Protecting Children: A Shared Responsibility

Chapter 2: BACKGROUND

Children's health and development may be harmed, either suddenly or over a longer period of time, by abuse or neglect which may take a number of different forms. These may occur either alone or in a combination of different types of abuse against one child or group of children:

• Physical injury
• Sexual abuse
• Non-organic failure to thrive
• Emotional abuse
• Physical neglect

(See Glossary of Terms Scottish Office 1992)

There is no commonly accepted view of how much child abuse happens and how this has changed over time (National Commission of Inquiry into the Prevention of Child Abuse 1996). Child abuse may present as an emergency in the form of a serious physical injury or after a sexual assault or following the sudden discovery of abuse which has been going on for a long time in secret. However, more subtle signs and symptoms of abuse may be noticed by, or revealed to health staff, in the course of their contact with the child and/or family for often an unrelated reason. Concerns about possible child abuse may be shared in confidence with health staff by neighbours or members of the extended family, or referrals may come from teachers, social workers or police.

The abusers may be adult members of the family or carers, adult friends, strangers, an organised network, the mother (or other adult) in the case of an unborn child and other children. Risk factors include domestic violence, post-natal depression or other mental illness in a parent or the circulation of pornography by organised networks, resulting in the systematic abuse of groups of children. When a parent or carer repeatedly presents a child as ill by fabricating history, signs or symptoms, the condition of Munchausen by proxy should be considered.

The UK Government is committed to the principles set out under the UN Convention on the Rights of the Child and the European Convention on Human Rights. The Children (Scotland) Act1995 is founded on the following principles and themes which are directly relevant to health care staff involved in child protection. These are:

• each child has the right to be treated as an individual.
• each child who can form his or her own views on matters affecting him or her has the right to express those views if he or she wishes.
• the child's views should be taken into account where decisions are made about his or her future.
• each child has the right to protection from all forms of abuse, neglect or exploitation.
• parents should normally be responsible for the upbringing of children and should share that
• responsibility.
• in decisions relating to protection of children every effort should be made to keep the child in the family home, providing that this is consistent with the child's welfare.
• any intervention by a public authority in the life of a child should be properly justified and should be supported by services from all relevant agencies working in collaboration.

The Children (Scotland) Act 1995 alters the traditional concept of parents having rights over their children to one where both parents have responsibilities towards their children. The Act ensures that children must be consulted and their wishes and views taken into account whenever major decisions are being taken which may affect them. Social work services and police have statutory responsibilities in relation to the welfare and protection of children (see Chapter 10).

For the purposes of Chapters 2 and 3 of Part II of the Children (Scotland) Act 1995, the definition of a child is someone who has not reached the age of 16 years, although a child can include those up to 18 if there is a supervision order made by a Children's Hearing in force in respect of them. For the purposes of supporting children and families Chapter 1 of Part II defines a child as a person under the age of 18 years. While therefore child protection procedures may not be appropriate for those over 16 years, authorities still have responsibilities towards children in need over that age. In the Health sector there are differing age criteria applied for children treated in the hospital and community sector and within different specialties.

The implications of the Children Act for health professionals mean that the child who may have been abused must be the focus of all child protection activity, using a child-centred and sensitive approach. This focus has then to be widened to include key family members within the social/cultural setting in which they live.

Whenever there is concern about the possibility of any type of child abuse, it should be considered in the social and cultural context of the child and the family. Particular care should be taken to involve appropriate people as interpreters where English is not the first language. Similarly in situations where the people involved may have visual, hearing or other impairment e.g. speech disorders or illiteracy, or have other disabilities, then appropriate methods of communication must be clearly established.

Health care staff looking after patients and families may need to consider the possibility that adult patients, and health care staff, may have been the victims of child abuse at some time or may be abusers of children in their care.