Recognition of Significant Harm

The Children Act 1989 introduced the concept of significant harm as the threshold, which justifies compulsory intervention in family life in the best interests of children.

Section 47 of the Act places a duty on local authorities to make enquiries, or cause enquiries to be made, where it has reasonable cause to suspect that a child is suffering, or is likely to suffer Significant Harm. A court may only make a Care Order or Supervision Order in respect of a child if it is satisfied that:

• The child is suffering, or is likely to suffer significant harm; and
• That the harm or likelihood of harm is attributable to a lack of adequate parental care or control (section 31).

Under Section 31(9) of the Children Act 1989, as amended by the Adoption and Children Act 2002:

'Harm' means ill-treatment or the impairment of health or development, including for example impairment suffered from seeing or hearing the ill-treatment of another;

'Development' means physical, intellectual, emotional, social or behavioural development;

'Health' means physical or mental health; and

'Ill-treatment' includes sexual abuse and forms of ill-treatment that are not physical.

Under section 31(10) of the Act:

Where the question of whether harm suffered by a child is significant turns on the child's health and development, his health or development shall be compared with that which could reasonably be expected of a similar child.

There are no absolute criteria on which to rely when judging what constitutes suffering significant harm. Consideration of the severity of ill-treatment may include the degree and the extent of physical harm, the duration and frequency of abuse and neglect, the extent of premeditation, the degree of threat, coercion, sadism, and bizarre or unusual elements in child sexual abuse. Each of these elements has been associated with more severe effects on the child and/or relatively greater difficulty in helping the child overcome the adverse impact of the maltreatment.

Sometimes a single traumatic event may constitute significant harm, e.g. a violent assault, suffocation or poisoning. More often, suffering significant harm is a compilation of significant events, both acute and long-standing, which interrupt, change or damage the child's physical and psychological development. Some children live in family and social circumstances where their health and development are neglected. For them, it is the corrosiveness of long term emotional, physical or sexual abuse that causes impairment to the extent of constituting significant harm. In each case, it is necessary to consider any ill-treatment alongside the family's strengths and supports.

To understand and establish significant harm, it is necessary to consider:

• The wider and environmental family context, including protective factors;
• The child's development within the context of their family and wider social and cultural environment;
• Any special needs, such as a medical condition, communication difficulty or disability that may affect the child's development and care within the family;
• The nature of harm, in terms of ill-treatment or failure to provide adequate care;
• The impact on the child's health and development; and
• The capacity of the parents/carers to meet adequately the child's needs.

The child's reactions, their perceptions, wishes, and feelings should be ascertained and the local authority should give them due consideration, so far as is reasonably practicable and consistent with the child's welfare and having regard to the child's age and understanding.

To do this depends on communicating effectively with children and young people, including those who find it difficult to do so because of their age, an impairment, or their particular psychological or social situation. This may involve using interpreters and drawing upon the expertise of early years workers or those working with disabled children. It is necessary to create the right atmosphere when meeting and communicating with children, to help them feel at ease and reduce any pressure from parents, carers or others.

Children will need reassurance that they will not be victimised for sharing information or asking for help or protection; this applies to children living in families as well as those in institutional settings, including custody. It is essential that any accounts of adverse experiences coming from children are as accurate and complete as possible. Accuracy is key, for without it effective decisions cannot be made and, equally, inaccurate accounts can lead to children remaining unsafe, or to the possibility of wrongful actions being taken that affect children and adults.

Abuse and neglect are forms of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting by those known to them or, more rarely, by others. Abuse can take place wholly online, or technology may be used to facilitate offline abuse. Children may be abused by an adult or adults, or another child or children.

The following definitions are taken from Working Together to Safeguard Children.

They have been included to assist those providing services to children in assessing whether the child may be suffering actual or potential harm.

The following guidance is intended to help all professionals who come into contact with children. It should not be used as a comprehensive guide, nor does the presence of one or more factors prove that a child has been abused, but it may however indicate that further enquiries should be made.

The following factors should be taken into account when assessing risks to a child. This is not an exhaustive list.

