Abuse, neglect and gender-based violence

Gender-based violence seriously affects physical, emotional and mental health, and can be both chronic and acute in impact. Children affected by gender-based violence may show symptoms such as failure to thrive, anxiety and depression, withdrawal, bedwetting, asthma, eczema, disability and attempted suicide.

Abuse, neglect, gender-based violence and inequalities in the early years

Abuse, whether directed at children or their carers, and child neglect can have serious and lasting effects on children's growth, development, health and wellbeing and contribute to health inequalities in adulthood.

Clear guidance is available on how best to respond to disclosures, suspected child abuse, neglect or gender-based violence (GBV).

Quick links:

Need immediate help or advice?

This webpage is for workers and managers involved in caring for children and their families.

If you require urgent assistance, please contact the Domestic Abuse Helpline on 0800 027 1234 (24 hours).

If you have concerns about the safety or welfare of a child, please contact the National Child Protection Line in Scotland on 0800 022 3222.

To find details of local child protection services, visit the WithScotland website (external link).

What are health inequalities?

The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups."

For a fuller discussion, please see Inequalities in the Early Years.

Policy context

Action to eliminate child abuse and neglect and gender-based violence is consistent with:

What is gender-based violence?

Gender-based violence includes domestic abuse, rape and sexual assault, childhood sexual abuse, commercial sexual exploitation, stalking and harassment, and harmful traditional practices (e.g. female genital mutilation, ‘honour’ crimes and forced marriage). It predominantly affects women, although men too can be victims of abuse.

Domestic abuse may be physical, sexual, verbal or psychological, involve financial constraints and coercions or a combination of any of these factors.

How do abuse, neglect and gender-based violence relate to inequalities?

There are clear links between experience of abuse, neglect and GBV and resultant health inequalities that can continue throughout the adult life of the child and affect the long-term health of mothers.

Please see the sections What risks are associated with child abuse? and What risks are associated with domestic abuse against women?

What is physical abuse?

Intentional use of physical force or implements against a child that results in, or has the potential to result in, physical injury.

What is psychological or emotional abuse?

Intentional behaviour that conveys to a child that he/she is worthless, flawed, unloved, unwanted, endangered, or valued only in meeting another’s needs.

Also includes harmful parent-child interactions which are unintentional: "the persistent emotional ill-treatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development". (From National Guidance for Child Protection in Scotland (external link)).

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What is childhood sexual abuse?

Any person…exploits a child… in any activity intended to lead to the sexual arousal or other forms of gratification of that person or any other person(s), including organised networks. This definition holds whether or not there has been genital contact and whether or not the child is said to have initiated, or consented to, the behaviour.

What is neglect?

Failure to meet a child’s basic physical, emotional, medical/dental, or educational needs; failure to provide adequate nutrition, hygiene, or shelter; or failure to ensure a child’s safety. Includes failure to provide adequate food, clothing, or accommodation and not seeking medical attention.

What health risks are associated with child abuse?

Emotional, physical and sexual abuse in childhood may result in physical injuries and sexually transmitted infections, mental health and behavioural problems and delayed or impaired cognitive development.

Evidence indicates that children exposed to one type of abuse are at high risk of other types and of repeated exposure over time and that the frequency of exposure is correlated with the severity of abuse. For a minority of children, maltreatment is a chronic condition, not an event.

Neglected children may fail to reach normal weight and growth or development milestones.

In its extreme form, neglected children can be at serious risk from the effects of malnutrition, lack of nurturing and stimulation. This can lead to serious long-term effects such as greater susceptibility to serious childhood illnesses and reduction in potential stature. 

Research is beginning to give clear indications that the brain’s development can be physiologically altered by prolonged, severe or unpredictable stress – including maltreatment – during a child’s early years. Such an alteration in the brain’s development can in turn negatively affect the child’s physical, cognitive, emotional and social growth.

With young children in particular, the consequences may become life-threatening within a relatively short period of time. National Guidance for Child Protection in Scotland (external link)).

Early trauma and abuse in childhood has far reaching health consequences, extending into adulthood and is manifested in elevated risks of cancer, heart disease, chronic pain and mental health problems.

Childhood sexual abuse is associated with increased subsequent risk of physical and sexual victimisation. Around half of mental health service users have been physically and/or sexually abused as children (What health workers need to know about gender-based violence: an overview (external link).

Exposure to abuse and maltreatment contributes to child mortality and morbidity and is a strong predictor of health behaviour. Long lasting effects include higher rates of health risk behaviours such as smoking, alcohol and drug use, risky sexual behaviour and unwanted teenage pregnancies.

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What health risks are associated with domestic abuse against women?

Women experiencing abuse are at increased risk of physical injury, chronic health problems particularly gynaecological problems, STIs, chronic pelvic pain, urinary tract infections; gastrointestinal symptoms, especially Irritable Bowel Syndrome; chronic pain and self-reported cardiac symptoms, for example hypertension; chest pain; mental health problems, including anxiety, panic attacks, depression and postnatal depression, post-traumatic stress disorder and suicide.

Children exposed to domestic abuse are at higher risk of developing a series of behavioural, cognitive and emotional problems that may persist into adulthood. Many children witness the domestic abuse, and are at increased risk of abuse within the household.

For more information please see (What health workers need to know about gender-based violence: an overview (external link).

A co-occurence of domestic abuse and child abuse has been reported in 40 per cent of cases.

  • Herrenkohl TI, Sousa C, Tajima EA, Herrenkohl RC, Moylan CA. 'Intersection of child abuse and children's exposure to domestic violence'. Trauma Violence Abuse 2008; 9: 84-99.
  • Appel A, Holden E. 'The co-occurrence of spouse and physical child abuse: a review and appraisal'. J Fam Psychol 1998; 12: 578-99.

