Child and toddler abuse: signs that should alert you, according to a psychiatrist

VIOLENCE – In early September, the release of a video showing a teacher hitting a three-year-old girl on the back deeply shocked public opinion. On Wednesday, September 18, The Ogres (ed. Flammarion), the investigation that journalist Victor Castanet devoted to the private nursery system, which once again shed harsh light on the mistreatment that very young children can be victims of.

Blows, deprivation of food, humiliation, neglect… Even if the violence suffered by children is sometimes obvious, the signs of abuse are sometimes difficult to detect, particularly in children who have not acquired language. Explanations with Dr. Gilbert Vila, child and adolescent psychiatrist at the Center for Victimology for Minors at Trousseau Hospital in Paris.

Dr Gilbert Vila. In infants under one year of age, signs of abuse are non-specific. The sudden onset of feeding and sleeping disorders, a change in behavior and slow development often put professionals on the trail of possible abuse. But these signs, particularly behavioral disorders, can be very diverse.

The pediatrician or general practitioner will, after a basic examination, be able to guide the parents according to their level of concern and their worries regarding the type of childcare.

What behaviors in young children should we be aware of?

Small children in a state of traumatic stress may withdraw socially, or on the contrary be in a state of persistent excitement. Some may cry a lot, scream a lot, be difficult to calm down while others will suddenly seem shut down, show sudden or progressive difficulties in making contact with their peers or with adults. These are very worrying signs but do not always put parents on the path to possible abuse. Hence the importance of going to the pediatrician at the slightest suggestive change: a child or baby who suddenly loses their appetite, who does not interact, this should alert very quickly.

We must also mention a loss of the pleasure of playing or what is called a development of post-traumatic play, reproducing on their toys or their peers the violence they suffer. In addition to fear, aggression is the second pole of symptoms of trauma. In children, this translates into opposition, provocation, anger, aggression towards their peers or adults.

Are the signs different in older children?

In older children, from the age of two or three, the signs become more and more similar to those of adults. For example, sleep disorders (repeated nightmares, night terrors, difficulty falling asleep, frequent awakenings), hypervigilance, an exaggerated startle reaction, attention disorders, multiple and sometimes atypical fears, etc. A child who has been washed in water that is too hot may develop a fear of water, a fear of bathing. Abused children may also show regressions: while they had learned to be clean, they need to wear diapers again, crawl on all fours, talk like a baby, etc.

Are the signs of child abuse hard to spot?

What should, in all cases, alert parents or professionals is a clear break in the child’s behavior, because it is linked to a specific event. When you place your child in a daycare center, with a childminder or when he or she starts school, you expect there to be a period of adaptation, which is perfectly normal. But if the difficulties persist over time and especially if they are accompanied by psychological distress in the child, you have to ask yourself questions.

Do children, once they have acquired language, still talk about the abuse they suffer?

If they are very young children, they talk about it in their own words, but they are not always heard, taken seriously or understood by adults. And then there are also children who do not talk because they are afraid or because they have been threatened if they do. As an adult, you have to draw the necessary conclusions, by warning the parents if they are not the perpetrators of the violence, by contacting the authorities who can issue a report. You have to be aware that it is not because you are worried that you accuse, it is a measure to protect the child. If you hesitate to disturb the adults, it means that you are no longer taking care of the children.

Who can parents turn to if they suspect child abuse?

The priority is to talk to the pediatrician or general practitioner, who will be able to detect the slightest symptom and raise concerns about the environment. For several years, there has been clear progress in the care of child victims of violence, even if much remains to be done, particularly to detect the first signs.

We can mention the creation a few years ago of the pediatric reception units for children in danger (UAPED), which have a highly specialized multidisciplinary team to accommodate children in a safe place. Parents, like professionals, can request a forensic medical examination there. The regional centers for psychotrauma can also be contacted as can, of course, the juvenile brigade.

The problem is that people are poorly informed, knowing who to contact to have the violence they observe recognised can sometimes be an obstacle course.

If you are a child in danger, or if you are a person who has witnessed or suspected that a child is in danger, you can contact L’Enfance en danger on 119 (free and confidential call, available 24 hours a day, 7 days a week) or visit the website allo119.gouv.fr.