Emotional & Physical Abuse

Child: What is Emotional Abuse?

-can be abuse persistent emotional maltreatment of a child.

Emotional Abuse: Definition and Types of Abuse Emotional abuse can be defined as the persistent emotional maltreatment of a child. It causes severe and persistent adverse effects on the child’s emotional development.

Types of Abuse :

  1. Rejecting the Child -an adult, parent or carer refuses to acknowledge the child’s worth and needs. Example: A parent regularly shuns a child from the family.
  2. Having inappropriate expectations of the child. A parent or carer may have inappropriate expectations for the child’s age and development. Example: A ten-year-old child being regularly expected to care for younger siblings.
  3. Corrupting the child. When An adult might make or encourage a child to engage in anti-social behaviour, such as stealing or vandalism. Example: A parent gives drugs to a child.
  4. Ill treatment of others witnessed by child The child may witness abuse between adults or of other children. Example: Regularly witnessing violent abuse against their siblings.
  5. Isolating the child. When An adult cuts the child off from normal social experiences and contacts and makes the child believe he/she is alone in the world. Example: A carer does not permit a child to interact with other children.
  6. Ignoring the child An adult deprives the child of essential stimulation and responsiveness, stifling emotional growth and intellectual development. Example: A parent giving a child the ‘silent treatment’.
  7. Terrorising the child.  An adult verbally abuses the child, creating a climate of fear. The child is bullied (this includes cyberbullying) and frightened by the adult or other person and is made to believe the world is hostile and dangerous. The child is never sure what the adult’s response will be to anything they do or say. Example: A carer behaves in a very unreasonable and unpredictable way towards a child.

Emotional abuse effect of abuse: Children and young people who experience emotional abuse can experience a variety of emotions and develop a range of behaviours.

Graph shows that:

  • lack of encouragement shown towards infacts can result in the impairment of social and other skills.
  • Infants may be withdrawn and developmentally delayed and indulge in acts of self-stimulation (banging of the head or rocking movements, for example) and there may be a noted lack of responsiveness to others.
  • Conversely, there may be an excessive responsiveness to others, as emotionally abused children will offen seek out attention from other parties.

Emotional abuse can result to Pre-school children as follows:

  • Can result in children in this age group being developmentally delayed. For example, there may be a significant delay in learning to talk, and in severe cases, the child may never learn to talk at all. Behavioural problems are also common and may result in reduced attention span and hyperactivity.
  • Children may be aggressive, especially towards their peers and may, at other times, be significantly withdrawn.
  • Children may be indiscriminate in their relationships with adults and will often seek physical contact with strangers, even in the presence of their main carer.
  • Difficulty in learning maybe a sign of emotional abuse, characterised by poor concentration and over-activity.
  • Children may be disruptive in school and may also exhibit behavioural abnormalities, such as aggression or inappropriate or unusual patterns of defecation or urination.

How can you help an emotionally abused Child?

Giving sensitive and appropriate emotional support to an emotionally abused child can lead to a rapid and dramatic improvement in grouth, development attainment, behaviour, and social and emotion adjustment.

Many Children and you people can be very resilient.  They have the capacity to deal with stressful situations and bounce back after a traumatic experience.

This resilience, when recognised and supported by a professional , can lead to positive outcomes for the child.  The concept of the professional using the necessary skills and knowledge to enable the child to achieve change is called “scaffolding”.

  • These children often have low self-esteem, which its mildest form presents as very poor social interaction and, more seriously, may result in other behaviour patterns, such as repetitive rocking, self –mutilation or excessive masturbation.
  • However, it’s important to note that children of any age group are complex beings and can present in differing ways and do not always fit the general definition.

What is Physical Abuse

Physical -is defined as deliberately/intentional causing or hurting a child and causing physical harm (Department of Health, 2017; Department for Education, 2018; Scottish Government, 2014; Wales Safeguarding Procedures Project Board, 2019). It includes injuries such as:

  • bruises
  • broken bones
  • burns

It may involve:

  • Hitting, burning, kicking, shaking, poisoning, throwing,drowing,  scalding, and any other method of causing non accidental harm to a child, including Suffocating and fabricated and induced illness

Physical abuse may also happen when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child. This is known as Fabricated or Induced Illness (FII) (Wales Safeguarding Procedures Project Board, 2019; HM Government, 2008; Department of Health Social Services and Public Safety, 2017; Scottish Government, 2014).

Breast ironing or breast flattening, a practice of using hard or heated objects to suppress or reverse the growth of breasts, is a recognised form of child abuse (Crown Prosecution Service, 2019).

Signs of Physical Abuse and Symptoms of Physical Abuse

Signs of Non-Accidental Injuries

  • There may have been a delay by the parents or carers in seeking medical help, or this may not have been sought at all.
  • The account of the accident may be vague or may vary from one person to another. Someone reliving a genuine accident will usually tell a detailed and vivid story that remains consistent.
  • There may be no explanation for the injury
  • The child may not be allowed to tell you the story
  • The injury does not fit the explanation given
  • Repeat Injuries , as they can also indicate abuse, includes:
    • Singular or repeat marks, bruises or injuries
    • A series of different marks or bruises
    • The greater the number of incidences, the less likely that they are accidental

Being able to interpret bruising patters correctly will also help you to understand if an injury could be accidental or caused by physical abuse. 

