Signs of abuse or neglect

Neglect is not meeting a child’s basic physical and psychological needs.

It is a form of child abuse that can have serious and long-lasting impacts on a child’s life - it can cause serious harm and even death.

The four main types of neglect are:

• physical neglect: not meeting a child’s basic needs, such as food, clothing or shelter; not supervising a child adequately or providing for their safety
• educational neglect: not making sure a child receives an education
• emotional neglect: not meeting a child’s needs for nurture and stimulation, for example by ignoring, humiliating, intimidating or isolating them
• medical neglect: not providing appropriate health care (including dental care), refusing care or ignoring medical recommendations.There’s often no single indicator that a child is being neglected. You may notice more than one sign and your concerns might become more frequent if problems are mounting up. This could indicate that a child and their family need support.

Children of all ages who are neglected may:

• live in an unsuitable home environment, for example in a house that isn’t heated throughout winter
• have a lack of, or inappropriate, stimulation, activities or toys
• not have enough sleep or a sleep routine
• be left alone for a long time
• struggle with personal hygiene and washing
• struggle with poor oral and dental health
• wear clothing that hasn’t been washed or is inadequate (for example, not having a winter coat)
• seem particularly hungry, seem not to have eaten breakfast or have no packed lunch or lunch money
• not be brought to medical appointments such as vaccinations or check-ups
• not be given the prescribed medication, treatment or adaptions needed for a diagnosed illness, disability or condition.

They may suffer from poor health, including:

• untreated injuries
• medical and dental issues
• repeated accidental injuries due to lack of supervision
• untreated or recurring illnesses or infections 
• long term or recurring skin sores, rashes, flea bites, scabies or ringworm
• anaemia.

Bumps and bruises don’t necessarily mean a child is being physically abused – all children have accidents, trips and falls. These injuries tend to affect bony areas of the body such as elbows, knees and shins and aren’t usually a cause for concern. 

However, some injuries are more likely to indicate physical abuse. Some of these signs are more obvious or common, or appear differently, for younger children.

Bruises
Potentially concerning signs include:

• commonly on the head but also on the ear, neck or soft areas (abdomen, back and buttocks)
• defensive wounds commonly on the forearm, upper arm, back of the leg, hands or feet
• clusters of bruises on the upper arm, outside of the thigh or on the body
• a bruised scalp and swollen eyes from hair being pulled violently
• bruises in the shape of a hand or object
• bruises on non-mobile babies (babies who cannot crawl, cruise, bottom shuffle or roll over)
• bruises with dots of blood under the skin (petechiae).

Burns or scalds
Burns or scalds can be from hot liquids, hot objects, flames, chemicals or electricity. Signs to look out for include:

• can be from hot liquids, hot objects, flames, chemicals or electricity
• these may be on the hands, back, shoulders or buttocks. Scalds in particular may be on lower limbs, both arms and/or both legs
• a clear edge to the burn or scald
• sometimes in the shape of an implement – for example, a circular cigarette burn
• multiple burns or scalds.

Bite marks
Signs include:

• usually oval or circular in shape
• visible wounds, indentations or bruising from individual teeth.

Fractures or broken bones
Indicators include:

• fractures to the ribs or the leg bones in babies
• multiple fractures or breaks at different stages of healing.

Behavioural changes
As well as physical signs of abuse, it’s important to be aware of behavioural indicators, including:

• fear of specific individuals
• flinching when approached or touched
• reluctance to get changed in front of others or wearing long sleeves or trousers in hot weather
• depression or withdrawn behaviour. 

Some signs are more obvious or common, or appear differently, for younger children.

Child sexual abuse (CSA) is when a child is forced or persuaded to take part in sexual activities. This may involve physical contact or non-contact activities and can happen online or offline.

Children and young people may not always understand that they are being sexually abused. 

Contact abuse involves activities where an abuser makes physical contact with a child. It includes:

• sexual touching of any part of the body, whether the child is wearing clothes or not
• forcing or encouraging a child to take part in sexual activity
• making a child take their clothes off or touch someone else's genitals 
• rape or penetration by putting an object or body part inside a child's mouth, vagina or anus.

