Unemployment and child abuse.

The employment state of men living in the homes of children at the time that child abuse was diagnosed was determined. The series included a wide range of abuse, including non-accidental injury, failure to thrive, neglect, and emotional deprivation. Two cohorts of children seen during 1974-9 and 1980-5 were compared; these periods were chosen because a large increase in unemployment began in Sheffield in 1980. Although the proportion of the men without work was significantly increased during the second period, this increase could not be ascribed to the rise in either long term or short term unemployment among those who had previously been in regular employment. It was accounted for by a rise in the proportions of single parent families and families in which the resident man had never had regular employment. This may reflect an increase in pregnancies among young mothers. There was no evidence to support the belief that the loss of a job in otherwise stable families leads to an increase in child abuse.     

Collaboration between child psychiatry and medical genetics. Genetic diseases with an atypical beginning

When a children psychiatrist, faced to atypical psychological troubles, comes up against difficulties in establishing a precise diagnosis, he may consider a genetic etiology and ask for a genetic consultation. He may encounter many problems when he suggests this specialized consultation to the parents. These have often been prepared for a long time to the necessity of a psychiatric therapy in order to cure their child's troubles. The geneticist's diagnosis will induce the parents and the psychiatrist to have a different look on the child and mostly will set limits to the possibilities of treatment.     

Attendance of general practitioners at child protection case conferences.

OBJECTIVE--To investigate general practitioners'' attendance at and views on child protection conferences and their confidence in dealing with sexual abuse in children. DESIGN--Anonymous postal questionnaire sent to all general practitioners in Tower Hamlets and review of consecutive case conferences held by social services for three months in 1989. SETTING--Tower Hamlets health district. SUBJECTS--91 general practitioners, 56 of whom (62%) responded. MAIN OUTCOME MEASURES--Number of conferences attended, reasons for non-attendance, and reported confidence in dealing with sexual abuse. RESULTS--General practitioners estimated that 202 child protection conferences had been held in 1989 on their patients and that they had attended 85 of these. Information from social services for three months suggested that general practitioners had attended only nine of the 114 conferences reviewed. Timing of the conference was the most important reason for non-attendance. All respondents wanted access to the minutes of these conferences irrespective of their own attendance. Most general practitioners were very or moderately confident of their ability to detect child sexual abuse and non-accidental injury and to communicate with the family. CONCLUSION--More effort should be made to ensure that general practitioners are notified of case conferences and that the timing and location of conferences is compatible with their other commitments.     

Physical violence,child abuse,and child homicide

The study of child abuse and child homicide has been based on the often implicit assumption that there is a continuum of violence ranging from mild physical punishment to severe abuse and homicide. Empirical data supporting this assumption are sparse. Existing data can be shown, however, to support an assumption that there are distinct forms of violence, not a continuum. This paper reviews these data and discusses their implications for the study of violence, abuse, and homicide in terms of substantive and methodological explanations. In addition, the implications of the assumption that violence consists of distinct behaviors as opposed to a continuum are discussed in light of sociobiological and evolutionary explanations of child abuse and child homicide. This paper was written under the auspices of the Family Violence Research Program at the University of Rhode Island. A complete list of books and articles is available upon request. Richard J. Gelles is Professor of Sociology and Anthropology and the Director of the Family Violence Research Program at the University of Rhode Island. He is the author or coauthor of 14 books and more than 90 articles and chapters on family violence. His most recent books areIntimate Violence, published in 1988 by Simon and Schuster;Physical Violence in American Families: Risk Factors and Adaptations in 8,145 Families, published by Transaction Books in 1990; andIntimate Violence in Families, published in 1990 by Sage Publications.     

Human and animal research into sex-specific effects of child abuse

Child abuse is the most potent experiential risk factor for developing a mood disorder later in life. The effects of child abuse are also more severe in girls and women than in men. In this review, we explore the origins of this epidemiological sex difference. We begin by offering the hypothesis that a sex-specific risk factor that influences how social cues are perceived and remembered makes girls more susceptible to the effects of child abuse. We then discuss the neural systems that mediate emotion and stress, and, how child abuse and/or mood disorders like anxiety and depression affect them. Drawing upon human and animal research, several candidates for such a risk factor are discussed. They include glucocorticoid receptor trafficking and corticotropin releasing factor receptor binding and signaling. Our own research shows that the morphometry of the prepubertal amygdala is sexually dimorphic, and could contribute to a sex difference in stimulus appraisal. We have also found that the brain of juvenile female rats is less selective than males' for threatening social stimuli. Thus, one way that women may be more vulnerable to the effects of child abuse is that they are more likely to perceive objectively benign stimuli as threatening. This bias in perception could compound with the genuinely traumatic memories caused by child abuse; the burden of traumatic memories and the increasingly reactive stress response systems could then dispose more women than men to develop depression and/or anxiety.     

