Safeguarding children/

maltreatment and the

developing child, emotional
abuse and neglect, looked after
children
By Dr Emmanuel
Lecturer: Dr Akimana, Psychiatrist
 Safeguarding and Child
Protection
• Worldwide, many children are exposed to abusive or neglectful
experiences that violate their rights
• Some of these children die as a result of maltreatment, while
many more develop psychiatric and medical disorders, higher risk
in criminal activities
• prevention, identification, and treatment of child maltreatment
cases should be conceptualized not only as a moral responsibility
but also as an urgent economic target.
• Safeguarding is more than child protection
 Safeguarding and Child
Protection
•Safeguarding begins with promotion and preventative
activity which enables children and young people to grow up
safely and securely.
•It includes support to families and early intervention to meet
the needs of children and continues through to child protection.
• Child protection work involves the close collaboration of
professionals with backgrounds in medicine, psychology,
education, social work, law enforcement, and policy.
 Safeguarding and Child
Protection
• Child protection also represents a significant challenge for
governments worldwide.
• Maltreatment of children continues to occur in all
societies and possibly more frequently in low- and middle-
income countries
• Implementation of the UN Convention on the Rights of the
Child
remains incomplete in several countries
 Maltreatment types

• Physical abuse, Sexual abuse

• Emotional or psychological abuse
• Neglect
• Child sexual exploitation (CSE)
• Female genital mutilation (FGM)
• Fabricated or induced illness
• Radicalisation
• Institutional or organisational abuse
• Modern slavery
• Forced marriage
Factors associated with occurrence
of maltreatment
• several risk factors show a statistical association with maltreatment,
• it is often unclear whether such factors have a causal role in its
occurrence
• Several factors associated with maltreatment tend to co-occur, and
it may be difficult to isolate causal elements within a complex
mixture of correlated
factors
• risk of maltreatment is likely to be more accurately predicted by
examining a comprehensive set of risk and protective factors.
Factors associated with occurrence
of maltreatment
• Child’s individual risk factors for victimization: age, gender,…
- Young: physical vulnerability, developmental immaturity-
maltraitance
- teenagers are at greater risk for sexual abuse
• Parents’ or carers’ individual risk factors for perpetration:
- young age of parent, low education, inaccurate knowledge of child
development, unrealistic expectations of their children,
- Impaired capacity for empathy, impaired emotion regulation,
parents’ own history of maltreatment
Factors associated with occurrence
of maltreatment
• Family risk factors: large family size, single parenthood, non
biological
transient carers in the home and intimate-partner violence, social
isolation, socio economic disadvantage, or lower levels of education
• Community risk factors: more impoverished neighborhoods,
poverty and unemployment- risk of neglect and physical abuse
• unstable housing, childcare burden, greater strain on families, and
attitudes toward violence.
Biological/psychological/medical consequences of
maltreatment
 Physical Abuse
Physical Abuse is deliberately hurting a child.
It might take a variety of different forms, including hitting,
biting, pinching, shaking, throwing, poisoning, burning or
scalding, drowning or suffocating a child.
 HPYSICAL
ABUSE
Behavioural
Physical
Indicators Indicators

 Self mutilation
 Scratches tendencies
 Bite marks or  Chronic runaway
welts  Aggressive or
withdrawn
 Bruises in places
 Fear of returning
difficult to mark home
(behind ears,
 Undue fear of adults
groin)
 Fearful
 Burns watchfulness
 Untreated injuries
 Emotional abuse
• Emotional abuse is the persistent emotional maltreatment of a child.
• It is also sometimes called psychological abuse and it can have
severe and persistent adverse effects on a child’s emotional
development.
• Emotional abuse may involve deliberately telling a child that they are
worthless, or unloved and inadequate
• It may include not giving a child opportunities to express their views,
deliberately silencing them, or ‘making fun’ of what they say or how
they communicate.
 Emotional abuse
Physical Indicators Behavioural Indicators

 Sudden speech disorders  Rocking, thumb sucking

 Wetting and soiling  Fear of change
 Signs of mutilation  Chronic runaway
  Poor peer relationships
Frequent vomiting
 Attention seeking behaviour
 Sexual abuse
• Sexual Abuse occurs when others use and exploit children sexually
for their own gratification or gain or the gratification of others.
• Recent def: “Sexual abuse involves forcing or enticing a child or
young person to take part in sexual activities, not necessarily
involving a high level of violence, 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.
 Sexual abuse
It may include non-contact activities, such as involving
children in the production of sexual images, forcing children
to look at sexual images or watch sexual activities,
encouraging children to behave in sexually inappropriate
ways or grooming a child in preparation for abuse
(including via e-technology).

Sexual abuse is not solely perpetrated by adult males.

