Part 4: Specific support needs and concerns 157 National Guidance for Child Protection in Scotland 2021 Version 1.0 September 2021 When obesity is a cause for escalating concerns about risk of harm 4.161 Severe obesity is not an automatic flag for child protection concerns. However NHS Scotland Standards (2019) have been developed in recognition of the complexity of the condition and in view of some situations in which significant harm or death may result from neglectful circumstances. Article 19 of the UNCRC requires public authorities to take all appropriate measures to protect and support children while in the care of parents and others, from a broad spectrum of harm including negligent treatment. 4.162 A child’s health condition and sustained recovery is likely to be influenced by a complex interaction of factors such as physical, emotional and cognitive abilities, environmental, familial and social issues. Professional curiosity is necessary and practitioners should be alert to the possibility of neglect and need for support due to an interaction of such factors. 4.163 If efforts by health services to provide information, guidance and support have been unsuccessful due to avoidance, hostility, denial, inability or unwillingness to follow essential clinical advice to prevent harm, these would be strong indications of the need to escalate concern. It will be essential to understand and address the barriers to teamwork around the child’s or young person’s needs, without delay. Resources and References – Obesity Child sexual abuse 4.164 Definition. Child sexual abuse (CSA) is an act that involves a child under 16 years of age in any activity for the sexual gratification of another person, whether or not it is claimed that the child either consented or assented. Sexual abuse involves forcing or enticing a child to take part in sexual activities, whether or not the child is aware of what is happening. 4.165 For those who may be victims of sexual offences aged 16-17 and who are at risk of significant harm, child protection procedures should be considered, and must be applied when there is concern about sexual exploitation or trafficking. 4.166 Article 19 of the UNCRC sets out requirements on public authorities to take appropriate protective measures. These include appropriate legislative, administrative, social and educational measures to protect the child from sexual abuse; support for the child and for those who have the care of the child; as well as forms of prevention, identification, reporting, referral, investigation, treatment and follow-up. 4.167 Sexual abuse may involve physical contact, including penetrative or non-penetrative acts. They may include non-contact activities, such as involving children in looking at, or in the production of, indecent images, or in watching sexual activities, using sexual language towards a child, or encouraging children to behave in sexually inappropriate ways. Children who experience sexual abuse may experience multiple forms of abuse and neglect within and beyond the family. 4.168 Overlapping categories of sexual abuse are represented in the diagram below. All require a child protection response. A child may experience multiple forms of maltreatment from different persons. Exposure to other forms of harm, such as domestic abuse or parental alcohol and drug use, may increase vulnerability to sexual abuse.