• An unexplained delay in seeking treatment that is obviously needed;
• An unawareness or denial of any injury, pain or loss of function;
• Incompatible explanations offered or several different explanations given for a child's illness or injury;
• A child reacting in a way that is inappropriate to his/her age or development;
• Reluctance to give information or failure to mention previous known injuries;
• Frequent attendances at Accident and Emergency Departments or use of different doctors and Accident and Emergency Departments;
• Frequent presentation of minor injuries (which if ignored could lead to a more serious injury);
• Unrealistic expectations/constant complaints about the child;
• Alcohol and/or drug misuse or other substance misuse;
• A parents request to remove a child from home or indication of difficulties in coping with the child;
• Domestic abuse;
• Parental mental ill health;
• The age of the child and the pressures of caring for a number of children in one household;
• Parental conflict about separation and contact with serious threats to harm the children. Follows on from Serious Case Reviews.

This section provides a guide to professionals of some common injuries found in child abuse. Whilst some injuries may appear insignificant in themselves, repeated minor injuries, especially in very young children, may be symptomatic of physical abuse.

It can sometimes be difficult to recognise whether an injury has been caused accidentally or non-accidentally, but it is vital that all concerned with children are alert to the possibility that an injury may not be accidental and seek appropriate expert advice. Medical opinion will be required to determine whether an injury has been caused accidentally or not.

Emotional abuse may be difficult to recognise, as the signs are usually behavioural rather than physical. The manifestations of emotional abuse might also indicate the presence of other kinds of abuse.

The indicators of emotional abuse are often also associated with other forms of abuse.

The following may be indicators of emotional abuse:

• Developmental delay;
• Abnormal attachment between a child and parent/carer e.g. anxious, indiscriminate or no attachment;
• Indiscriminate attachment or failure to attach;
• Aggressive behaviour towards others;
• A child scapegoated within the family;
• Frozen watchfulness, particularly in pre-school children;
• Low self esteem and lack of confidence;
• Withdrawn or seen as a 'loner' - difficulty relating to others;
• Eating disorders and/or mental health problems;
• Spending more time away from home than would be expected;
• Avoiding going home particularly at night and sleeping at a friends or neighbours etc.
• Seeking support from inappropriate and dangerous adults;
• Misusing drugs and alcohol;
• Inability to recognise risk.

Children of both genders and of all ages may be sexually abused and are frequently scared to say anything due to guilt and/or fear. This is particularly difficult for a child to talk about, and full account should be taken of the cultural sensitivities of any individual child/family.

Recognition can be difficult unless the child discloses and is believed. There may be no physical signs and indications are likely to be emotional/behavioural.

Some behavioural indicators associated with this form of abuse are:

• Inappropriate sexualised conduct;
• Sexual knowledge inappropriate for the child's age;
• Sexually explicit behaviour, play or conversation, inappropriate to the child's age;
• Continual and inappropriate or excessive masturbation;
• Self-harm (including eating disorder), self mutilation and suicide attempts;
• Running away from home;
• Poor concentration and learning problems;
• Loss of self-esteem;
• Child Sexual Exploitation;
• An anxious unwillingness to remove clothes for - e.g. sports events (but this may be related to cultural norms or physical difficulties).

Some physical indicators associated with this form of abuse are:

• Pain or itching of genital area;
• Recurrent pain on passing urine or faeces;
• Blood on underclothes;
• Pregnancy in a younger girl where the identity of the father is not disclosed and/or there is secrecy or vagueness about the identity of the father;
• Physical symptoms such as injuries to the genital or anal area, bruising to buttocks, abdomen and thighs, sexually transmitted infections, presence of semen on vagina, anus, external genitalia or clothing.

See also: Harmful Sexualised Behaviour Practice Guidance & Procedure and Child Sexual Exploitation for further guidance of what constitutes sexual abuse.

The growth and development of a child may suffer when the child received insufficient food, love, warmth, care and concern, praise, encouragement and stimulation.

Apart from the child's neglected appearance, other signs may include:

• Short stature and underweight;
• Red/purple mottled skin, particularly on the hands and feet, seen in the winter due to cold;
• Swollen limbs with sores that are slow to heal, usually associated with cold injury;
• Recurrent diarrhea;
• Abnormal voracious appetite at school or nursery;
• Dry, sparse hair, reoccurring headlice;
• A child seen to be listless, apathetic and unresponsive with no apparent medical cause;
• Unresponsiveness;
• Indiscrimination in relationships with adults (may be attention seeking);
• Spending more time away from home then would be expected;
• Going missing and/or presenting as homeless;
• Being late or missing appointments, school, college etc.
• Feeling unwell/awful most of the time, tired, fed up and hungry (observations of taking or asking for food);
• Unattended illness or injury;
• Frequent and/or increased levels of anti-social behaviour or offending behaviour, such as but limited to, verbal abuse or stealing food and drink;
• Appearing 'resilient' and able to make choices about their lives, when in fact they are adopting behaviours and coping mechanisms that are unsafe;
• Seeking support from inappropriate and dangerous adults;
• Misusing drugs and alcohol.