Non-contact abuse involves activities where there is no physical contact. It includes:

• flashing at a child
• encouraging or forcing a child to watch or hear sexual acts
• not taking proper measures to prevent a child being exposed to sexual activities by others
• making a child masturbate while others watch
• persuading a child to make, view or distribute child abuse images (such as performing sexual acts over the internet, sexting or showing pornography to a child)
• making, viewing or distributing child abuse images 
• allowing someone else to make, view or distribute child abuse images
• meeting a child following grooming with the intent of abusing them (even if abuse did not take place)
• sexually exploiting a child for money, power or status (child sexual exploitation).

Physical indicators include:

• bruising
• bleeding
• discharge
• pain or soreness in the genital or anal area
• wetting or soiling unrelated to toilet training
• sexually transmitted infections 

In children who are able to become pregnant, pregnancy can also be an indicator of sexual abuse.

Emotional and behavioural indicators include:

• displaying sexualised behaviour or having sexual knowledge that’s inappropriate or problematic for their stage of development
• being afraid of or avoiding a particular person (including a family member or friend)
• changes in sleep such as difficulties sleeping or nightmares
• being withdrawn
• alluding to ‘secrets’
• self-harming
• running away from home
• developing eating problems
• misusing drugs or alcohol 

Emotional abuse is the ongoing emotional maltreatment of a child, which can have a severe and persistent negative effect on the child’s emotional health and development. It's also known as psychological abuse.

Exposing a child to aggression, cruelty or abuse between others is also a form of emotional abuse.

Most forms of abuse include an emotional element, but emotional abuse can also happen on its own.

Children can be emotionally abused by anyone:

• parents or carers
• family members
• other adults
• other children.

Signs and indicators in babies and young children
Infants and very young children aren’t able to talk about how they are feeling or what is happening to them. Young children who are able to speak may not yet have the language to share their experiences. So, it’s especially important to observe the child’s behaviour, relationships and interactions to gain an insight into what they’re experiencing.

Signs and indicators that might indicate that an infant or young child is being or has been emotionally abused, include:

• displaying passive and withdrawn behaviour when interacting with their caregiver
• not seeming upset when separated from their caregiver
• being angry or disinterested when playing and showing little creativity.

You might also observe caregivers:

• not responding to their needs or not being sensitive to their child’s feelings. For example, rarely speaking to or interacting with them, not often showing affection, or not responding to their signals for help
• describing their child as irritating or demanding, even within the first few days of life.

Infants who experience emotional abuse may demonstrate developmental delay within the first year, particularly in their speech and language. If developmental delay is suspected, it is important to have a formal development assessment carried out by a specially qualified professional.

Signs and indicators in older children
Children who have been emotionally abused may:

• lack confidence and have low self-esteem
• be withdrawn and very quiet
• experience mental health issues
• have a language delay
• struggle to focus and concentrate on tasks
• struggle to make or maintain relationships
• display behaviour perceived to be aggressive or hostile
• seem isolated from their parents, carers and peers
• lack social skills or have few, if any, friends.

Domestic abuse is any type of controlling, coercive, threatening behaviour, violence or abuse between people who are, or who have been in a relationship, regardless of gender or sexuality. It can also happen between adults who are related to one another.

Domestic abuse can include:

• coercive control such as being told where to go and what to wear or being isolated from friends and family
• physical abuse such as being punched, kicked, cut, or being hit with an object
• emotional abuse such as being constantly undermined, sworn at, intimidated, ridiculed, harassed, or threatened with harm or death
• sexual abuse and rape including within a relationship or being made to have sex with other people
• stalking and harassment such as being repeatedly followed or spied on, being regularly given unwanted gifts or receiving unwanted communication
• economic and financial abuse such as having access to money controlled or withheld or being prevented from earning money
• technology-facilitated abuse such as having messages and emails monitored or deleted, constantly being sent messages or calls, or being tracked via device locationIt can be difficult to tell if domestic abuse is happening, because perpetrators can act very differently when other people are around.

Changes to children's behaviour
You might notice changes in a child's patterns of behaviour, for example if they aren't doing as well in school as they used to. Or they might display behaviour that the adults around them perceive to be challenging.

Signs of anxiety in children and young people
Children who experience domestic abuse might feel constantly stressed or on alert. They might be afraid of what's happening at home. This might all feel 'normal' to them if they have lived with domestic abuse for a long time.

You might notice children showing signs of anxiety or fear.

Links to animal abuse
Harm to a pet or a threat to harm a pet has found to commonly form part of patterns of domestic abuse. In such cases, a bond with a pet can be used to inflict psychological abuse and coercive control or force a person to act against their will.

