise concerns?

I wonder if there is a system in place - a central place for professionals and non-professionals to raise concerns or musings of behaviour which are documented, but not acted upon as an isolated incident. If everyone was able to raise their concerns, without fear that they would cause unnecessary harm to the family involved, then perhaps all of these small concerns being fed in would reveal a larger picture that should be acted upon. Perhaps there already is a system in place. Is there one place where information is held centrally - or are all of the individual departments and care providers making their own reports, and never really sharing what they witness? When we as members of the public report concerns, are they added do the concerns of others, or kept as isolated reports?

It should be the responsibility of all of us to keep on top of the signs of child abuse - but how do we know what is child abuse and what is just different styles of parenting?

What do you feel the solution is? Have you witnessed behaviour which could have been an early warning sign of abuse or negelct? Would you feel confident to report it?

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