Spotting the early signs of abuse

Written by: Suzanne O'Connell | Published:
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Most schools are clear about those signs of abuse and neglect that should lead to a referral. But what about those subtle first warning signs that something needs further investigation? NICE has released draft guidance to help schools and others know what these are. Suzanne O’Connell takes a look

The guidelines from the National Institute for Health and Care Excellence (NICE) are intended to help practitioners recognise and respond to indicators of abuse and neglect. The full draft is a long document of 581 pages, but a summary version is also available, and at 43 pages, is far more accessible.

The drafts are intended for practitioners working across the services including health and social care. Some of the assessment, early help and response guidance is not directly applicable to schools. However, the information about the indicators you might look out for is useful to share.

The guidance is based on the premise that children and young people can find it difficult to tell someone about what they are experiencing and in some cases may not want other people to know. However, the presence of abuse and neglect can be detected indirectly through the child’s behaviour and appearance.

Practitioners are asked to use their judgement and not to rely solely on protocols, procedures and recording systems. Those people with direct contact with children should be prepared to think critically and analytically.

Working practices

The recommendations that NICE includes here are generally well-known and understood by education practitioners. However, it is worth reinforcing with staff some of the main principles that span services and age groups:

  • Take a child-centred approach to all work with children and involve them in decision-making to the fullest extent possible according to age and stage.
  • Use a range of methods for communicating with children e.g. drawing, books, activities where appropriate.
  • Explain confidentiality and when you might need to share specific information and with whom
  • Always do what you say you are going to do and if circumstances change and this is no longer possible, explain why as soon as you can.

NICE identifies good practice too when it comes to working with parents. This includes actively listening to them, being open and honest and avoiding blame even if parents may be responsible for the neglect. Where possible, practitioners should identify what parents are doing well and build on this. Parents should be kept informed and trust developed between parties while also respecting professional boundaries.

Consider or suspect

The guidance usefully divides concerns that a practitioner might have into two levels – those where you need to consider the possibility that child abuse or neglect is an explanation, and those where you suspect that abuse or neglect is the cause.

Where you “consider” the possibility of abuse or neglect the situation should continue to be monitored. Where you “suspect”, then there is a more serious level of concern.

However, the signs noted may not be proof that abuse or neglect is taking place, but they may justify further enquiries and for practitioners to be “curious” at this stage.

Of course, schools must still react immediately to the high-level signs that something is wrong. Referrals should be made immediately, for example, in the case of a child attending with an injury, being regularly unclean or demonstrating overtly sexual behaviour when under the age of puberty.

Child behaviour indicators

The guidance highlights a number of indicators which might lead practitioners to “consider” or “suspect” that abuse or neglect has taken place or the child is at risk. Practitioners should take seriously any marked change in behaviour or a repeated, extreme or sustained emotional response. Examples might include:

  • Indiscriminate contact or affection-seeking.
  • Being over-friendly to strangers.
  • Excessive clinginess and persistently seeking attention.
  • Habitual body rocking.
  • Being withdrawn and reluctant to communicate.

The way the child interacts with adults can be particularly revealing. For example, you might have concerns about a child who shows excessively “good” behaviour to prevent parent or carer disapproval.

Alternatively the child may not seek affection from an appropriate adult when distressed or even show excessive comforting behaviour when parents are distressed themselves. Practitioners who are able to witness adult and child together, for example during school-entry home visits, are in a particularly good position to pick up on these signs.

Practitioners can find it difficult to establish whether a child is suffering from neglect or not. The use of the categories of “consider” and “suspect” can help them to decide what level of concern the indicators should trigger.

You should consider that there might be current or past neglect if, for example:

  • There are severe and persistent infestations such as scabies or headlice.
  • There is consistently inappropriate footwear or clothing, e.g. for the weather or the child’s size.

You should suspect current or past neglect if:

  • A child repeatedly scavenges, steals, hoards or hides food with no medical explanation.
  • You repeatedly hear reports of a poor standard of hygiene in the home that affects a child’s health, inadequate provision of food, or a living environment that is unsafe for the child’s developmental stage.
  • A child is persistently smelly and dirty – where dirt is ingrained.

It is important to distinguish between neglect and material poverty. Practitioners must keep in mind the constraints there can be on parents who may struggle to meet the child’s needs in relation to food, clothing and shelter.

Other indicators

The child’s physical and educational development might also raise concerns. NICE suggests that we should consider neglect where a child displays faltering growth. School leaders would most likely wish to discuss any concerns with the school nurse.

An area in which they should feel more assured in their concerns is that of language development.

The guidance recommends that schools consider physical or emotional abuse or neglect if a child under-12 shows poorer than expected language abilities for their overall development that is not explained by other factors such as speaking English as another language.

The way children interact with each other and their parents can provide indications that the child is at risk. Practitioners are advised to consider neglect or physical abuse if a child’s behaviour towards their parent indicates:

  • Dislike or lack of cooperation.
  • Lack of interest or low responsiveness.
  • High levels of anger or annoyance.
  • That they are passive or withdrawn.

These can be warning signs, particularly if this behaviour is absent from interactions the child has with other people.

Where schools do have opportunity to observe a parent’s interactions with their child there can be a number of indicators of emotional abuse. For example, where a parent is overly negative or hostile, or if they are emotionally unavailable and unresponsive.

Failure to anticipate dangers for a child and omitting to take precautions to protect them can lead to suspected neglect. Failure to provide access to medical care or treatment can constitute a concern.

The whole picture

This is a useful document for schools who might prefer to access the summary version. It is good to have a significant document like this aimed at all children’s services. There might be different emphases for different departments, but essentially everyone can contribute a perspective by alerting each other to these signs.

This is where it is so beneficial if schools have developed good, working relationships with other practitioners, such as the school nurse, educational psychologist and health visitors.

Schools can be afraid of acting too hastily and making unjustified referrals. However, we are told that under-recognition is more of a problem than over-reporting.

Erring on the side of curiosity, is what we’re advised to do.

  • Suzanne O’Connell is a freelance education writer and a former headteacher.

Further information

Child Abuse and Neglect, NICE draft guidelines, April 2017 (short version) (full document)


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