A clear distinction needs to be made between organic and non-organic failure to thrive. This will always require a medical diagnosis. Non-organic failure to thrive is the term used when a child does not put on weight and grow and there is no underlying medical cause for this.

Non-recent abuse (also known as historical abuse) is an allegation of neglect, physical, sexual or emotional abuse made by or on behalf of someone who is now 18 years or over, relating to an incident which took place when the alleged victim was under 18 years old.

Allegations of child abuse are sometimes made by adults and children’s years after the abuse has occurred. There are many reasons for an allegation not being made at the time including fear of reprisals; the degree of control exercised by the abuser, shame or fear that the allegation may not be believed. It may also be because the person has become aware that the abuser is being investigated for a similar matter or their suspicions that the abuse is continuing against other children may trigger the allegation.

Reports of historical allegations may be complex as the alleged victims may no longer be living in the situations where the incidents occurred or where the alleged perpetrators are also no longer linked to the setting or employment role. Such cases should be responded to in the same way as any other concerns and report a concern about a child process should be followed. It is important to ascertain as a matter of urgency if the alleged perpetrator is still working with, or caring for, children or young people. If it is established that the perpetrator is still working with/caring for children, this must be referred to the Local Authority Designated Officer: Managing Allegations Against People who work with Children Procedure. 

Organisational responses to allegations by an adult of abuse experienced as a child must be of as high a standard as a response to current abuse because:

• There is a significant likelihood that a person who abused a child/ren in the past may still be doing so;
• Criminal prosecutions can still take place despite the fact that the allegations are historical in nature and may have taken place many years ago.

If it comes to light that the historical abuse is part of a wider setting of institutional or organised abuse, the case will be dealt with according to the Complex Safeguarding (Organised or Multiple) Abuse also known as Gold Group Procedure. See also: Organised and Complex Abuse Procedure.

The sustained abuse or neglect of children physically, emotionally, or sexually can have long-term effects on the child's health, development and well-being. It can impact significantly on a child's self-esteem, self-image and on their perception of self and of others. The effects can also extend into adult life and lead to difficulties in forming and sustaining positive and close relationships. In some situations, it can affect parenting ability and lead to the perpetration of abuse on others.

In particular, physical abuse can lead directly to neurological damage, as well as physical injuries, disability or at the extreme, death. Harm may be caused to children, both by the abuse itself, and by the abuse taking place in a wider family or institutional context of conflict and aggression. Physical abuse has been linked to aggressive behaviour in children, emotional and behavioural problems and educational difficulties.

Severe neglect of young children is associated with major impairment of growth and intellectual development. Persistent neglect can lead to serious impairment of health and development, and long term difficulties with social functioning, relationship and educational progress. Neglect can also result in extreme cases in death.

The report 'Growing up neglected: a multi-agency response to older children' July 2018, produced in response to the joint targeted area inspection (JTAI) examining older children experiencing neglect, has a number of case studies that outlines indicators of neglect and emotional neglect in older children and explores what professionals should consider when working with older children.

Sexual abuse can lead to disturbed behaviour including self-harm, inappropriate sexualised behaviour and adverse effects which may last into adulthood. The severity of impact is believed to increase the longer the abuse continues, the more extensive the abuse and the older the child. A number of features of sexual abuse have also been linked with the severity of impact, including the extent of premeditation, the degree of threat and coercion, sadism and bizarre or unusual elements. A child's ability to cope with the experience of sexual abuse, once recognised or disclosed, is strengthened by the support of a non-abusive adult or carer who believes the child, helps the child to understand the abuse and is able to offer help and protection.

There is increasing evidence of the adverse long-term consequences for children's development where they have been subject to sustained emotional abuse. Emotional abuse has an important impact on a developing child's mental health, behaviour and self-esteem. It can be especially damaging in infancy. Underlying emotional abuse may be as important, if not more so, than other more visible forms of abuse in terms of its impact on the child. Domestic abuse, adult mental health problems and parental substance misuse may be features in families where children are exposed to such abuse.

The context in which the abuse takes place may also be significant. The interaction between a number of different factors can serve to minimise or increase the likelihood or level of significant harm. Relevant factors will include the individual child's coping and adapting strategies, support from family or social network, the impact and quality of professional interventions and subsequent life events.