Child abuse

From Ganfyd

A case of a battered baby was first described by Caffey in 1946 although he did not draw the obvious conclusions.

Epidemiology

In the UK:

• 7% of children suffer serious abuse at the hands of carers and family
• 25% experience violence or abuse in the home

The mistreatment of children seems to be found in every national, ethnic and religious group when looked for. Recognition of its existence, on the other hand, varies widely.

Types of abuse

The categories under the Child Protection system are Physical, Sexual, Emotional, and Neglect.

• Physical abuse - is commonly referred to as Non-accidental injury.

• Sexual abuse
• Emotional abuse - eg rejection, isolation, terror or corruption. Manifests as clingy with relentless attention seeking, hyperactivity, sudden speech disorder, behaviour change or developmental delay.

• Neglect - indicated by poor personal hygiene and clothing, frequent accidental injuries, untreated medical problems.

David Southall used covert video surveillance to show that parents are sometimes responsible for apparent life threatening episodes.^[1] Meadow described bizarre symptoms in a child which turned out to be fabricated. Such cases are sometimes called Munchausen's syndrome by proxy, but it is unclear whether they are distinct from other cases of child abuse.

Risk factors

• unplanned pregnancy
• concealed pregnancy
• poor parenting experience
• parents under 21
• prematurity or low birth weight
• disabled child
• domestic violence
• unstable relationships
• mobile families (frequent changes of address)
• financial problems
• alcohol/substance misuse
• history of offending
• parental mental health problems
• significant life crises eg pregnancy, moving house
• animal abuse
• lower socioeconomic groups (serious abuse only)

Intervention

As Lord Laming's Climbie Inquiry noted, child abuse continues to be missed or ignored by agencies working with children, with sometimes fatal consequences.

Where abuse by a non-family member is suspected, then it is the police who take the matter forward as a criminal investigation. Where a close family member is suspected then a multiagency approach involving health, social work and police is necessary to assess the evidence, establish a place of safety for the child, and investigate further. If there is thought to be immediate risk, then the police have emergency powers to remove the child if necessary to a place of safety.

Prognosis

Previous abuse predicts future abuse. Children maltreated previously are approximately six times more likely to experience recurrent maltreatment than children who had not previously been maltreated. The risk of recurrent abuse is highest in the 30 days immediately after the first episode, then diminishes thereafter.

Four factors most consistently identified as predicting future maltreatment:^[2]

• number of previous episodes of maltreatment;
• neglect (as opposed to other forms of maltreatment);
• parental conflict;
• and parental mental health problems.

External links

• The National Association for People Abused in Childhood
• When to suspect child maltreatment: Guidance on when to suspect child maltreatment from NICE^[3]

References