Malnutrition in infants receiving cult diets: a form of child abuse.

Severe nutritional disorders, including kwashiorkor, marasmus, and rickets, were seen in four children and were due to parental food faddism, which should perhaps be regarded as a form of child abuse. All disorders were corrected with more normal diets and vitamin supplements. In view of the potentially serious consequences of restricted diets being fed to children, families at risk should be identified and acceptable nutritional advice given. When children are found to be suffering from undernutrition due to parental food faddism a court order will normally be a necessary step in providing adequate treatment and supervision.     

Ethical use of covert videoing techniques in detecting Munchausen syndrome by proxy.

Munchausen syndrome by proxy is an especially malignant form of child abuse in which the carer (usually the mother) fabricates or exacerbates illness in the child to obtain medical attention. It can result in serious illness and even death of the child and it is difficult to detect. Some investigators have used video to monitor the carer''s interaction with the child without obtaining consent--covert videoing. The technique presents several ethical problems, including exposure of the child to further abuse and a breach of trust between carer, child, and the professionals. Although covert videoing can be justified in restricted circumstances, new abuse procedures under the Children Act now seem to make its use unethical in most cases. Sufficient evidence should mostly be obtained from separation of the child and carer or videoing with consent to enable action to be taken to protect the child under an assessment order. If the new statutory instruments prove ineffective in Munchausen syndrome by proxy covert videoing may need to be re-evaluated.     

Inhibition of mourning by pregnancy: psychopathology and management.

A bereavement during pregnancy is difficult to mourn: a pregnant woman is so increasingly preoccupied with the new life that mourning is interrupted and often impossible to resume later. This may lead to idealisation of the child as a reincarnation of the dead person or child abuse. A bereaved woman should be helped to mourn at the time of death and to keep alive the expectation of future mourning once her baby is thriving.     

Some experience in an area health authority child health clinic.

Three years'' experience as a doctor taking two clinics a week in an area health authority child health clinic was reviewed. A wide range of clinical conditions was seen, including: problems associated with feeding in breast- and bottle-fed infants; minor developmental abnormalities (mental, behavioural, and physical); surgical and orthopaedic conditions requiring treatment; medical conditions, mainly respiratory and alimentary infections, skin conditions, and problems of over-treatment for minor ailments; and minor genetic abnormalities. Mothers asked for advice on a wide range of topics, risks and benefits of immunisation being the most common. The clinic doctor needs a wide experience in paediatrics to deal with such problems. It is suggested that all lecturers in child health and paediatric and senior registrars should take one clinic a week for six months, and all medical students should attend some clinics as part of their paediatric training. Health visitors have an important role in helping the clinic doctor, but their training should be more realistic and appropriate facilities should be provided to keep them up to date in their work.     

Your child is dead.

OBJECTIVE--To determine parent''s views on how death of their children should have been handled. DESIGN--Retrospective questionnaire survey of parents who had experienced death of their child. SETTING--Charitable organisation of bereaved parents. SUBJECTS--150 bereaved parents, all members of the organisation, of whom 120 (80%) participated voluntarily in the study. MAIN OUTCOME MEASURES--Child''s age; date and cause of death; details of person breaking the news and handling of the interview; time parents spent with dead child, their attitude to requests for organ donation, and follow up support received. RESULTS--122 children''s deaths were described; the largest single group was due to road traffic accidents, 16 were suicides, and eight were murders. Twice as many interviews were rated as sympathetically or reasonably handled as badly or offensively handled (68 v 34). The interview ratings depended on the sensitivity and personal skills of the interviewers rather than on their previous contact or professional position; police were rated as more sympathetic than doctors and nurses. Of 109 respondents, 81 had seen their child''s body, 44 of whom thought that sufficient time had been denied. Of the 28 parents who did not see the body, 17 subsequently stated their regret. In 82 parents organ donation had not been discussed. Only 16 parents recorded any follow up support from hospital staff and very few support at the time. CONCLUSIONS--The consistency of the responses suggests a serious need to revise the in service training and education of the police and health professionals in their approach to informing of death; organ donation should be discussed sensitively and parents allowed time with their dead child with fewer restrictions.     

