134 battered children: a medical and psychological study

Unusual injury? Recent injury in normal children and children with suspected non-accidental injury

Four hundred normal children aged between 2 weeks and 11 years were examined to determine the prevalence and site of recent injury of any type. There was evidence of injury in 37% with a steady increase in prevalence to 60% by the end of the third year of life. Bruising of the hands and feet and of the lower legs was the most frequent type of injury. Head and facial injuries were most common between 18 months and 3 years (17% of children) but were rare at other ages. Injury to the lumbar region was unusual before 5 years but was present in 14% of children of school age. In 84 children of similar age where non-accidental injury was proved or suspected a different pattern of injury was present. Sixty per cent had injuries to the head and face; this increase in prevalence was seen at all ages. These children also had more frequent injuries in the lumbar region, particularly before the age of 5 years.

Neonaticide, infanticide and child homicide

A total population study of neonaticide, infanticide and child homicide is reported. There are seven defineable syndromes of unlawful child killing which include: neonaticide, infanticide, non-accidental injury, the deprivation-starvation syndrome, euthanasia, killing of family members followed by the suicide of the killer, and child murder. 49 such cases are reported from a base population of 2 million people, over a 10-year period of investigation. The syndromes of neonaticide and non-accidental injury each contribute some 20 per cent of cases in the full spectrum of unlawful child killing. 18 cases of fatal non-accidental injury were reported over this time. With modern crisis intervention facilities, standard hospital rules for the management of acute cases of non-accidental injury, and co-ordinated child abuse centres, approximately 2 per cent only of non-accidental injury cases should come to a fatal conclusion.

Developmental effects of child abuse: a review

Most research investigating the effects of physical child abuse on children's development has been based on uncontrolled or poorly controlled studies having small samples, no long-term follow-up, and weak instrumentation. These studies, as well as some which have been more carefully designed, have generally suggested seriously detrimental developmental consequences in physical, intellectual, behavioral, and emotional areas. Some recent controlled follow-up studies challenge such a negative picture of abuse. In particular, a study by Elmer, which is probably the most carefully conducted study yet done, found that the harmful effects of abuse dissipated years after the abusive incident and that socioeconomic status (SES) and related factors may be more important than abuse in determining the course of child development. To improve the quality and clarity of future research on developmental effects of child abuse, this paper discusses, in four major areas, problems which plague the research.

DEFINITION

The extent, type, and frequency of abuse should be more carefully defined to allow studies to be compared. The types and amounts of social service interventions should also be specified. Generalization: Research should include more middle and upper SES children, more of the mildly and moderately abused, and more neglected children to allow generalization to the total population of maltreated children. Causality: Since developmental deficits may be the cause as well as the effects of abuse and because outside factors such as SES may lead to both the abuse and the deficits, there is a need for large-scale longitudinal studies which can untangle the cause and effect web of abuse by following children from birth and measuring many factors which might affect development (e.g., SES, birth abnormalities, abuse).(ABSTRACT TRUNCATED AT 250 WORDS)

Objective birth data and the prediction of child abuse

The Cardiff Births Survey contains objective data that are easily collected and are reproducible between observers. We have compared survey records of 80 abused children with those of 80 control children. Of 44 factors that were examined 11 were appreciably more common in abused children. Such factors included the fact that the baby was preterm and had been admitted to a special care baby unit. Other factors were young maternal age, marital instability, low social class, and maternal smoking. 66% of abused children had at least 5 of these factors compared with only 16% of the control group.

Medical histories of abused delinquents

The medical histories of 12 abused and 69 nonabused incarcerated delinquent children from the same geographic area were compared. Children who were abused had significantly more hospital visits, emergency room visits, ward admissions, accidents, (especially head and face trauma), and respiratory illnesses through age 16. Perinatal difficulties and psychiatric symptoms were more prevalent in the histories of abused delinquents than in those of nonabused delinquents. The authors discuss the role of child abuse in the development of serious delinquent behaviors.

