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

A retrospective epidemiological analysis of non-accidental head injury in children in Scotland over a 15 year period

A retrospective analysis of the epidemiological characteristics of non-accidental head injury (NAHI) in children in Scotland over the last fifteen years from 1981 until March 1996 was performed. The information was provided by the Information and Statistics Division of the Scottish Health Service. The average incidence of NAHI calculated over this period was 0.04 cases per year per 1000 children under 5 years. Fifty-five per cent of all cases occurred in those children who were less than a year old. 41% of cases were inflicted by a parent but in 47% the perpetrator could not be identified. The mortality rate was found to be 2%. Non-accidental head injury cases identified using the ICD-9 coding classification system gives a surprisingly low incidence. This number is probably an underestimate and the reasons for this are discussed. A prospective epidemiological analysis of NAHI in children in Scotland is being undertaken to determine the true incidence.

Can infant death from child abuse be prevented?

OBJECTIVE

To assess the effectiveness of a child abuse surveillance and intervention program in protecting infants at risk.

DESIGN AND SETTING

A retrospective review of all children discussed by the Suspected Child Abuse and Neglect Team of the Mater Misericordiae Children's Hospital, South Brisbane, over the five year period January 1986 to December 1990.

PATIENTS

A total of 2126 children were discussed by the team; 375 were infants (less than 12 months of age) at the time of the initial discussion. Nine infants died suddenly and these nine deaths were examined in detail.

RESULTS

All deaths were considered initially to be due to sudden infant death syndrome (SIDS), but autopsy findings in six suggested death was not accidental and in the other three significant doubt was raised by the history. Identifying risk factors for non-accidental injury were clearly present in all cases; however, there were major problems with notification to the appropriate authorities. Even in cases where appropriate identification and notification occurred planned interventions by multiple agencies failed to prevent death of these infants.

CONCLUSIONS

There is a growing awareness of child abuse as a significant cause of morbidity and mortality in developed countries, but intervention is fraught with multiple difficulties and prevention programs are few. Recommendations are offered for improvement in recognition and notification of incipient child abuse as well as appropriate interventions to prevent infant deaths. Inappropriate death recording procedures may result in some sudden deaths being recorded as SIDS when in fact they are caused by child abuse.

Intervention with infants at risk for abuse or neglect

The need for direct services to infants at risk for abuse or neglect is addressed, with an emphasis on the advantages to the child of the integration of various modalities of treatment. The expertise of professionals who work with infants and young children in therapeutic and stimulation programs is required. Their experience also underscores the need for direct intervention in the parent-child interaction process. The developmental line of mastery and competence is reviewed with highlights of how this may be derailed in the at-risk infant. Finally, two suggestions are developed: that empathy might be taught to parents through an educational mode and that surrogate parenting, part-time, might be implemented routinely with mistreated children, at-risk infants, and perhaps for all infants.

Relationship between abortion and child abuse

Although permissive abortion has been advocated on the grounds it will reduce the prevalence of child abuse and infanticide, there is no evidence to prove it has. There is a growing concern that it may have contributed to the problem. This article outlines eight possible methods whereby an increasing rate of abortion will lead to an increasing rate of abuse. There is evidence that an abortion results in depression which hinders mother-infant bonding in a subsequent pregnancy. An abortion of the first pregnancy may interrupt the developing bonding mechanism and interfere with the ability to bond to the next infant. If the hypothesis is correct, medicine by endorsing abortion on request may be jeopardizing the safety and care of a large number of children.