Recognition Of Child Maltreatment Research Articles

Recognition of Child Maltreatment by Mothers Raising Infants Up to Four Months of Age and Types of Support Felt Necessary

Recognition of Child Maltreatment by Mothers Raising Infants Up to Four Months of Age and Types of Support Felt Necessary

Reducing Secondary Traumatic Stress and Fueling Knowledge of Child Maltreatment Among Health Care Providers.

Child maltreatment is widespread, and its victims are frequently treated by trauma providers. However, providers across disciplines report feeling ill-equipped to identify and treat victims of child maltreatment and also report high levels of burnout and secondary traumatic stress. This study aims to evaluate an intervention to improve health care provider knowledge, recognition, and reporting of child maltreatment and promote provider resilience as they care for victims of child maltreatment. This is a single-group pre/posttest study design conducted from April to October 2019 of an educational intervention addressing child maltreatment knowledge, recognition, and self-care strategies for providers. Baseline and 6-month post-event questionnaires evaluated child maltreatment recognition and reporting, and the Professional Quality of Life instrument was used to measure compassion satisfaction, burnout, and secondary traumatic stress. Statistical analyses were conducted to evaluate the impact of the intervention on participants' self-reported knowledge, compassion, burnout, and secondary traumatic stress. A total of 164 health care providers participated in the study; the majority were nurses (69.5%). There was a 51.2% response rate for the 6-month post-event questionnaire (n = 84). Health care providers' knowledge of child maltreatment recognition and reporting significantly improved from pre-event (Mdn = 24.0) to post-event (Mdn = 27.0), z =-6.4, p < .001, and significantly decreased in secondary traumatic stress pre-event (Mdn = 20.0) to post-event (Mdn = 17.5), z =-2.11, p = .035. No changes were noted in compassion satisfaction or burnout. Educational activities can improve provider knowledge and recognition of child maltreatment and facilitate secondary traumatic stress reduction.

Recognition of child maltreatment in emergency departments in Europe: Should we do better?

ObjectivesTo evaluate the different policies to recognize child maltreatment in emergency departments (EDs) in Europe in order to define areas of improvement.MethodsA survey was conducted on the recognition of child maltreatment in EDs in European countries with a focus on screening methods, parental risk factors, training and hospital policies. The survey was distributed through different key members from the EUSEM, REPEM and the EuSEN. A summary score based on the NICE guideline (4 questions on child characteristics, 4 questions on parental characteristics and 5 questions on hospital policy) was calculated.ResultsWe analysed 185 completed surveys, representing 148 hospitals from 29 European countries. Of the respondents, 28.6% used a screening tool, and 31.8% had guidelines on parental risk factors. A total of 42.2% did not follow training based on child characteristics, and 57.6% did not follow training on parental characteristics. A total of 71.9% indicated that there was a need for training. 50.8% of the respondents reported a standardized policy for the detection of child maltreatment. Translating the survey results to NICE summary scores of the EDs in Europe, we found that 25.6% (34/133) met most, 22.6% (30/133) met some and 51.9% (69/133) met few of the NICE guideline recommendations. More specifically, with respect to hospital policies, 33.8% (45/133) met most, 15.0% (20/133) met some and 51.1% (68/133) met few of the NICE guideline recommendations.ConclusionThere is high variability regarding policies for child maltreatment detection and only a quarter of the EDs met most of the NICE guideline recommendations for child maltreatment. There is a need for the use of screening tools, training of ED staff and implementation of local hospital policies.

A descriptive study of accidental skeletal injuries and non-accidental skeletal injuries of child maltreatment

BackgroundLack of awareness and recognition of child maltreatment is the major reason behind underreporting. All victims often interact with the health care system for routine or emergency care. In several research works, non-accidental fractures are the second most common injury in maltreated children and it is represented up to one-third of cases. Aim of the studyTo determine the incidence of different types of accidental and non-accidental skeletal injuries among children, estimate the severity of injuries according to the modified injury severity score and to determine the degree of fractures either closed or opened (Gustiloe-Anderson open fracture classification). Moreover, identifying fractures resulting from child abuse and neglect. This aimed for early recognition of non-accidental nature of fractures in child maltreatment that can prevent further morbidity and mortality. Patients and methodA descriptive study was carried out on all children (109) with skeletal injuries who were admitted to both Main Alexandria and El-Hadara Orthopedic and Traumatology University Hospitals during six months. History, physical examination and investigations were done for the patients. A detailed questionnaire was taken to diagnose child abuse and neglect. Gustiloe-Anderson open fracture classification was used to estimate the degree of open fractures. ResultsOut of 109 children, twelve cases (11%) were categorized as child maltreatment. One case was physical abuse, eight cases (7.3%) were child neglect and three cases (2.8%) were labour exploitation. Road traffic accidents (RTA) was the commonest cause of skeletal injuries followed by falling from height. Regarding falls, they included 4 cases of stair falls in neglected children and another four cases of falling from height (balcony/window). The remaining 36 cases of falls were accidental. The skeletal injuries were in the form of fractures in 99 cases, dislocation in two cases, both fracture and/or dislocation in three cases, and bone deformity from brachial plexus injury in five cases. Fractures of the lower limb (42.2%) and both bones of the forearm (35%) represented the highest incidence of skeletal injuries in children. 54.5% of fractures due to neglect were lower limb fractures due to falling from height. Ninety-nine cases were diagnosed as long bone fractures and classified as the following; eighty patients as closed fractures, six patients as open grade I fractures, three patients as open grade II fractures, three patients as open grade IIIA fractures, four patients as open grade IIIB fractures and three patients as open grade IIIC fractures. Conclusion and recommendationCases of neglect and child abuse represented 11% of all the studied cases, where neglect was the main cause. RTA and falling from height represented the most common cause of skeletal injury in children. Most fractures due to neglect were lower limb fractures resulting from falling from height. This demonstrates the need for early detection of neglect and child maltreatment aiming for early initiation of parental educational programs about child care and safety. Misinterpretation of skeletal injuries due to neglect or abuse can be avoided by proper training of orthopedic and traumatology staff on signs of child neglect and abuse.