Narcissistic traits in certain abused children

Three groups of severely abused, emotionally disturbed children are described, one of which is made up of "private" children, who seem to share many of the characteristics of the adult narcissistic personality disorder. These children appear pleasant and tractable, seem better adjusted, and are rarely referred for treatment; they are remarkably able to assess their environment and made predictions. However, they remain aloof, fear dependency, and are unable to form meaningful relationships. The therapy of one such child is described in detail.

Separation and other stress in child abuse

80 children who had been abused by their parents or caretakers were examined for separation experience early in life and for other stress factors within their families. Although early separation of parent and infant was common in abusing families, combinations of other stresses and conflicts were also present. These were considered to have predisposed towards the battering.

Disturbance in parent-child relationship following preterm delivery

Increasing concern is expressed that the psychosocial development of preterm infants may be hindered by a disturbance of parental attitudes following the initial period of specialised care. Attitudes of parents of 17 preterm infants were compared with those of parents of 17 full-term infants at a single semi-structured interview six to 20 months after the birth. The groups of parents were matched for parity and did not differ in their social, ethnic and educational backgrounds. There was evidence of some disturbance in parent-child relationships in the preterm group, consisting of delays in maternal attachment to the child, negative maternal perception of the child compared with expectation of an 'average' baby, and persistent parental anxiety about leaving the child with a baby-sitter. In addition, two preterm children had been abused or neglected. Parental reaction to a preterm birth is discussed and the need for adequate support to be given to parents in the early period following the birth is stressed.

One hundred and eighty-seven cases of child abuse and neglect

The case histories of 187 abused and neglected children, admitted to the Royal Alexandra Hospital for Children over a three-year-period, were reviewed. Multiproblem families from the lower socioeconomic groups predominated, reflecting the hospital's geographic catchment area. Eight children died and 30 were made state wards. A high proportion of mothers described problems during the pregnancy, a difficult delivery and neonatal problems. The majority of parents in this study were married and had small families. First-born male infants of young isolated mothers were found to be at greatest risk of child abuse and neglect.

Non-accidental injury: a two-year study in central Liverpool

In the two years following the implementation in Liverpool of a case conference system for dealing with non-accidental injury to children, 76 children were discussed at 73 such conferences. Factors in both the children and their families were identified as predisposing to non-accidental injury, notably male sex, illegitimacy, low birthweight, previous injuries in the children, the mothers having become pregnant at an early age, and the families having environmental stress factors. The evolving rôle of the case conference system in providing support for affected families is discussed.

Review: battered children, their parents, treatment and prevention

This paper reviews the literature on battered children, their parents, management, treatment and prevention. The work suggests that socioeconomic factors are less important than the psychology of the parent, who has often been a battered child himself. Management and treatment of the syndrome in the UK and the USA are indicated. The paper concludes with an outline of the preventive and research projects in the field.

Epidemiology and family characteristics of severely-abused children

Severe child abuse in north-east Wiltshire was studied retrospectively during the period 1965-71, and prospectively for 18 months from January 1972, after a period of consultative activity with those actively involved to increase awareness of the phenomenon. Severe abuse was strictly defined. A rate of 1 per thousand children under four years old was obtained, together with a death rate of 0-1 per thousand. The families of the retrospective series of abused children were studied in detail and identifying characteristics of large family size, youthfulness, low social-class, instability, and gross psychiatric, medical, and social pathology described. The implications of the ascertainment and death rates are discussed in relation to data from some other studies, and the need emphasized for detailed studies of the apparent clustering of disorder in the families, using linked record systems.

Inflicted burns and scalds in children

Ten children who had been burnt and six who had been scalded by parents or those caring for them were seen over three years. In no case did the thermal injury affect more than 5% of the body surface and there were no deaths. In seven the perineum or buttocks were in the burnt area. In 12 children there was evidence of other inflicted injury including six recent fractures. Staff caring for burnt children should be aware of this type of inflicted injury. X-ray skeletal surveys should be carried out in doubtful cases and a case conference initiated with the appropriate social work services to consider supervising the family after the child's discharge or taking legal care proceedings.

Microcephaly following baby battering and shaking

Three cases of microcephaly following the rough handling of babies are described. If detailed social and psychiatric information had not been available, these three children would have become part of the large proportion of individuals in subnormality hospitals who have unsatisfactory and incomplete diagnoses.