Professionals should routinely discuss concerns regarding pets with adults or children. These discussions can provide insights about potential dynamics of domestic abuse within a family

Child sexual exploitation (CSE) is a type of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity.

Children and young people in sexually exploitative situations and relationships are persuaded or forced to perform sexual activities or have sexual activities performed on them in return for gifts, drugs, money or affection.

CSE can take place in person, online, or using a combination of both.

Child sexual exploitation (CSE) can be very difficult to identify. Warning signs can easily be mistaken for 'normal' teenage behaviour.

Behavioural indicators

Children and young people who are being sexually exploited may display certain behaviours:

• displaying inappropriate sexualised behaviour for their age
• being fearful of certain people and/or situations
• displaying significant changes in emotional wellbeing
• being isolated from peers/usual social networks
• being increasingly secretive
• having money or new things (such as clothes or a mobile phone) that they can't explain
• spending time with older individuals or groups
• being involved with gangs and/or gang fights
• calling an older person their ‘boyfriend’ or ‘girlfriend’
• missing school and/or falling behind with schoolwork
• persistently returning home late
• returning home under the influence of drugs/alcohol
• going missing from home or care
• being involved in petty crime such as shoplifting
• spending a lot of time at hotels or places of concern, such as known brothels
• not knowing where they are, because they have been trafficked around the country (Department for Education, 2017).

> Read about the impact of choice of language on discussions about young people’s behaviour

Physical signs include:

• unexplained physical injuries and other signs of physical abuse
• changed physical appearance - for example, weight loss
• scars from self-harm.

Repeat sexually transmitted infections, pregnancy and terminations can also be a sign of CSE.

What is problematic sexual behaviour?

Problematic sexual behaviour (PSB) is developmentally inappropriate or socially unexpected sexualised behaviour which doesn’t have an overt element of victimisation or abuse.

What is harmful sexual behaviour?

Harmful sexual behaviour (HSB) is developmentally inappropriate sexual behaviour displayed by children and young people which is harmful or abusive1.

What is peer-on-peer sexual abuse?

Peer-on-peer sexual abuse is a form of HSB where sexual abuse takes place between children of a similar age or stage of development. Child-on-child sexual abuse is a form of HSB that takes place between children of any age or stage of development.

More guidance on these issues can be found at the following NSPCC resource around harmful sexual behaviour.

Bullying is when individuals or groups seek to harm, intimidate or coerce someone who is perceived to be vulnerable.

It can involve people of any age, and can happen anywhere – at home, school or using online platforms and technologies (cyberbullying). This means it can happen at any time.

Bullying encompasses a range of behaviours which may be combined and may include the behaviours and actions we have set out below.

Verbal abuse:

• name-calling
• saying nasty things to or about a child or their family.

Physical abuse:

• hitting a child
• pushing a child
• physical assault.

Emotional abuse:

• making threats
• undermining a child
• excluding a child from a friendship group or activities.

Cyberbullying/online bullying: 

• excluding a child from online games, activities or friendship groups
• sending threatening, upsetting or abusive messages
• creating and sharing embarrassing or malicious images or videos
• 'trolling' - sending menacing or upsetting messages on social networks, chat rooms or online games
• voting for or against someone in an abusive poll
• setting up hate sites or groups about a particular child
• creating fake accounts, hijacking or stealing online identities to embarrass a young person or cause trouble using their name.

Bullying and cyberbullying can be a form of discrimination, particularly if it is based on a child’s disability, race, religion or belief, gender identity or sexuality.

Signs and indicators

Indicators that a child could be experiencing bullying or cyberbullying include:

• being reluctant to go to school
• being distressed or anxious
• losing confidence and becoming withdrawn
• having problems eating and/or sleeping
• having unexplained injuries
• changes in appearance
• changes in performance and/or behaviour at school.

Adults may notice that a child isn't spending time with their usual group of friends, has become isolated or that other children's behaviour towards a child has changed.

Technology is an integral part of children’s and young people’s lives. It has transformed the way they learn, play, connect and communicate.

But these opportunities don’t come without risk. Children and young people may experience abuse online and they may be exposed to harmful content. And this can have a long-lasting impact on their wellbeing.

