Body safety for special needs children: beyond good touch and bad touch

Research from several countries suggests that children with disabilities face a higher risk of abuse than other children. The reasons are practical rather than mysterious. Many depend on adults for toileting, bathing and dressing, so being touched and undressed is a normal part of their day. Some cannot speak, or cannot yet describe what happened in a way adults understand.

Many have also been taught, kindly and for years, to comply: sit when told, go with the adult, let the aunty help. A child who always does what grown-ups say is easier to manage and easier to harm. Add a long list of people in the child's life, from drivers and helpers to therapists, tutors and relatives, and the need for clear rules becomes obvious.

None of this is a reason for fear. It is a reason to teach body safety as deliberately as you teach reading, and to build safer routines around the child's care.

Many Indian families use pet words or no words at all for private parts. That is understandable, but it leaves a child without the language to report a problem. A child who says 'my susu hurts' or points vaguely may not be understood by a teacher or a doctor, and a child who has no word at all may say nothing.

Use the correct names calmly and matter-of-factly during bathing and dressing, the same way you name elbows and knees. Use the same words across the family, in each language spoken at home, and tell the school and the special educator which words the child knows. A child who can name body parts clearly is also a child whom an abuser may see as more likely to tell.

Rules work better than feelings for most children with autism or an intellectual disability, because 'a bad touch feels yucky' asks the child to judge a sensation they may not read the way others do. Keep the rules short, the same every time, and on a picture card if that helps.

• Private parts are the parts covered by underwear.
• Nobody touches or looks at your private parts, except the named adults who help you wash or use the toilet, or a doctor with a parent there.
• You do not touch other people's private parts, and nobody asks you to.
• Nobody takes photos of your private parts or shows you pictures of private parts.
• You can say no, even to a grown-up you know.
• If someone breaks a rule, tell a safe adult, even if you were told not to.
• It is never your fault, and you will not be in trouble for telling.

Practise the rules through short role plays and a social story read regularly, not only once. Children with language difficulties may need to rehearse the actual words or a sign for 'no' and 'stop' many times before they can use them under stress.

A circles visual helps a child understand who is who. Draw the child in the middle. The first circle holds the few adults who may help with bathing and toileting, named with photos. The next holds people the child may hug, such as grandparents, if the child wants to. Further out come people we greet with a namaste or a handshake: teachers, neighbours, the watchman. The outer ring is strangers.

From the circles, pick three or four safe adults the child can tell about anything, at home and at school, and practise going to them. Include at least one person outside the household.

Then teach the difference between a surprise and a secret. A surprise is fun, like a birthday gift, and everyone finds out soon. A secret that must be kept from parents, especially about touching, photos or being alone, is never allowed. Families can make this a house rule: 'We do not keep secrets in our family, only surprises.'

Consent is learned through daily experience long before it is understood as an idea. Ask before helping: 'Can I help you with your shirt?' Tell the child what you are about to do: 'I am going to wash your back now.' Let them do as much as they can themselves, and respect a 'no' to hugs, tickling and cheek-pinching from relatives, even at a wedding.

Personal care deserves a written plan, especially as the child grows. It protects the child and the adults who help them.

• Name the adults who may help with toileting, bathing and changing, at home and at school.
• Agree that bathroom doors stay closed to others, and that care happens in private, not in front of visitors.
• Say which tasks the child is learning to do alone, and how help is being reduced.
• For older children, prefer a same-gender carer where the family and child want it.
• Put the plan in writing for the school, the shadow teacher and any professional in the home.

The guide to shadow teacher roles and responsibilities covers what should be agreed in writing at school, and safeguarding a child in a private home covers the household rules for professionals who work there.

The skills are the same for every child; the teaching changes. Most children with special needs learn best from pictures, short scripts, role play and practice in the real setting, repeated many times over months. The table shows how each skill can be taught.

Teach in small doses, a few minutes at a time, and return to it every few weeks. The same approach carries into adolescence, which the guide to puberty and teenagers with special needs takes further.

There is no list that proves abuse, and many of these changes have other explanations, from illness to a new teacher. But a change in the child is worth taking seriously, especially where the child cannot explain it. Note the date and what you saw, and raise it with the child's paediatrician and, where relevant, the school.

• A new fear of a particular person, place, vehicle or room.
• Sudden changes in sleep, toileting, eating or behaviour with no clear cause.
• Pain, marks or soreness around private parts, or unexplained injuries.
• New sexual words, knowledge or behaviour that does not fit the child's age or understanding.
• Gifts, sweets, money or phone use from someone outside the family's agreed circle.
• An adult who seeks time alone with the child, or resists open doors and visits.

Online contact can be part of the picture too; online safety for children with special needs covers that side.

How an adult responds in the first minutes shapes whether a child ever tells again. Your job is not to investigate. It is to listen, keep the child safe and pass the matter to people whose job it is.

1. Stay calm, even if you feel shocked; the child will read your face.
2. Believe them, and say so: 'Thank you for telling me. You did the right thing.'
3. Let them say what they want to say; do not ask the same question again and again, or suggest names.
4. Write down, as soon as you can, exactly what the child said and did, with the date and time.
5. Keep the child away from the person concerned.
6. Report it to the police or the child helpline, and seek medical care if the child may be hurt.
7. Tell the school or agency if the person works there, and keep a record of who you told and when.

The police and the child helpline can explain what the law requires and what happens next; a lawyer can advise on your family's situation. When a family chooses a professional to work with the child, vetting matters: Special Minds, for example, holds a separate interview on safeguarding, speaks to at least two referees and runs background verification where available with consent, as set out on its safeguarding page.