Skeletal Manifestations of Child Maltreatment

Musculoskeletal manifestations of child maltreatment represent common presentations to the emergency department. The recognition of child maltreatment is an essential role for the practicing emergency physician, as it can directly prevent further serious injury. Orthopedic trauma in children presents very differently than that in adults. Understanding of the unique properties of pediatric bone as well as the developmental capabilities of children in relation to injury mechanism is essential in the interpretation of these injuries. Children younger than 3 years are most vulnerable to bony injury from child maltreatment. Common presenting findings include complex skull fractures, rib fractures, long bone fractures, and metaphyseal corner fractures. Skeletal survey remains the mainstay of detection for injuries, but recent work has also elucidated a role for other modalities in fracture detection. Management should include proper orthopedic interventions, along with mandatory reporting of possible maltreatment to the local child protective services or other equivalent agency.

Safeguarding children awareness amongst foundation trainees

Aims Foundation Trainees occupy frontline positions in reviewing children. The aim of this study was to assess whether they were confident to recognise and respond to suspected cases of child maltreatment and their acquisition and progression of these competencies through the foundation training. Methods A controlled study compared Foundation Trainee year 1 (FY1, n=32) and year 2 (FY2, n=33) with the null hypothesis that there were no significant differences in their confidences in recognising child maltreatment. A 5 point Likert questionnaire in a visual analogue scale with 7 domains was implemented. These domains were recognising history, suspicion from interaction of carers and child, recognising radiological features, suspicion of child sexual abuse (CSA), teaching on child maltreatment and guidance on what to do. Results were statistically analysed using non parametric algorithms with Stats Direct version 2.7.8 at 95% CI. Further, an open ended questionnaire looked at perceived dilemmas/challenges trainees might face in recognition of child maltreatment. Results In all domains in the FY1 group the main response was the ambivalent response. In the FY2 group, notable exceptions included confidence in recognising history, suspicion from interaction of carers, recognising radiology and teaching on child maltreatment. In the Mann Whitney test, there were no statistically significant differences (p >0.05) in confidences between the groups in recognising history, suspecting features from parental or child interaction and teaching received. However, statistically significant differences (p Conclusions In conclusion, this study shows that a Foundation Trainee gains confidence in safeguarding matters with time which in turn is reflective of the training. However, there are uncertainties. Importantly, this study highlights gaps in training delivery in crucial aspects emphasising on relevant history taking and observational skills over Foundation years. These areas necessitate the need for tailored sessions throughout Foundation placement. To our knowledge, this is the first statistical study of its kind.

Recognition of child maltreatment as a result of parents presenting to hospital

AimsThere is increasing recognition of the safeguarding needs of children whose parents are affected by domestic violence (DV), mental health problems and substance misuse highlighted in Local Safeguarding Board Child...

Factors associated with the recognition of child maltreatment by mothers rearing children from infancy to primary school age

Factors associated with the recognition of child maltreatment by mothers rearing children from infancy to primary school age

Am I Sure I Want to Go Down This Road? Hesitations in the Reporting of Child Maltreatment by Nurses

The purpose of this study was to explore the process of mandated reporting of child maltreatment by pediatric nurses. Qualitative description using a grounded theory lens was used with a cross-section of pediatric nurses. A point of divergence in the reporting process appears to occur at the first of three moderating points. When nurses hesitate at this first point, decision-making becomes complex and delays the reporting process, giving rise to two themes: "It's the law" and "The ones that haunt you." Increasing educational efforts focused on the recognition of child maltreatment may impact nurses' low rate of reporting.

Update on child maltreatment with a special focus on shaken baby syndrome

The many forms of child maltreatment exact an unacceptably heavy toll on our children. Recent work exploring the risk factors for child abuse and neglect, long-term consequences of child maltreatment, and potential for primary prevention will be reviewed. In the past year there have been many notable contributions in the field of shaken baby syndrome that have deepened our understanding of this devastating form of child abuse. Evidence of the long-term sequelae of child abuse and neglect continues to accumulate, but with increased understanding of the clinical manifestations of child maltreatment has come greater ability to intervene early and perhaps improve long-term outcomes. Although the effectiveness of some home visiting programs to prevent child maltreatment is coming into question, rigorous review of program components is helping to improve quality. There remain controversies in the diagnosis of shaken baby syndrome but several carefully done case-series are clarifying our knowledge of the myriad presentations of this form of non-accidental head trauma. Pediatricians have an important role to play in the prevention and recognition of child maltreatment.