Safeguarding children – why children are more at risk

Despite apparently being well placed to identify and respond to the abuse of children, one recent review of the literature identified nurses have insufficient knowledge of abuse and lack the skills and abilities to both observe for abuse and support families in which the risk of abuse is high (Lines et al., 2017). While it is often repeated that abuse can happen to anyone, there are some groups of children who bare the greatest risk of being abused because of the characteristics they share (National Society for the Prevention of Cruelty to Children, NSPCC, 2022).

Some nurses may think it is obvious why children are at more risk of abuse and that this, as it does for adults, relates to their need to have other people provide care for them. This is to some extent true however nurses need to be aware of the increased potential for abuse in some groups of children.

Broadly speaking the increased risk for abuse among children falls into two categories:

• Family characteristics
• Child characteristics

(National Institute for Health and Care Excellence, NICE, 2017).

While these characteristics may be distinct, Cleaver et al. (2011) remind nurses they are often interlinked with the more issues a child and family are facing the greater the risk for abuse. Nurses need to have an understanding of these risk factors if they are to be able to identify families who need extra support in order to reduce the risk of abuse to their children. It is also important to recognise that just because these characteristics are present does not mean abuse has, is, or will occur (NICE, 2017). 

Family characteristics

There are some characteristics which relate to families, and to parents or carers in particular which increase the risk to children of experience different forms of abuse and neglect. Many of these issues are heightened where the family unit lacks support from friends or family.  Some key characteristics include:

A history of substance abuse including drugs and alcohol

Parents or carers who engage in substance misuse can be:

• More disorganised in respect of the care they offer their children, e.g. they fail to consider the need for food
• Less capable of supervising their children
• More likely to be engaged in criminality
• Impacted by mental health issues, e.g. depression and anxiety

A history of mental health issues

Parents or carers living with mental health issues are more likely to struggle to care for themselves and with everyday tasks. This may mean they fail to:

• Consider the physical, psychological and emotional needs of the child
• Have the capacity to undertake simple care tasks, e.g. washing, dressing and feeding the child
• Hold down a job adding financial stress to the family situation
• Notice when their child is unwell or in need of medical attention

Parents who experienced abuse themselves

While most people who were themselves abused as children do not go on to abuse their own children, there is evidence to suggest parents who experienced abuse as a child are at greater risk of perpetuating that abuse on their own children, so called intergenerational transmission. Widom et al. (2015) suggest that when this happens it is less likely to include physical abuse but the risks for sexual abuse and neglect are increased.

Where there is a history of domestic abuse

The risks of child abuse are heightened in families where there is a history of domestic abuse, sexual violence and exploitation. The NSPCC (2022) identify that in the case of families where domestic abuse is present, children may experience direct abuse or indirect abuse from witnessing abuse or seeing the impact of it on their home, other family members and being denied the care they need.

Child characteristics

Some children are more at risk of abuse because of factors intrinsic to themselves. No child is to blame for these characteristics, but nurses do need to be alert to the fact they demonstrably increase the risk of the child experiencing abuse.

Children living with disability

It is widely recognised children and young people living with a disability are more likely to experience abuse (NICE, 2017). The NSPCC (2022) identify disability to include issues such as living with:

• Deafness
• A learning or physical disability
• Chronic illness

And that these children are less likely to receive the protection and support they need than their peers who are not living with disability.

Looked after children

Looked after children are those children whose care is provided or overseen by a local authority. Many are at risk of having been abused because of the home lives they have come from.

Other issues  

Cleaver et al. (2011) and NICE (2017) identify some other issues which might constitute or contribute to the abuse of children be that active abuse or neglect. These include:

• Genetic factors such as the parent and the child living with a learning disability or mental health issues
• Children acting as carers to parents living with substance abuse, mental health issues or a learning disability
• Parents or carers experiencing issues with anger management or a period of stress
• Parents or carers who won’t engage with social services
• Parents or carers with a history of prior child abuse

Conclusion

While remembering that these characteristics are only indicative of the increased risk of abuse, nurses need to remain alert to the risks faced by children affected by them. Nurses need to use a knowledge of these risks alongside an understanding of the signs and symptoms of child abuse, so they can play their part in protecting children “who are vulnerable or at risk from harm, neglect or abuse” (Nursing and Midwifery Council, 2018, p.15).