  • Fingertip Bruising: Bruising on the upper arm or chest wall may suggest that the child or adults has been held tightly and then shaken. In this situation delicate blood vessels in the eyes might be also have been damaged, causing visible reddening within the eyeball.  They may also be injuries to the brain surface, although this would not be apparent unless the child underwent a medical scan.
  • Bruising to the ear, –unusual and inherently suspicious, usually caused when the ear is either @pinched or boxed’ how ever, we must never assume that pinching or boxing was the cause until we have followed up medically, as this could be accidental.
  • The frenulum is a small fold of membrane which goes from the floor of the mouth to the middle of the underside of the tongue. Damage to the frenulum can be caused by a blow to the mouth, or a feeding bottle being forced into a baby’s mouth. 
  • Burns and scalds and hot to interpret them to gain a better understanding of what might be going on. Neglected children are more prone to accidental burns and scalds . Abused children or adults may be deliberately burned or scalded. Burns and scals are not uncommon, but repeat incidents could point towards a child having been neglected or abused, if you suspect neglect or abuse, you must initiate further checks and investigation.  When these could be an indication of abuse?    
    • Contact Burns-from hot, dry surface are often uniform in density and may follow the shape of the branding’ object. Like example you may see the outline of a hotplate, bars of an electric fire or an iron on a person’s skin. Occasionally, children are burned when a hot iron is used to push them away or when another person has been ironing and iron falls on the child.
    • Cigarette burns- are relatively common typically; deliberately inflicted cigarette burns form a lesion around a central crater. Be aware skin infections and other conditions can create almost identical damage, so seek immediately medical attention to ensure the correct action is taken.
    • Scalds : include:
      • Blistering-this often occurs; then skin may be pale, soggy and peel off in sheets
      • Scald injuries tend to be of variable depth and reflect either drip, pour or splash characteristics.
      • A person whose hands or feet have been dipped into scalding water will show a gloves or stocking pattern.
    • Fractures: children quite frequently sustain fractures which are accidental and where the cause is clear. However, research suggest that as many as half of all fractures on children under the age of two are not accidental (International Society for the Prevention of Child Abuse and neglect (ISPCAN) Child Physical Abuse, 2011).
      • How to Identify Fractures?
        • A possible fracture of the skull can be indicated by a boggy swelling above the fracture that appears over a period of hours following the injury
        • A person with a limb fracture will usually be in pain, especially if the limb is moved, or will usually not use the limb that is fractured.
      • Diagnosing a person’s injury as an accident or as abuse requires the specialist skills of a medical profession, never attempt to make this diagnosis on your own.
    • Fabricated and Induced Illnesses (FII)
    • previously known as Munchausen’s Syndrome by Proxy)is where another person fabricates or induces they symptoms of illness in a child for their own emotional gain.
      • It is a form of physical abuse and emotional abuse so it’s important you are aware of it.  However, it can be very difficult to diagnose.  You might first be alerted to the possibility of FII when you notice frequent incidents in your records of injuries and illnesses relating to one child. 
      • You might first also find that the child has been investigated for numerous physical, psychological or educational problems over a period of time. Evidence of any of the following signs:
        • Blood in the urine, but only found when the carer is present
        • Vomitting blood, but only when the carer is present
        • Fits that are only ever witnessed by the care
        • The Carer reports episodes when the child stops breathing
        • Behavioural signs such as a child being hyperactive at home
        • As on problem is diagnosed, or when an investigation comes to an end, another problem may develop.
        • Seek immediate advise form medical professionals, if you encounter any of the symptoms, behavior’s or injuries, if it is not safe, do not leave the adult or child with the person who may have caused physical abuse and seek immediately help like Police or ambulance, and protect yourself whilst seeking help.
        • Do not jump to conclusions before the matter is fully investigate.
        • There are many possibilities of evidence and this list is not exhaustive.

Summarise what to consider when deciding whether a physical injury is accidental or not.

  • Take picture into account including the injuries and story given.
  • Do not attempt to make this decision independently; always seek further medical advice and guidance.

Impact of physical abuse

Effects on infants

Shaking or hitting babies and very young children can cause:

  • fractures
  • broken bones
  • Internal injuries.

Non-accidental head injuries (NAHI) can cause brain injury which can lead to:

  • learning problems
  • behaviour problems
  • seizures
  • hearing and speech impairment
  • visual impairment or blindness
  • changes in personality
  • severe brain damage
  • long-term disability
  •  

Effects on older children

“My parents fight with each other, and they end up taking it out on me. Every day they argue and shout at me, when they get really angry they hit me and kick me too. They tell me that everything’s my fault and they don’t want me to be their child. I feel responsible for everything that’s going wrong with my family. I’m so scared to be at home, I’m terrified that my parents will hit me again. Usually I leave the house and walk around until my parents find me. The only way I can calm down is to self-harm, I feel so upset and on edge all of the time, I just don’t know what to do.”

(Childline counselling session with girl aged 16)

Children who have been physically abused may experience effects including:

  • behavioural or conduct problems
  • mental health problems such as depressive disorders, anxiety disorders, and eating disorders
  • drug and alcohol problems
  • Suicidal thoughts and feelings (Norman et al, 2012).

The psychological impact can last long after their injuries have healed.

Brain development

Physical abuse, as an adverse childhood experience, can have a negative effect on the development of children’s brains, potentially impacting their mental and physical capacities in later life.

The effect of physical abuse on a child’s developing brain can lead to an overactive stress response, impaired cognitive development and weakened executive function skills.

(Shonkoff et al, 2008; Shonkoff et al, 2014).

// Find out more about how trauma and abuse effects children’s brain development

***