The procedure for assessing and responding to allegations of physical abuse should be read in conjunction with Chapter 2.2 entries:
Conducting a Child Safety Investigation and
High risk infants
Physical abuse occurs when a child has experienced severe and/or persistent ill-treatment through behaviours such as beating, shaking, inappropriate administration of alcohol and drugs, attempted suffocation or excessive discipline or excessive physical punishment.
The purpose of the assessment is to identify whether the injury or illness is non-accidental by determining whether the explanation for the injury is consistent, and whether it fits with the developmental abilities of the child.
Note: CEO refers to the Chief Executive Officer of the Department of Communities (the Department).
You must send a child for immediate medical attention at an emergency health service where:
You must consider the possibilities below and ask parents, their network of people. and professionals questions that will elicit information about which of these situations are most likely.
Child physical abuse can be targeted to one child in the family, referred to as the 'scapegoat'. Scapegoating is a serious family dysfunctional problem where one child is often blamed, picked on, shamed and abused.
Scapegoating of a child can occur in varying degrees of severity. The scapegoated child feels abandoned, rejected, bullied, ostracised and disfavoured over another sibling.
Children that are not scapegoated often experience emotional abuse because they witness and participate in the abuse of their siblings. The non-scapegoated children often initially attempt to reach out to the child victim, but quickly learn that empathic behaviour is not a safe response.
These children may experience emotional trauma through witnessing or participating in the abuse of their sibling and may develop empathy deficits as a way to protect themselves from the effects of witnessing the process or effects of the abuse.
Parents can take different roles in non-accidental injuries:
You should also be aware of Fabricated or Induced Illness (FII). This occurs when a parent or carer deliberately causes frequent physical or psychological harm to a child to garner medical attention. For more information refer to the section
'Fabricated or Induced Illness in children' below.
Consider whether the perpetrator's behaviour may be affecting the adult victim's ability to respond protectively towards the child, particularly where the adult victim may have been a bystander (witnessed the abuse without intervening) and/or acted to conceal the event.
Map the perpetrator's pattern of behaviour so that the physical abuse is considered within that context. For more information on family and domestic violence, refer to
Chapter 2.3 Assessing Emotional Abuse – Family and Domestic Violence.
However, prolonged alcohol and other substance misuse can compromise parents' ability to consistently provide a stable, nurturing and safe environment for children. This can result in children being at heightened risk of abuse and neglect. It is also a key risk factor for physical abuse.
Consider the impacts of parental alcohol, drugs, substance misuse and risks to children such as:
parental dis-inhibition and poor impulse control (e.g. poor tolerance for frustration, violent outbursts)
difficulty regulating emotions (e.g. fluctuating mood swings from depression, manic to euphoria)
mental and cognitive impairment (e.g. poor recall of behaviour and events including violence, lack of awareness of impact on the child, lack of empathy for the child)
parental preoccupation with immediate adult needs (e.g. lack of attention to child's needs and routine)
inadequate supervision of the child (e.g. child being left unsupervised with unsuitable others, or parents unconscious)
parental preoccupation and substance dependence may expose child to unsafe adults and activities (e.g. exposure of child to criminal behaviour such as drug use and/or dealing, drug overdose)
diminished parental responsibilities and difficulty maintaining basic household routines (e.g. preparing meals, doing laundry and ensuring the child attends school), and
deliberate or accidental ingestion of parents' drugs by child (e.g. through lack of supervision or intentionally administered to subdue the demands of the child).
Many children whose parents or carers have mental health issues go on to achieve their full potential in life. However, there is a risk that parental mental health problems can have a negative impact on children when mental illness is not adequately managed and causes problems across a range of domains, including parenting capacity and associated impacts on the child.
Consider whether parental mental health issues are resulting in:
Abusive Head Trauma (AHT) refers to an injury to the skull or the intracranial contents (e.g. brain) due to inflicted blunt impact (child being hit in the head or having their head hit against something) and/or shaking. Consider the additional vulnerability of babies and young children to AHT.
This type of injury has some of the most severe consequences for a child's future wellbeing and is the leading cause of death amongst children who have been abused.
Children aged less than six months are most vulnerable to AHT. The greatest risk period for babies is between six weeks and four months of age when the frequency of their crying increases. Shaking a baby vigorously causes the fragile brain to bounce back and forth against the sides of the skull and can result in serious brain trauma.
Refer to Chapter 2.2 High Risk Infants for more information about how to investigate harm to infants.
It is lawful in Australia for parents, or those with parental responsibility, to use reasonable force to manage a child's behaviour.
Consider the following factors to assess whether the use of physical punishment is reasonable:
must assess physical abuse through a variety tasks including:
must refer a report of alleged child physical abuse to WA Police if you consider that the degree of physical abuse warrants a WA Police investigation.