SOME VIEWPOINTS ON CHILD PSYCHIATRY

There is a great tendency in recent years to seek psychiatric answers to well-nigh all kinds of child problems. This tendency is seriously questioned. The average child has splendid capacities to solve his own growth problems, within the limits of home, school, neighborhood. Evidence accumulates that the average parent who seeks counsel has done a rather respectable job; that in his fear of setting limits because of “how the child will feel,” there is more of psychological threat to the child than in daring to comfortably move ahead and make some mistakes.Psychiatric treatment of a child implies that the child is unable to meet situations as adequately as other children. Such treatment should be reserved, in the main, for use in situations in which the psychiatrist and parents are willing to underwrite the implications of treatment. Treatment aimed at the vague goal of making the child “happier” is dubious. Treatment by a psychiatrist is presumably medical treatment and carries with it the advantages and disadvantages inherent in this fact. When given without carefully defining the reasons for it and the goals at which it is aimed, within medical framework, it is potentially an undesirable procedure.     

The Winnipeg Children's Hospital child protection centre: a provincial medical initiative.

The Winnipeg Children''s Hospital child protection centre is a hospital-based provincial protection program that focuses on the diagnosis, treatment and prevention of child abuse and neglect in Manitoba. The multidisciplinary group of professionals working in the centre differs from most hospital-based teams in that it has a strong government liaison both functionally and financially, has strong ties to the welfare system and has legal counsel relating to the court system. The centre represents the philosophy that medical participation in welfare matters relating to children need not be relegated to the sidelines. This paper describes the centre''s history and structure, and it outlines some of its research projects.     

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.     

Is there a link between cot death and child abuse?

Forty five babies delivered in Oxford obstetric units who subsequently died unexpectedly in infancy were compared with 134 controls matched for maternal age, social class, parity, and year of birth to see whether five factors identified in an earlier study as predictive of subsequent child abuse would also predict the sudden infant death syndrome. Epidemiological findings had suggested certain similarities between the two events. In contrast with babies who were abused, four of the five factors did not distinguish between babies who died suddenly and unexpectedly and their controls, but there was a slight increase in the proportion of mothers of babies who died suddenly and unexpectedly for whom nursing staff thought that support and advice on feeding the baby were needed. Factors predictive of child abuse did not predict sudden infant death in this study.     

Examining reluctance and emotional support in forensic interviews with child victims of substantiated physical abuse

Socio-emotional dynamics were examined in 230 forensic interviews of 3- to -13-year-old Israeli children who disclosed chronic physical abuse that could be substantiated. Half of the children were interviewed using the Standard (SP) National Institute of Child Health and Human Development Protocol and the others using the Revised Protocol (RP) that emphasized emotional support from interviewers. When children disclosed physical abuse in the RP interviews, they did so in response to fewer prompts than children in the SP interviews. The number of turns in the transitional phase (during which the interviewer transitioned from rapport-building to exploring the possibility of abuse) was associated with increased directness and more specific utterance types. The younger children displayed reluctance more than older children. The RP interviews were characterized by more emotionally supportive statements throughout. These findings highlight various aspects of child forensic interviews that should be considered when seeking to understand children’s willingness to engage with interviewers.     

Effect of number, order, and spacing of siblings on child and adult outcomes: an overview of current research

The impact of the number, order, and spacing of siblings on child and adult outcomes has been the topic of research by scholars in 4 separate fields (human biology, psychology, sociology, and economics), and the barriers to communication between academic disciplines are strong. Also most researchers have had to work with data sets gathered for other purposes. This has resulted in a relative inadequacy of research. Social scientists have 3 theories concerning the relationship between the number, order, and spacing of siblings and child and adult outcomes: that an increase in the number of siblings or a decrease in the spacing between them dilutes the time and material resources that parents can give to each child and that these resource dilutions hinder the outcome for each child; that account must be taken not only of parental resources but also of the resources given to each child by his/her siblings; and that there is no causal relationship between number, order and spacing of siblings and child outcomes and that any apparent relationships are spurious. In light of these theories, the question arises as to how should the sibling variables be measured. The most important aspect of sibling number is that it is a variable over time. Yet, the proper measurement of sibling number has an additional complication. According to all existing theories, the ages of the other siblings are relevant for the outcome for the given child. All of the relevant information is now available only when it is possible to construct a matrix in which the rows present the age of the given child and the columns the age grouping of the siblings for whom a count of sibling number will be made. Many such matrices could be developed, some much more elaborate than others. For illustrative purposes, Table 1 presents the matrix of the number of siblings for a child who is the first-born among 5 children, all of whom are spaced exactly 3 years apart and all of whom are financially dependent only up to exact age 21. Table 2 presents the matrix for the last-born child among 5 children with characteristics identical to those in Table 1. It can be inferred from these tables that the oldest child in the family, as compared to the youngest child, probably will suffer from a diminution of parental resources, most likely financial resources, in adolescence. The youngest will suffer from a reduction of parental resources, probably time resources, in infancy and early childhood. Research concerned with the consequences of the number and spacing of children should be based on data sets for which some version of this matrix can be constructed.     

