Over a million people in the UK have a visible difference. People with a visible difference or disfigurement often report feeling self-conscious and isolated, and deal with bullying, stereotyping and low expectations from others.
These feelings and experiences may be shared by children and young people with visible differences in your school. However, there are many things you can do as a teacher or education professional to support pupils to overcome these challenges.
On this page, we provide some information about visible difference and its impacts, and how you can overcome the social challenges it may pose in your school.
At least 1.3 million children, young people and adults in the UK are estimated to have visible differences, including 569,000 with a facial visible difference – that’s one out of every 111 people in the population.
They all have to live with a face or body that attracts attention and the stigma our culture associates with visible difference and disfigurement. They often report feeling self-conscious, isolated and friendless, facing teasing, ridicule and staring in public, low expectations in school, problems getting work, and stereotyping in the media because of the way they look.
The Equality Act 2010 recognises “severe disfigurement” as a disability. While there are many that would prefer that disfigurement (or visible difference, as we prefer to call it) was not considered a disability, this is the part of the law that protects those with a visible difference.
What causes visible difference?
There are many reasons why a child or young person can have a visible difference:
Born with a condition, for example, birth mark, cleft lip, Apert syndrome, Saethre-Chotzen syndrome.
Traumatic injury, for example, a burn or dog bite.
Illness – visible difference resulting from the illness itself or its treatment, for example, cancer.
A condition that develops during childhood, for example, psoriasis.
Some conditions are permanent and relatively stable (for example, loss of an eye, facial paralysis). Others change over time (for example, eczema, vitiligo, acne).
How are visible differences treated?
Medical treatment can include:
Surgery to graft or remove bone or other tissue, for example, to repair a cleft palate or help a burn to heal.
Laser treatment, for example, to reduce birthmark.
Ongoing management, for example, eczema, burn scars, craniofacial condition.
Surgery and other treatments can make conditions less conspicuous but complete transformations are rare. For many conditions there is no medical intervention that can remove or reduce the visible difference or disfigurement. However, that does not mean that there is nothing that can be done to help. For example, attending support groups or meeting with a trained therapist can make a significant difference.
Also, how visible difference and disability are perceived is very important. Most models of inclusion ascribe to the social model of disability which means that the problem is with the environment and those in it and not with the individual with the visible difference.
UK children, young people and adults
have a visible difference
people in the UK
have facial visible differences - that's one in every 111
How might a visible difference affect a child?
It might seem that children with the most severe visible difference or disfigurement will be the most adversely affected, but research shows that this is not so. A pupil may be seriously affected by their changed or changing appearance, even though it does not look so very bad to you or others.
Research also shows that discomfort around a child with a facial visible difference increases with age: older children tend to be less accepting.
Visible differences and disfigurements of the face or hands are particularly noticeable, but other parts of the body will also be on show at times. Summer clothes, swimming and getting changed for sport can trigger curiosity or staring, even from good friends and familiar classmates. Conditions such as cerebral palsy or scoliosis, affecting a child’s posture or movement, may also trigger staring, name calling and curiosity in others.
Even though others may not consciously intend to treat a person differently or less favourably when they have a visible difference, due to unconscious or implicit bias, almost all people do, especially upon first meeting them.
Whatever the cause and the apparent severity of a child’s visible difference, they may experience a number of challenges:
Out and about in public places such as supermarkets or on public transport – other people look and stare, pass comment, ask questions, or give advice. Having an illness, injury or condition that affects the way you look deprives you of the ordinary social anonymity others take for granted when we go out.
Meeting new people – the noticeable feature is distracting, particularly if the eyes-nose-mouth “communication triangle” is affected. New people may either be over-focused on the visible difference or determinedly try to ignore it – in either case, it is hard to “act natural”.
Underachievement in education and working life because of:
Lowered self-esteem due to lack of confidence in social interactions because of reactions to visible difference outlined above
Lowered expectations because of a prevailing social myth that a child with a visible difference doesn’t have much of a future
Discrimination throughout society in favour of people with conventionally “attractive” facial features.
Why are children with visible differences stigmatised?
The usual first “lesson” most of us learn about visible difference will have taken place when we were quite small and saw someone who looked unlike anyone we’d ever seen before. As young children do, we immediately asked whichever grown-up was with us, “Why is that man’s face like that?”
This kind of question invariably brings a stern response – “Shhh! It’s rude to stare!” The outcome, over time, is that while visible difference is typically associated with reactions such as surprise, concern, and curiosity, there is also a strong general rule – a taboo – against asking or talking about it.
At the same time, human beings have an enormous capacity for noticing and remembering faces, identifying likenesses and recognising people we haven’t seen for ages. Appearance matters to us – we don’t look and react as we do to a person with a visible difference because we’re rude (although some reactions are excessive and unnecessary), but simply because we’re human.
In the absence of a free flow of questions and answers when someone has a visible difference, our imagination tends to step in. Common myths about visible difference and disfigurement include imagining that:
Someone who looks like that cannot have a happy, fulfilling life.
Plastic surgery can make it go away.
Appearance doesn’t matter because it’s the inside that counts.
Myths like these make it much harder to meet and get to know a child or young person with a visible difference.
Overcoming the social challenges of visible difference
The most commonly expressed concerns of children and young people with visible differences and disfigurements are:
Other people’s embarrassment.
Reactions, including staring, comments and questions about their appearance.
Teasing, name-calling and ostracism.