Every child deserves to be, and to feel, safe online. And we can all play a role in helping make online spaces safer for children and young people by:

• talking to children and young people about anything worrying they experience online
• recognising how important the online world is to children and young people, and talk to them about it
• making sure online safety is an ongoing part of your work with children and young people, not just a one-off session
• setting rules for the use of online platforms in your organisation. Involve children and young people in setting these and make sure they’re well understood
• using technical solutions to manage access to online platforms and make sure everyone knows about and understands why you’ve put them in place
• helping children and young people understand and manage their privacy settings online.

Female genital mutilation (FGM) is the partial or total removal of the external female genitalia for non-medical reasons. It's also known as female circumcision or cutting.

FGM is often performed by someone with no medical training who uses instruments such as a knife, scalpel, scissors, glass or razor blade. Children are rarely given anaesthetic or antiseptic treatment and are often forcibly restrained.

FGM can happen in the UK or abroad. Instances of FGM have been recorded in some African countries, areas of the Middle East, some Asian countries, the Americas, Europe and Australia.

Children are also considered to be at higher risk if FGM has already been carried out on their mother, sister or a member of their extended family.

Signs and indicators

A child at immediate risk of FGM may ask you directly for help. But even if they don’t know what's going to happen, there may be other signs. You may become aware of:

• a relative or ‘cutter’ visiting from abroad
• a special occasion or ceremony to 'become a woman' or prepare for marriage
• a female relative being cut – a sister, cousin, or an older female relative such as a mother or aunt
• a family arranging a long holiday or visit to family overseas during the summer holidays
• unexpected, repeated or prolonged absence from school
• a girl struggling to keep up in school and the quality of her academic work declining
• a child running away from or planning to leave home.

A child or woman who's had female genital mutilation (FGM) may:

• have difficulty walking, standing or sitting
• spend longer in the bathroom or toilet
• appear withdrawn, anxious or depressed
• display unusual behaviour after an absence from school or college
• be particularly reluctant to have routine medical examinations
• ask for help, but may not be explicit about the problem due to embarrassment or fear.

Child trafficking is child abuse. It's defined as recruiting, moving, receiving and harbouring children for the purpose of exploitation.

Child trafficking is a form of modern slavery.

Many children are trafficked into the UK from overseas, but children can also be trafficked from one part of the UK to another. 

Signs and indicators

Children who are trafficked are intentionally hidden and isolated from the services and communities who can identify and protect them. While identification may be difficult, there will be signs that you can watch for.

Children who have been trafficked or are at risk of being trafficked may:

• have to do excessive housework chores
• rarely leave the house and have limited freedom of movement
• not have any documents (or have falsified documents)
• give a prepared story which is very similar to stories given by other children
• be unable or reluctant to give details of accommodation or personal details
• not be registered with a school or a GP practice
• have a history with missing links and unexplained moves
• be cared for by adults who are not their parents or carers
• not have a good quality relationship with their adult carers
• be one among a number of unrelated children found at one address 
• receive unexplained or unidentified phone calls whilst in a care placement or temporary accommodation

(Department for Education and Home Office, 2011).

Signs an adult may be trafficking a child include:

• making multiple visa applications for different children
• acting as a guarantor for multiple visa applications for children
• having previously acted as the guarantor on visa applications for visitors who have not left the UK when the visa expired

County lines is a form of criminal exploitation where urban gangs persuade, coerce or force children and young people to store drugs and money and/or transport them to suburban areas, market towns and coastal towns (Home Office, 2018). It can happen in any part of the UK and is against the law and a form of child abuse.

Children and young people may be criminally exploited in multiple ways. Other forms of criminal exploitation include child sexual exploitation, trafficking, gang and knife crime.

The following signs may indicate that a child is being exploited by a county lines gang:

• frequently going missing from school, home or care
• travelling to locations, or being found in areas they have no obvious connections with, including seaside or market towns
• unwillingness to explain their whereabouts
• acquiring money, clothes, accessories or mobile phones which they seem unable to account for
• receiving excessive texts or phone calls at all hours of the day
• having multiple mobile phone handsets or sim cards
• withdrawing or having sudden changes in personality, behaviour or the language they use
• having relationships with controlling or older individuals and groups
• unexplained injuries
• carrying weapons
• significant decline in school results or performance
• being isolated from peers or social networks
• associating with or being interested in gang culture
• self-harming or having significant changes in mental health