Evidence on the impact of child labor on child health in Indonesia, 1993–2000

Despite an abundant literature on child labor in developing countries, few papers have attempted to investigate the consequences of child labor on health. This paper explores whether child labor affects child health using data from the Indonesian Socio-Economic Surveys during the 1990s. For our empirical analysis, we restrict our attention to children currently enrolled in school and we use several discrete indicators for health. Our results show that child labor is associated negatively with health. We obtain this result by introducing labor participation as an exogenous covariate in the different health equations. Similar results are found once the work decision is instrumented.     

Habilitation of Patients with Congenital Malformations Associated with Thalidomide: Psychiatric and Psychological Aspects

Nearly 100 cases of congenital malformations associated with thalidomide ingestion by the mother have been reported in Canada to the Department of National Health and Welfare. Depression and selfcastigation have been the specific psychiatric reactions noted, particularly in the mother. In most cases it is preferable psychologically for the parents and the child if the child is kept at home rather than placed in an institution. Parents should be fully informed concerning the child''s prognosis for future development. Most of the children followed up for about two years showed no intelligence defects. A prosthesis, if required, should be applied early (at three to six months) so that it may become a part of the child''s body-image, but it should not interfere with play activities. Assessment by a psychiatrist and a psychologist is indicated at about six months.     

Proximity to SNAP-authorized retailers and child maltreatment reports

The Supplemental Nutrition Assistance Program (SNAP) has been shown to have positive benefits for children. Families may face fewer barriers to accessing food they can purchase with their benefits if more stores in their neighborhoods accept SNAP benefits. We examine whether proximity to stores accepting SNAP benefits is related to child maltreatment (abuse and neglect) reports, particularly those potentially related to food insecurity. We combine geographically identified child maltreatment report data from the state of Connecticut from 2011 through 2015 with state SNAP-authorized retailer data. Using within-Census block group changes in the presence of a SNAP-authorized store, we find that in large, rural areas, one additional SNAP store is associated with a 4.4 percent decrease in the child maltreatment report rate (p < 0.05), and an 11.3 percent decrease in substantiated cases of maltreatment (p < 0.10), even net of changing zip code level factors and time-invariant neighborhood characteristics. The relationship between a neighborhood SNAP store and child maltreatment reports in these rural areas is largely driven by neglect, concentrated among young and school-aged children (ages 0–9), and primarily due to fewer reports by medical personnel. We find no effects of a neighborhood SNAP store on child maltreatment reports in smaller, more densely populated neighborhoods. Sensitivity checks affirm these results. Results indicate the benefits of access to SNAP retailers on the child welfare system and child well-being more broadly, especially in rural areas.     

Care of the diabetic child in the community.

Brief admission of the new diabetic child and of a parent to an enlightened hospital for stabilisation, preliminary education, and familiarisation with hospital and community staff is well worth while. The greater the demand for constant control of the highest quality, the greater the need for a close understanding of the psychosocial factors concerned and for clinical skill. The nature of the home and the family relationships should in theory be available from the child''s general practitioner at the time of the first referral since he has so much information about the whole family. With the virtual disappearance, however, of mutual consultation in the patient''s home in many places, the opportunity for oral communication has declined, and availability on the telephone is not always easy. The busy general practitioner (far less an unknown physician from a deputising service without access to the records) has little time to write a comprehensive letter. In practice a relatively small hospital-based mobile team of specially experienced sisters who are keen to communicate in the home, the GP''s surgery, and the school makes a major contribution to the diabetic care of a young population vulnerable to major handicap in what should be the prime of life. Their cost effectiveness may be difficult to prove but it is not at all in doubt--especially when the sisters as in this area deal in the community with a wider range of chronic illnesses and handicaps in children.