Refer the child for a medical assessment for the purposes of:
Consider all available medical evidence alongside evidence gathered through interviews, observation and other relevant information sources.
Credible evidence can include:
1. Consult with social workers and/or consultant paediatricians in the Perth Children's Hospital Child Protection Unit (PCHCPU) in metropolitan areas or the local medical service (GP or hospital) in regional areas in the following circumstances:
2. Make an appointment for the child at the PCHCPU or local medical service before taking the child there. This will allow relevant health professionals to prepare for the child's assessment appropriately so the child is not further traumatised by being kept waiting.
3. Take the child to an emergency department if their injuries are serious. Where necessary the child will be referred to the PCH CPU by emergency department/hospital staff.
For detailed information on medical assessments in both metropolitan and regional areas, refer to the section 'The medical assessment' in Chapter 2.2 High Risk Infants.
Information in this section for both metropolitan and regional and remote areas applies to children of all ages.
The purpose of the interview is to gather information on:
For further information, refer to the sections 'Child assessment interview – planning and considerations' and 'Undertaking a child assessment interview' in Chapter 2.2 Conducting a Child Safety Investigation.
Interviewing parents and other relevant individuals
In your interviews consider the following:
You should also be aware of delays in parents seeking medical assessment of injuries.
It is important to note that assessments and responses are irrespective of whether the child's parents' cultural values and beliefs have contributed to their behaviour.
Consider interviewing any other individuals who may have relevant information, particularly those who have, or may have, witnessed the events that led to the child's injuries.
Reviewing the child, siblings and other related children's medical history and previous contacts with the Department
Review previous contacts with the Department and consider obtaining medical records to establish a chronology for the child to assess whether this is a pattern of abuse, and/or whether it is escalating.
Consider the medical histories of the child, siblings and other related children and note:
The following tasks may be involved in seeking a medical history:
This may assist in establishing a pattern of abuse and/or identifying where child protection workers should seek medical information. For information on obtaining Medicare records, refer to the section 'Medicare' in Chapter 4.2 Working with other agencies – Memoranda of Understanding and information sharing.
When developing a chronology of events, focus on identifying and analysing:
If there is a sibling group, consider the above list for each child including the developmental trajectory. This should also include any unrelated children living in the family.
On occasion, you may have concerns about the following forms of physical abuse.
Female Genital Cutting/Mutilation (FGC/M) is a form of physical abuse which can have significant emotional and psychological impacts, and serious lifelong medical consequences. It includes all procedures involving the partial or total removal of the external female genitalia or any other injury to the female genital organs for non-medical reasons.
The World Health Organisation classifies Female Genital Cutting/Mutilation into four types:
Female Genital Cutting/Mutilation is practiced in across the world. The resource
Traditional terms for Female Genital Mutilation lists over forty countries where FGC/M is practiced.
Girls most at risk of FGC/M in Australia are from Kenyan, Somali, Sudanese, Sierra Leonean, Egyptian and Eritrean communities. Non-African communities that practice FGM include Yemeni, Afghani, Kurdish, Indonesian and Pakistani.
The procedure may be carried out on girls of any age but is most commonly performed before puberty in girls between the ages of five and eight years.
must use interpreters whenever required, in order to clearly communicate with children and their family. For more information Language services - Managing interpreter issues in child protection practice (also in related resources).
Female Genital Cutting/Mutilation is not a religious practice. It is practiced by people from many religions, including Christianity, Islam and other traditional religions. Neither the Bible or the Koran support FGC/M. It is an ancient cultural practice which predates Christianity and Islam.
For more information refer to
Female Genital Cutting/Mutilation: A Guide for Health Professionals.
The 2019 Australian Institute of Family Studies (AIFS) report
Towards estimating the prevalence of FGC/M in Australia estimates that 53,000 girls and women may have undergone FGM in Australia.
The AIFS also has additional research and resources on
Female Genital Mutilation.
Female Genital Cutting/Mutilation in WA
Female Genital Cutting/Mutilation is a criminal offence in WA when it is practiced for cultural or non-medical reasons. A person who takes a child from the state or arranges for a child to be taken from the state with the intention of subjecting the child to FGC/M can also be charged with a criminal offence under s.306
Criminal Code Act Compilation Act 1913.
Trauma resulting from FGC/M
Female Genital Cutting/Mutilation can have ongoing psychological issues related to trauma, serious long-term health consequences, including death.
Short-term consequences include severe pain and bleeding, shock, genital swelling and infection, difficulty urinating and acute urinary retention.
long-term women can suffer chronic pain and infection, painful sexual intercourse, infection, genital cysts and abscesses, difficulties with periods, fertility problems and pregnancy and childbirth complications.
