Failure to prevent physical child abuse despite detection of risk factors at birth and social work follow-up

Paediatric nurses' identification of violence against children

AIM

This paper is a report of an evaluation of paediatric nurses' assessment and diagnostic skills and interventions used for child maltreatment.

BACKGROUND

The use of violence against children occurs in all environments worldwide. Therefore, broader theoretical and practical knowledge related to this issue is needed in health care to facilitate more accurate identification of child maltreatment in order to instigate implementation of appropriate care for these children.

METHODS

The study was based on cross-sectional data obtained with a convenience sample of 160 Registered Nurses employed at paediatric wards at two large cities in Poland (response rate 80%). Data collection took place between December 2005 and March 2006. The research tool was a questionnaire form designed on the basis of international literature concerning battered child syndrome.

RESULTS

Battered child syndrome seems to be a relatively common phenomenon, as a great majority of participants (86·25%) had encountered it in their practice. The form of child maltreatment which was most often mentioned (by 30·00% of participants) was neglect. Almost three-quarters of the nurses (61·25%; n = 98) said that they had been involved in providing care for a maltreated child.

CONCLUSION

Nurses should work with maltreated children on an individualized basis, combined with interdisciplinary cooperation with specialists from related disciplines concerned with the issue. There appears to be a need for specialized training for nurses to increase their competence in working with maltreated children and their families.

Identification of child maltreatment while caring for them in a university hospital

The purpose of the study was to look at how nurses and physicians of a university hospital rated their ability to identify child maltreatment while caring for those children. In this study, child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child under the age of 18 by parents or caregivers. The total population of staff caring for children (N=513) in a university hospital were surveyed. Data were collected with a questionnaire developed for this study with reference to the literature. Altogether 317 questionnaires were returned, which yielded a response rate of 62%. The data were analysed using statistical methods and quantitative content analysis. Forty per cent of the respondents estimated that they had never cared for a maltreated child. Two-thirds of the respondents believed that they would be able to identify a child maltreatment case. The most distinct signs by which maltreatment could be identified were fractures, multiple bruises and the fact that the child had frequent injuries. The child's or parent's behaviour often aroused suspicion of maltreatment. Seventy-one per cent of the respondents rated the identification of maltreatment as rather difficult or difficult. Awkwardness of the phenomenon, the staff's pressure of work and relative unfamiliarity with the phenomenon were assessed as things that make the identification difficult. The fact that no jointly agreed guidelines were available for handling the matter was seen as a particular weakness. The respondents had fairly much theoretical knowledge about child maltreatment. However, child maltreatment is a multi-dimensional phenomenon that calls forth emotions. The development and improvement of practical nursing and medical care and of staff collaboration require that education be provided to different occupational groups and parties caring for children and that jointly agreed hospital-specific and regional models for operation be developed.

Unintended childbearing, maternal beliefs, and delay of prenatal care

BACKGROUND

Delay of prenatal care is an important risk for poor birth outcome, yet its association with maternal knowledge and beliefs remains insufficiently studied. This research examined the relationship of unintended childbearing and beliefs about the importance of prenatal care with initiation after the first trimester, adjusting for key sociodemographic determinants.

METHODS

One hundred fifty-four Texas hospitals accounting for 80 percent of state births were asked to collect surveys from all women delivering infants during a one-week interval in 1986. Seventy-four percent of hospitals and 70 percent of women participated (n = 2032). No differences occurred between the sample and the population on rates of delayed care and low birthweight or maternal demographics.

RESULTS

Since delayed prenatal care is more frequent among low-income women, analyses were limited to those below the 200 percent poverty level. After adjustment for maternal age, marital status, education, parity, race, and health insurance status employing logistic regression, unintended births were 1.6 times more likely to involve delayed care. Mothers who believed prenatal care was unimportant were 2.1 times more likely to delay care. These coefficients exceeded or about equaled those for the covariates.

CONCLUSIONS

Preconception education about the value of prenatal care and family planning programs to prevent unintended pregnancies should be conducted together with efforts to overcome financial and structural barriers if progress toward national prenatal care objectives is to be achieved.

[Evaluation of the psychosocial care in maternity: experience at the Poitiers University Hospital]

BACKGROUND

High psychosocial risk pregnancies require specialized multidisciplinary help and follow-up in order to improve the outcome of babies.

POPULATION AND METHODS

Thirty pregnancies were selected among 3500 and followed by a multidisciplinary team during 1990 and 1991. Evaluation included risk predictors, neurodevelopmental outcome of children at 9 and 24 months, number and time of judicial notifications. Evaluation of the mother-to-baby relationship by a psychologist as well as the environmental variables were performed.

RESULTS

Four families had one or two, 20 families three or five and six families, six or more of the 15 risk predictors studied. Over the babies followed-up until the age of 24 months, four were placed out of the family, three hospitalizations were medically unjustified and there was no hospitalization for child abuse or neglect. Twelve children had development delay and two developed an environmental-related staturo-ponderal delay. Judicial notifications were realized 18 times during pregnancy or just after delivery and six times during the follow-up for child abuse and neglect.

CONCLUSIONS

Taking care of high psychosocial risk pregnancies could be improved in special hospitalization units for mother and child. A better awareness of this problem could also improve the outcome of children, which remains very alarming.