Identifying those at risk of gender-based violence

Any woman can experience abuse. However, factors such as poverty, financial dependence, disability, homelessness or insecure immigration status can increase both women’s vulnerability to abuse and their ability to prevent or escape victimisation.

The Confidential Enquiry into Maternal and Child Health's 2007 report 'Saving Mothers' Lives (Chapter 13 - external link) noted that, in England and Wales, 40-60 per cent of women experiencing domestic abuse are abused during pregnancy and that 30 per cent of all domestic abuse cases start during pregnancy.

Age is also important. Evidence shows that young women between 15-24yrs have a higher risk of abuse (Partner exploitation and violence in teenage intimate relationships and 'Standing on my own two feet’: disadvantaged teenagers, intimate partner violence and coercive control (external links).

For more information and guidance relating to young mothers, please see Teenage Pregnancy and Inequalities.

Midwives, health visitors and mental health practitioners are tasked with routinely asking women whether they are experiencing abuse. It's also important to link with other professionals who may know more about the woman and her circumstances, e.g. carers, GPs, social workers, the police and voluntary sector agencies.

Indicators of domestic abuse include:

  • a history of repeated miscarriages, terminations, still births or pre-term labour
  • frequent non-attendance at healthcare appointments or non-compliance with treatments
  • attendance always with a partner who refuses to leave the room, is dominant or over solicitous
  • multiple injuries at different stages of healing
  • appearing evasive, socially withdrawn and hesitant
  • children on the child protection register or referred to other specialists for behavioural, emotional or developmental problems
  • alcohol or drug problems.

For a fuller discussion, see section 3.3 of Responding to domestic abuse: A handbook for health professionals (external link).

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Identifying children at risk of abuse and neglect

Child protection and the assessment of risk to children is a complex area of practice.

Professionals involved in the care of children who are charged with assessing risk should follow the GIRFEC approach as laid out in The National Guidance for Child Protection in Scotland (external link)).

Areas of particular concern requiring action include:

  • disclosure by the child of physical, sexual or emotional abuse
  • unexplained injury, especially multiple injuries at different stages of healing
  • frequent attendance at GP surgery or A&E
  • sexually transmitted infections
  • age-inappropriate sexual behaviours
  • behavioural indicators e,g, internalising (anxiety, depression) and externalising (aggression, acting out) behaviour.

Further guidance for health professionals can be found in NICE CG89 - When to suspect child maltreatment (external link).

Any concerns or worries about the welfare of a child should be reported to local child welfare services or to the National Child Protection Line in Scotland 0800 022 3222.

To find details of local child welfare services, visit the WithScotland website (external link).

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Articles in this topic

Policy

Evidence

Professional support materials

  • External Resource

    CHILDREN 1st website

    CHILDREN 1st offers a range of services to children and families, including counselling and mediation, befriending and trauma support.

    • When was this published? 8/17/2010
  • External Resource

    National Child Protection line

    This helpline is for anyone who is worried about the safety or wellbeing of a child.

    • When was this published? 5/6/2013
  • External Resource

    NICE Clinical guideline 89: Guidance on when to suspect child maltreatment [1.9MB]

    These guidelines from the National Institute for Health and Clinical Excellence (NICE)cover the alerting features in children and young people (under 18 years) of: physical, sexual and emotional abuse, neglect and fabricated or induced illness.

    • When was this published? 8/18/2010
  • External Resource

    Responding to domestic abuse: guide for health professionals [457KB]

    This handbook gives practical guidance to healthcare professionals on working with patients who may have experienced or are experiencing domestic abuse.

    • When was this published? 5/28/2013
  • External Resource

    Scottish Women’s Aid

    Scottish Women's Aid tackles domestic abuse and works to end violence against women. It also runs training and events, and publishes material on domestic abuse and its effects on women and children.

    • When was this published? 8/17/2010
  • External Resource

    What health workers need to know about gender-based violence [4.1MB]

    This guide forms part of a package of resources developed by NHS Scotland for staff. It briefly explains the nature of gender-based violence and outlines how to respond.

    • When was this published? 8/18/2010
  • External Resource

    WithScotland

    WithScotland supports child protection policy, practice and research. It provides a range of inter-agency research, policy and practice to support professionals, groups and organisations who work in child care and protection.

    • When was this published? 5/27/2013

Information for the public

  • External Resource

    Childline

    ChildLine is a 24 hour counseling service for children and young people up to and including 18 in the UK provided by The NSPCC.

    • When was this published? 9/20/2013
  • External Resource

    CHILDREN 1st website

    CHILDREN 1st offers a range of services to children and families, including counselling and mediation, befriending and trauma support.

    • When was this published? 8/17/2010
  • External Resource

    National Child Protection line

    This helpline is for anyone who is worried about the safety or wellbeing of a child.

    • When was this published? 5/6/2013
  • External Resource

    Violence reduction posters and leaflets

    The Violence Reduction Unit has a range of posters available which are free to download and can be amended, leaflets targeting parents and children are available which details simple, everyday ways for parents to help to reduce the risk of violence in a child’s life.

    • When was this published? 5/23/2013
  • External Resource

    With Scotland

    With Scotland is a national resource for the benefit of everyone involved in protecting children. The Multi-Agency Resource Service (MARS) and the Scottish Child Care and Protection Network (SCCPN) have joined forces to develop stronger connections between child, adult and public protection.

    • When was this published? 4/15/2013
  • External Resource

    You and your little child

    Book for parents with learning disabilities with children aged 1 - 5 years. This book is available free of charge to Early Years professionals in Scotland from NHS Health Scotland as an alternative to Ready Steady Toddler! To order contact nhs.HealthScotland-EarlyYears@nhs.net.

    • When was this published? 2/15/2011