Problems im the identification of child deprivation

Abstract

The last decade has seen a remarkable advance in the breadth and depth of understanding of non-accidental injury, and the gradual, painful and not always edifying development of community codes within which to resolve the ethical dilemmas of diagnosis and management. However, in relation to the wider field of child deprivation and neglect this process has barely begun, though the Children and Young Persons Act in 1969 accepted “avoidable prevention or neglect of the child's proper development, or impairment or neglect of his health” as valid alternatives to ill-treatment on which to base court proceedings. Obvious problems arising in this area include the practical difficulties of quantifying a child's emotional or intellectual development and of judging whether it be impaired, and if so, how far such impairment can be regarded as attributable to action or inaction by the parents and whether such parental contribution was “avoidable” and hence culpable. In the case of physical development, measurement at least is reasonably simple, though the interpretative difficulties remain. Height and weight can define a child's physical status in relation to a comparable population of normals; but two major difficulties arise. Firstly, it may be necessary to obtain serial measurements in order to define the dynamics of the situation; and secondly, complete elucidation may require a study of the child's progress in a controlled environment, that is, other than his own home. Clearly, it is precisely those parents who are most conscious that their care of their child has been inadequate, or suspicious that it may be judged so by others, who are least likely to co-operate with procedures which may result in establishing culpability. It is with the problem of these recalcitrant families, a special section of a broader group, that I am presently concerned. Their numbers are by no means negligible; during a two-year period they have constituted about one fifth of all the families (and a higher proportion of the children, since the pattern tends to be repeated consistently throughout a sibship) presenting to my paediatric service with problems of child abuse.