Usually a girl's parents or her extended family are responsible for arranging FGC/M. A combination of the following factors or behaviours may indicate that a female child is at immediate risk of FGC/M:
Communities that practice FGC/M tend to use local names and may not identify with the term 'mutilation' or 'cutting'. When engaging with a community or individual in sensitive discussions, be the naïve enquirer and ask what the local word for FGC/M is, and if they would prefer to use that word.
This list provides traditional terms for FGC/M in different countries.
Medical Child Abuse is a form of physical and/or emotional abuse. It refers to a parent or carer who deliberately causes frequent physical or psychological harm on the child's health and reports concerns to garner medical attention. This was formerly known as Fabricated or Induced Illness in Children (FII), Munchausen by Proxy and Factitious Disorder Imposed Upon Another.
Erroneous verbal reports (with or without the intention to deceive) are more common than direct methods to deceive, such as falsifying records or inducing signs of illness. The reports may occur over many years and not progress to inducing illness in a child. These cases are more difficult to identify and assess than cases involving deliberately induced illness in a child (Induction). Induction produces direct and often serious physical harm to a child or children.
Medical Child Abuse in children affects the entire family system and you should consider the safety issues for each child in the family. You should be mindful that more than one child may be affected and that another child in the family could become the focus of the parent's behaviour if the original child is no longer available in the sick role.
Keeping their actions towards the child 'secret/undetected' is a high priority for the parent, particularly in cases of induced illness.
The following impacts are associated with Medical Child Abuse in children:
Physical health - The child may experience:
Daily life and functioning - The child may experience:
Emotional - The child may:
Examples of harmful behaviours by the parent include:
The types of conditions that the parent is most likely to present the child with include those that:
Motivations and mechanisms that explain Medical Child Abuse include:
Research has identified the following characteristics in parents and carers who fabricate or induce illness in their children:
The following indicators are associated with Medical Child Abuse:
Child abuse linked to a belief in spirit possession or witchcraft is uncommon but can lead to significant physical, sexual and emotional harm and in some cases child death.
A multi-agency response to the immediate safety concerns for the child is critical.
Cultural beliefs in spirit possession refers to an evil force that has entered a child and has taken possession of him or her. The term 'witch' may be used if the child's family believe that the child is able to use an evil force to harm others.
Abuse and neglect occur when a child's parents attempt to rid the child of 'evil' through methods such as beating, burning, starvation, cutting, stabbing and/or isolation within the household.
Rituals used to neutralise a 'witch' or rid the child of a 'demon' are commonly known as deliverance, exorcism, and less commonly as healing or 'praying for children'. Other terms used include:
'beating the devil out' (beating);
'burning the devil out' (burning, scalding, rubbing chilli in the child's eyes and genitals);
'creating a way out for evil' (refers to cutting/stabbing);
'squeeze the life out of the evil' (refers to strangulation);
'weakening the evil spirit' (starving or fasting, making the child go without water, tying the child up);
'stopping the spread of evil' (isolation including siblings not allowed to speak with the child, not touching or allowing the child physical contact, not allowing the child to eat with the family or share a room with family member, making the child sleep in the bath); and
'purging the child of evil' (forcing the child to ingest poisons by the mouth, eyes or ears to induce vomiting or defecation).
Parents and family members of a child believed to be possessed or a witch may seek help from their place of worship, faith leaders or traditional healers for help and guidance. Children may then be subject to 'deliverance' or 'exorcism' carried out by the faith leaders and other members of the community.
Language the parents may use about the child could include:
'The child has something evil in them.'
'The child needs to be fixed.'
'We need to send the child home (overseas) to be fixed/treated.'
Belief in spirit possession and witchcraft is not confined to particular countries, cultures or religions or to recent migrants, and it does not always lead to harmful practices.
Perpetrators may be parents, family members, family friends, carers, faith leaders and other figures in the community.
There is a clear distinction in the way the child and their risk to others is perceived between a belief that a child is possessed by spirits or demons and a belief that a child is a witch.
Spirit/demon possession: the child is believed to be harmed by the spirit or demon
Parents and family members believe that the child has been taken over completely by 'the evil'. The perpetrators may genuinely believe that abuse is not going to affect the child because they are not really there anymore, and the behaviour is directed at 'the devil/the evil'.
Witchcraft: the child is believed to inflict harm on others
Parents and family members believe that the child has the ability to inflict harm on others, by causing illness or misfortune on a family member. In these cases family members may be fearful or even terrified of the child, believing that everything, including their own lives, is under threat.
