Child protection from the perspective of a school doctor

By Ulrike Lorenz, July 2015

School doctors are frequently also charged with dealing with child protection in schools. This means that the school doctor, together with a teacher, is the contact for questions on this subject. The Mannheim Waldorf School offers parents and teachers further training by the child protection officers in order to heighten sensitivity with regard to children who may be affected. They take action to ensure that preventive measures are implemented in the school.

Photo: © Charlotte Fischer

Sexual abuse primarily affects children under the age of 14 and occurs so frequently that in purely statistical terms one child could be affected in every class. Since school doctors must have an intensive awareness of the children during this period in particular, they must – particularly when there are mental disorders – include abuse in their differential diagnosis as a possible cause. The symptoms are rarely clear and might also have quite different reasons. It is not always simple to recognise abuse, let alone prove it. A wrongly voiced suspicion can have serious consequences for everyone involved.

How to recognise abuse

The physical examination undertaken for example as part of regular checkups rarely produces clear signs, let alone evidence – in contrast to physical violence. Specific symptoms are deemed to be injuries in the genital area if they have not been caused by an accident.

Psychosomatic disorders such as head and stomach aches, lack of appetite, sleep disturbance and also lack of concentration frequently occur.

But all of these are symptoms which often also have other causes. In contrast, typical symptoms are sudden changes in behaviour such as the withdrawal of the child from the social community, the sudden drop in school performance which cannot otherwise be explained, or the onset of overly fearful behaviour which cannot be explained in other ways.

What a child says is almost always a clear indication. But on average a child has to say something eight times before it is understood or taken seriously. That is why we, as trusted persons for the child as well as the parents, must create the space in which such indications can be expressed. It is necessary to build the kind of trust which will give a mother the courage, for example, to imagine or allow the thought that her child could be a victim in the hope that the doctor can help her and the child.

The doctor is not always the first person to whom the affected pupil goes. Often it is the class teacher, another trusted teacher, or also fellow pupils who then in turn confide in their parents or teachers. In such a situation our colleagues frequently seek advice in order to find out specifically how to speak with the child, what can be asked without putting words in the child’s mouth or being hurtful.

The child’s messages are often encrypted. A child might say, for example, “Your place is nice!”, but the actual message expresses a deep sadness which should put us on the alert. Or a child re-enacts a scene which they have experienced with a young person in order to come to terms with the event. In this case the parents were able to find out rapidly where and by whom the assault had taken place.

Children will repeatedly paint eye-catching pictures in the presence of a teacher or therapist which they then show to them – an indication that it is important for the child that an adult should get into conversation with them about it. On one occasion a teacher received a small note with a paedophile text which he was to read without fail.

The biggest help is close collaboration

The expectations of the doctor are great. Doctors on the one hand are subject to the duty of confidentiality and on the other face the task of providing rapid assistance as necessary. But once the hurdle of silence has been overcome, a start has been made on the sometimes long path to a resolution.

Even if school doctors have meanwhile been prepared to handle abuse cases as child protection officers, they are nevertheless gripped by a profound horror and feel great empathy on each occasion. But the important thing is to keep calm. Because, bad as the situation might be, it has mostly been going on for some time and the child has as a rule adjusted to it. Mostly it is the adults who are very upset and who now need help and advice as to how to deal with the situation so that it does not become worse for the affected children and they are not re-traumatised. Here collaboration with other establishments such as advice centres, the youth welfare office and other social services, which one should know about, is necessary.

At our school we collaborate with “Mädchennotruf”, a local advice centre. In uncertain situations their staff will also come to the school for a “round table”. They in turn know suitable therapists and the relevant people in the authorities. In our experience, such close collaboration makes it easier for parents to accept help from these facilities. Since I am the contact person for the teachers, I receive many snippets of information and indications which on their own often do not represent sufficient grounds for a diagnosis or to express a suspicion. But the individual parts of the “puzzle” may then come together to form a clear picture.

Prevention – up to and including the design of the school grounds

As child protection officers, we try to develop meaningful preventive measures in the school which accord with our educational model. We are working on the question as to the extent to which Waldorf education itself is already preventive and what specific preventive measures are additionally required? So far we have used further training for teachers and parents’ evenings at our school to help the adults develop a stronger awareness of the risk to children. In upper school we have a module on relationships which also includes abuse.

We meanwhile also have a greater awareness of the need to protect pupils through the design of the school grounds. Thus we have given windows to our playhouses in the grounds. Unfortunately it happens with ever greater frequency that older pupils try to recreate scenes they have seen in the media with younger pupils. On the one hand it is important to create spaces in which the pupils can encounter one another, on the other it is also important to ensure the presence of teachers.

The introduction of a voluntary commitment as well as the requirement of an extended criminal record certificate for all staff as part of the employment contract are intended to help strengthen accountability for child protection.

Despite all prevention, we will never be able to avoid children getting into such a situation completely. For us as adults – parents, pre-school teachers, teachers, and doctors – it is crucial that alongside our knowledge about abuse we have the courage not to look away. As a result of our tasks for children and young people, we have the opportunity, but also the duty to help the affected children.

About the author: Dr Ulrike Lorenz is a school doctor at the Mannheim Waldorf School.