Women can commit acts of sexual abuse, as can other
children.
 Sexual abuse
Physical Indicators
 Soreness, bleeding in genital or anal areas
 Itching in genital areas
 Stained or bloody underwear
 Stomach pains or headaches
 Pain on urination
 Difficulty in walking or sitting
 Bruises on inner thighs or buttocks
 Anorexic / bulimic
 Sexual abuse
Behavioural Indicators
 Chronic depression
 Inappropriate language, sexual knowledge for age group
 Making sexual advances to adults or other children
 Low self esteem
 Afraid of the dark
 Wariness of being approached by anyone
 Evidence of substance misuse
 Acquisition of money, mobile phones etc without plausible explanation
 Association with older people, particularly men, outside the usual range of
contacts
 Phone calls/messages from adults outside the normal range of contacts
 Neglect
Neglect is the failure to provide for a child’s basic needs,
whether it be adequate food, clothing, hygiene, supervision
or shelter that is likely to result in the serious impairment of
a child’s health or development.
Children who are neglected often also suffer from other
types of abuse.
Often neglect is linked with a complex range of deep-seated
family difficulties.
 Neglect
Physical Indicators Behavioural Indicators
 Constant hunger
 Exposed to danger; lack of  Listlessness
supervision
 Lack of peer relationships
 Inadequate / inappropriate
clothing  Low self-esteem
 Poor hygiene  Compulsive stealing /
 Untreated illnesses begging
 Persistent tiredness
 Child Exploitation
• Exploitation is the intentional ill-treatment, manipulation or abuse
of power and control over a child or young person; to take selfish or
unfair advantage of a child or young person or situation, for
personal gain.
• Forms: child labour, slavery, servitude, engaging in criminal activity,
begging, benefit or other financial fraud or child trafficking.
• It extends to the recruitment, transportation, transfer, harbouring
or receipt of children for the purpose of exploitation.
• Exploitation can be sexual in nature.
 Sexual exploitation of children
and young people
• Child sexual exploitation is a form of sexual abuse where
children are sexually exploited for money, power or status.

• It can involve violent, humiliating and degrading sexual

assaults.
• In some cases, young people are persuaded or forced into
exchanging sexual activity for money, drugs, gifts,
affection or status.
 Looked after children
• The term looked after children can have different
definitions in the law according to the countries
• In general , a child is looked after by a local authority if he
or she is in their care or is provided with accommodation
for more than 24 hours by the authority
• Some include children in friends and family placements ,
adopted children as result of safeguarding concerns
 Looked after children
Look out for the child who:
• Has unexplained bruising or injury
• Is afraid to go home
• Is hungry , tired or unclean,
• Is left unattended
• Has too much responsibility for themselves or others
• Knows too much about sex drugs or alcohol for their age
 Looked after children

Listen to the child who tells you;

• they are abused or neglected
• feels worthless or inadequate
• they are misusing drugs or alcohol
• about violence at home
• about concerns about other children
 Neglect and separation
 Separating children from their parents is one of the most
serious interventions made by children’s social care
services.

 Decisions associated with separation and return are very

difficult ones for professionals to take.

 Separation can have long term effects on children, but in the

right care circumstances can provide the best chances and
long term outcomes for children.
 Decision making
 Often there is no clearly identifiable ‘incident’ or ‘episode’
in neglect cases upon which to focus.

 The constellation of difficulties may confuse and

overwhelm practitioners attempting to identify, assess
and develop intervention strategies.

 Interaction of these multiple adversities may increase risk

of poor outcomes for children and young people.
 Reunification
 Key principle of Children Act 1989 - supporting children within their
family, and following separation, returning them to their families as
soon as it is safe to do so.

 This philosophy has resulted in fewer children becoming looked after.

 However, increased looked after children population is a result of
children staying longer in the system.

 Studies found that if children do go home, it is usually quite quickly –

usually within 2 years.
 Reunification
 Decision to reunify is usually influenced, to some extent, by the
child’s wishes and feelings

 Neglected children typically remain looked after longer than those

who are physically or sexually abused, and are less likely to be
reunified.

 Studies have found that reunification should not be viewed

automatically as a safe policy – risks of recurrence of maltreatment
and outcomes for the child should be carefully considered.
 Strongest predictors
of return home
 Whether risks to the safety of the child were assessed as being
acceptable.

 Whether the problems that had led to the child’s admission were
seen as having improved during the child’s period of being looked
after.

 Family focused social work interventions have been provided.

• Reunification often results in further neglect through poor
parenting and worsening of children’s mental health
 Positive reunification practice
 Detailed assessments.
 Purposeful and inclusive planning.
 Clear goals and targets in relation to changes needed.
 Agreed timescales for change.
 Support to achieve change.
• Planning is purposeful and inclusive.
 References
• Anita T., Daniel S. Pine, James F. Leckman et al (2015).
Rutter’s child and adolescent psychiatry, Sixth edition