Children most vulnerable to accusations of spirit possession and witchcraft include:
infants born with a congenital defect, albino children, twins, 'badly born' (breech, posterior, face up positions)
children with physical disability or difficulties with speech (stammering is commonly linked with these accusations)
orphans/divided family structure
children with a psychological disorder, learning difficulty, mental health problem or those who are particularly gifted
children who display 'naughtiness', stubbornness, aggression, thoughtfulness, laziness or who are withdrawn
stepchildren within a family
children who experience nightmares and/or bedwetting, and/or
children that have been trafficked.
Indicators of abuse linked to belief in spirit possession include:
the child discloses to someone that they are or have been accused of being 'evil' and/or that they have had the 'evil' beaten out of them
there is a complex family structure where the parents live with other family members and/or unrelated individuals, and some of these relationships may be transient
the child is vulnerable due to disability, a weak attachment with a parent or carer and/or the child may not be the biological child of the parent/carer – these factors may lead to the child being singled out
the child has marks such as bruises (especially multiple bruises in soft tissue areas) or burns in unusual patterns or locations, e.g. superficial circular burns on their back
the child has become noticeably confused, withdrawn, disorientated or isolated and appears alone amongst other children
the child's physical care has deteriorated, for example, the child is always hungry, attends school without lunch and presents as more and more unkempt
the child's parent/carer does not appear to show concern for the child or have a close bond with the child
parent's appear afraid of the child and avoid physical contact with the child
the child's attendance at school has become irregular or the child has been taken out of school altogether without another school place having been organised, or there is a deterioration in the child's performance at school
the child appears to be the only child in the family showing signs of abuse and neglect – it is common for one child in family to be targeted due to a difference such as disability, bed wetting, a medical condition, or the child's particular temperament
parents recognise their faith leader as all powerful, and/or
parents place a very high value on preserving family honour.
Child abuse linked to belief in spirit possession usually stems from a child being used as a scapegoat in response to underlying factors such as family stress, deprivation, family and domestic violence, alcohol and substance misuse and/or mental health issues.
Could the parents' behaviour be related to mental health concerns?
Is there a place of worship or community that the child and family are connected, and could any of its members be implicated in the abuse? If so, could other children be at risk?
Is the child a victim of child trafficking?
Once a child is stigmatised, the possibility that they will be accused again is very high.
The child may also believe that they are a witch or possessed.
The child's siblings may have been encouraged to participate in the abuse.
It may be very difficult or impossible for professionals to change the family's beliefs. This may require the assistance of a community member.
Refer to Chapter 2.2: Signs of Safety - child protection practice framework for guidance on safety planning, including developing harm and/or danger statements and safety goals.
The following considerations also apply to safety planning in relation to physical abuse:
Unable to determine who is responsible for harm
There may be circumstances where you are unable to determine who is responsible for harm. In these circumstances you must initiate safety planning and ongoing assessment to actively manage this uncertainty.
Considerations for safety planning
Consider the following when developing a safety plan for allegations of physical abuse cases:
Strategies to manage or reduce stress at trigger times, such as feeding, night waking, financial difficulties, unexpected illness.
Management and monitoring of medical care and treatment for injuries or illness.
Parental behaviours that indicate strengths, and when tested, demonstrate safety
Specific parental behaviours that indicate strengths and when tested demonstrate safety can include:
parents overcome their initial feelings of fear, suspicion or hostility to take part in discussions that focus on the concerns for the child
parents complete necessary tasks because they want to benefit the child and family, not because they have to
parents start to reflect on their thoughts, feelings and behaviours from the perspectives of others
parents are able to describe and reflect on how their behaviour has affected the child, siblings and other related children
parents are able to reflect on their contributions to complex situations, rather than blaming others for difficult situations
information and themes are retained and linked between meetings. Parents show evidence of continuing to reflect on the key concerns between sessions, rather than going over the same material from the same starting point each time
parents demonstrate greater awareness and insight into their own behaviour and an increased recognition of the need for change in relation to our concerns. For example, using agreed strategies to respond to behavioural triggers or altered/planned use of substances
parents become willing to participate constructively in joint sessions with each other and with significant others (e.g. key extended family members) allowing for effective solutions to difficult issues
parents are increasingly able to receive and consider feedback on their behaviour and underlying attitudes and/or assumptions, and show that they have given the feedback serious consideration by demonstrating changed behaviours
parents take practical steps to reduce the impact of psychosocial stressors and increase the stability of their lifestyle
parents are open to a coordinated assessment that includes sharing relevant information with other service providers. They play an active role in identifying and discussing how to meet the child and family's needs, and/or
parents focus on what they need to do to maintain behavioural changes and plan for how they will respond to any relapses, with the child's safety as their primary consideration.
Where physical injury to a child in the CEO's care constitutes or results from an offence (whether before or after the child comes into the CEO's care), the child may be able to claim Criminal Injuries Compensation. For further information, refer to Chapter 3.3 Legal rights of children and caseworker responsibilities.