Advice from experts on how to spot signs of child abuse that go beyond physical marks and bruises

This week, there have been not just one, but two cases where preschool teachers in Singapore are accused of hurting children. The viral videos which showed teachers handling preschoolers roughly and making them drink water forcefully, have shocked the community.

While the images are unsettling, they underscore the importance of recognising and addressing potential signs of abuse within preschool environments.

To shed light on this matter, CNA Lifestyle consulted with psychologists and experienced therapists to learn how parents can better detect signs of abuse in their young children, even if these do not always come in the form of bruises or physical marks. Experts also gave advice on how parents can communicate with children to get them to open up about any troubles. 

NOT AS UNCOMMON AS WE THINK

Clinical psychologist Dr Annabelle Chow, who oversees a child psychology arm at her private practice Annabelle Psychology, shares a disconcerting fact: Child abuse cases are not as uncommon as we think.

In fact, Singapore's Ministry of Social and Family Development (MSF) investigated 2,141 cases of child abuse in 2021 alone. In 2017, 40 per cent of child abuse and neglect cases involved children below the age of seven.

You might be wondering: Is neglect also a kind of abuse? It turns out that physical and sexual abuse, concepts many people are familiar with, aren’t all there is to it.

“Neglect occurs when a caregiver intentionally or unjustifiably fails to offer necessities like food, shelter, clothing, medical attention or needed supervision,” explained Dr Chow.

She also elaborated on emotional or psychological abuse, which hurts a child’s sense of self-worth.

“It can involve threats, shouts, criticism, blaming and humiliating acts. In a way, almost verbally bullying a child,” she said.

Given the insidious nature of child abuse, how can parents spot the signs before it’s too late?

Gladys Hu, a psychotherapist with close to a decade of experience at Fei Yue’s Child Protection Specialist Centre and Family Service Centres, sheds light on both physical and behavioural cues.

SPOTTING THE SIGNS

Hu points out that unexplained bruises in unusual places where kids don't usually get hurt, such as the back, inner thighs and underarms, might raise red flags. Behavioural signs, on the other hand, can be more covert but equally important to notice.

• Avoidance or refusal of school
• Flinching easily and avoiding touch
• Fear of specific staff members of the school
• Mood changes (Becoming very withdrawn, aggressive or hypervigilant).
• Emotional changes (Increased irritability, crying, clinginess and outbursts).
• Sleep disturbances
• Loss of appetite
• Persistent reports of nightmares
• Frequent complaints of somatic, or physical symptoms, from the child even though they are otherwise healthy 
• Frequent bedwetting in a child who is already toilet-trained

Hu also mentions that a child's play can offer insight. Repeatedly acting out certain scenarios during playtime, like using dolls to role-play troubling behaviour, can provide hints. Similarly, drawings that contain concerning themes might be a signal of traumatic experiences.

“Often, younger children may not have the cognitive ability to fully understand what has happened. Even if they do, they may not have the vocabulary or language skills to convey it clearly. Their emotional and bodily responses, as well as their play and expressive work, can be a window (to) their inner world.”

With that said, preschoolers can be a handful and caregivers may have difficulty distinguishing between a tantrum and possible signs of abuse. In light of this, Dr Chow highlights duration and consistency to be defining factors.

“If the fluctuations are consistent over a sustained period of time that seemingly cannot be explained by any occurrence or incident you are aware of, you may want to check in with your child or authorities in school," she said.

BROACHING THE TOPIC

Addressing the solemn topic of child abuse with a four-year-old calls for a gentle approach. Dr Chow advises caregivers to ask open-ended questions and pay close attention to their reactions. For example: How was your day? Did anything special happen in Singapore? How are your friends and teachers?

Children may struggle to articulate their experiences with an extensive or even accurate vocabulary, but they can often categorise whether a person is “good” or “bad”.

No doubt, this conversation can be triggering and caregivers may feel enraged when confronting the disconcerting possibility that their child had been vulnerable. But maintaining their composure is key, cautioned Daisy Tan, an educational psychologist who has worked with children in schools, hospitals and early intervention centres for over a decade. 

“If the child does disclose information suggesting abuse or mistreatment, remain calm, let them talk, listen carefully to what they say, validate their feelings and assure them that you believe them and are always available to listen if they want to share more,” Tan shared.

“Avoid reacting strongly in shock or anger, asking leading questions, making assumptions, or repeatedly pressuring the child to share more information when they are unwilling to or appear distressed.”

In instances where a child remains tight-lipped, caregivers might explore creative methods.

Hu suggests encouraging the child to narrate a story as if they were recounting the sequence of events in a video.

“For example, you can say: Tell me what happened from when you spilled your bowl, to when you cried,” she said.

Shirley Woon, a psychotherapist with more than 15 years of counselling expertise, proposes using art as an outlet for expression.

“Young children may have difficulty expressing their challenges through words. Parents could ask their children to draw. For example, if parents suspect that their children are experiencing abuse in school, they could ask them to draw the school or the classroom,” suggested Woon. 

She reiterates the need for parental courage, acknowledging that some might fear potential repercussions on their children and, as a result, opt to remain silent.

“I’d remind parents that the welfare of their children is a priority. If the fear of subjecting their child to more abuse is great enough, change school.”

In the cases at Kinderland Preschool, Woon recommends caregivers whose preschoolers are affected by abuse, whether directly or as witnesses, to consider therapy as an avenue for processing adverse childhood experiences sooner rather than later.

Echoing this sentiment, Dr Chow emphasised the importance of timeliness when flagging an issue to the school or centre. She urges parents to always clarify when physical indicators of abuse show up, and ask about their child’s relationships with peers and teachers.

“Don’t wait till another time. Make sure to keep documentation and photographs. Express the concerns and observations to the teachers, and seek to understand what has occurred for these signs to have appeared. If needed, escalate the matter and seek action from the school or authorities,” said Dr Chow.

MAKING OPEN COMMUNICATION A HABIT

Instead of waiting for a crisis to arise before taking action, consistent engagement with a child is crucial for their emotional growth and safety. As Woon puts it, “we can’t just tell preschoolers to talk”, we need to meet them where they’re at.

“Parents need to connect with preschool children through doing things together. Have meals together. Put them to bed. No matter how tired or busy parents are, they need to listen to the child even if it’s about small matters. What adults regard as small matters may be big matters to the child.”

Showing a willingness to listen is both a verbal and non-verbal undertaking, explains Gladys Hu, who shares the following tips:

• Devote full attention to the child while they're sharing, rather than multitasking.
• Sit at eye level, maintaining physical proximity rather than crossing your arms at a distance.
• Allocate five to 10 minutes of dedicated one-on-one time with each child, explaining its purpose. A caregiver may say, “This is Mummy’s special time with you and you can tell me anything you want to”. 
• Pose inquisitive questions that encourage sharing and avoid teaching or instructing when a child opens up.

Hu added: “What young children share makes sense in their world, even if it does not make sense to the adult. Children are impressionable and can quickly take your unintentional verbal cues or body language to mean you don’t approve of what they’re saying or you’re not interested in hearing them out." 

In addition to creating a safe space at home, educational psychologist Daisy Tan suggests caregivers take a proactive stance in safeguarding children from various forms of abuse.

“Have early conversations to teach them about body safety, their rights in situations that make them feel unsafe (for example, to inform a trusted adult) and to evaluate how safe they feel in different situations using a scale of one to five,” she said.