General practice observed. Child abuse and general practice

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.

Postneonatal mortality in children from abusing families

The postneonatal death rate was studied for 332 infants from 160 families, ascertained through an abused proband. There were nine deaths compared with 2.9 expected from the legitimacy, social class, age, and parity distribution (p = 0.003). All but one of the babies died at home, and all were referred to a coroner or procurator fiscal. No adequate explanation of death could be found in four cases. Bonding problems probably existed in most of the nine families before death occurred.

Separation at birth and the mother-child relationship

Mother-child relationships were investigated between: (a) 32 mothers and their singleton children with birthweights of 2000g or less who had been separated immediately after birth for a minimum period of 17 days (index families), and (b) 32 control mothers and their singleton children, matched with index cases for type of residence, sex and month of birth, but who had not been separated at birth and whose birthweights were 2700g or greater. From interview, validated by questionnaire and semantic differential scoring, six of the index mothers, but none of the control mothers were assessed as having rejected their children. Comparisons were made between rejected and non-rejected index children. Rejection occurred more commonly in the low-birthweight group if the mother had been a teenager at the birth of her first child or of the study child, especially if she had not planned or wanted the pregnancy. The mothers of rejected children tended to have had poor relations with their own fathers, were unhappy with their life-style, and perceived their children as having difficult or unlikeable personalities. The rejected children were more likely to have had poor health, severe temper tantrums, and to cause their mothers concern over their poor appetite.

Non-accidental injury in children. Memorandum of evidence to the Parliamentary Select Committee on Violence in the family

Historically, in mediaeval times, the epoch of childhood was less clearly defined. If babyhood was survived, all but the most favoured children became little adults and a convenient source of labour. Instances of the barbarous treatment of children, infanticide, exploitation, starvation, flogging and mutilation, abound (Mause, 1976) and until comparatively recently these seemed to have caused little public reaction.

Predicting child abuse: signs of bonding failure in the maternity hospital

Fifty children referred to the Park Hospital because of actual or threatened abuse were compared with 50 controls born at the same maternity hospital. Five factors were significantly more common in the abused group than among their controls: (a) mother aged under 20 at birth of first child, (b) evidence of emotional disturbance, (c) referral of family to hospital social worker, (d) baby's admission to special care baby unit, (e) recorded concern over the mother's ability to care for child. Thirty-five of the abused group had two or more of these factors compared with only five of the control group. As these data were collected from information recorded routinely at the maternity hospital, it is possible to identify most abusing families when the child is born. Such identification must lead to a comprehensive assessment of each case followed by constructive preventive action.