It is not the visible difference that creates barriers but people’s responses to visible difference – as outlined in Changing Faces founder James Partridge’s 1990 text, Changing Faces: The Challenge of Facial Disfigurement. This is a very important research finding because it opens up the possibility of devising social interventions which enable barriers to be overcome.
Approaches children with visible difference can take
On one side, the child or young person with the visible difference can learn to deal positively with other people’s preoccupation with or avoidance of their appearance.
This is best achieved if they learn to take the initiative by saying something to acknowledge the reaction of surprise or curiosity and enable others to “see” them as the ordinary person they are.
On the other side, we can all learn something more socially useful than, “It’s rude to stare.”
Particularly in our media-dominated and style-conscious culture, we can all benefit from learning to see the “whole person” – seeing how people look but without judgement and combining what we see by way of appearance with what we discover by making eye contact, perhaps with a smile, and exchanging a few words.
The guide on working inclusively with groups outlines learning activities to help children and young people to develop their powers of perception, expression and communication in the important areas of appearance, personality and difference. Again you can find three versions of this guide, one for each age-group.
As well as being the place where children and young people come to learn, early years settings, schools, and colleges provide ideal social environments for addressing the challenge of visible difference.
How our guides will help you overcome these challenges
Our series of guides will enable you to:
Address everyone’s real reactions of surprise, concern and curiosity.
Teach the child or young person you are working with to acquire a better understanding of other people’s reactions to the way they look, develop resilience and learn a range of social skills which help to deal with these reactions.
In this way everyone can learn to deal with visible difference with greater confidence.
Resources for parents and carers
We have a list of books, TV and film and toys which parents and carers can use to explore difference with children. The resources are handpicked by Changing Faces ambassadors and campaigners and may also be of use to parents of children with visible differences. Feel free to share a link to the page with parents and carers.
Visible difference and the law
The Equality Act 2010 establishes severe disfigurement as a disability. As with many people who are considered to be disabled by the Government and the Disability Rights Commission, children and young people with visible difference may not consider themselves to have a disability. However, the legislation still applies.
A person is considered to be disabled (and covered by the legislation) if they have a disability or long-term illness that has an impact on their day-to-day life, and this includes severe disfigurement (although at Changing Faces we prefer to talk about “visible difference”).
What this means for early years settings, schools and colleges is that it is unlawful to discriminate against a pupil with a visible difference in respect of
Education and associated services, covering all aspects of school life
A pupil with a visible difference can be discriminated against if:
The child receives less favourable treatment at school than other children because of their visible difference.
The school has failed to make a reasonable adjustment to ensure that the child is not at a substantial disadvantage compared with other pupils, because of their visible difference.
A child or young person with a visible difference might be at a substantial disadvantage if, for instance, their experience at school provides less opportunities or facilitated less progress than other pupils, or entailed indignity or discomfort or required more effort than was the case for other children.
The legislation requires education providers to think ahead, and keep their policies, preparations and provision under review. Early years settings, schools and colleges have an anticipatory duty towards all pupils and potential pupils with a visible difference (even if they do not see themselves as disabled, as explained above).
The Equality and Human Rights Commission has a lot of useful information about the rights of people with disabilities as well as specific resources for use with children and young people.
To help you in your work with a child or young person who has a visible difference, and with all the children or young people you work with, use the guidance for meeting the needs of children and young people with special educational needs and disabilities in your part of the UK.
Education and visible difference
To enable a child or young person with a visible difference or disfigurement to enjoy and achieve in early years, school or college, be healthy and safe, and to be enabled to make a contribution and achieve economic well-being, you and your colleagues will need to undertake some preparation and to make some adjustments.
Staff need a basic understanding of the basic psychological and social issues that arise for everyone when someone has a visible difference.
Anticipate the curiosity and the questions that children or young people will experience and prepare responses which will be socially positive for everyone.
Carefully monitor social interactions among pupils.
Develop interventions to discourage teasing or ostracism and facilitate positive social interactions.
If required, create special opportunities for a child or young person with a visible difference to discover and practise better social interactions, including positive responses to other people’s reactions to their visible difference.
Identify signs of low self-esteem and build good self-esteem, a positive self-image and resilience.
Work closely with parents and with other professionals, if involved, to ensure good care and support if required and good transitions; for example, if the child or young person is away receiving medical treatment and then returning to school, and when moving to a new school.
Ensure learning activities and resources enable children and young people to go beyond stereotypes around appearance, difference and disfigurement.
All these actions and adjustments are covered by the guides to help you plan, prepare and provide inclusive learning experiences, both socially and academically. Changing Faces and University College London have also produced some resources for use with staff and children and young people, which you can view on our resources page.
Using our guides
The guides cover three age groups – early years (3-7 years), junior (7-11 years) and secondary (11-16 years). For each age-group there are twelve guides which aim to address all the different questions and concerns that may arise when working with a child or young person who has a condition, illness or injury that affects the way they look.
Starting early years or school
Working with parents and siblings
Working collaboratively with other professionals
Working inclusively with groups
Having something to say
Building self-esteem and resilience
Practical support with social skills
Teasing, name-calling and bullying
Addressing speech and language difficulties
Choosing and using resources
Moving on (primary school, secondary school, college and work)
We have made the guides as brief and accessible as we can so that you can find what you need without having to work through a lot of other material. Each one aims to be both informative and practical so that you can approach the challenge of visible difference knowledgeably, sensitively and effectively.