Suspected Child Abuse And Neglect Research Articles

Non-compliance with Outpatient Follow-up in Child Abuse Cases - A Single Centre Study

Introduction: To study the characteristics of child abuse cases and determine the risk factors associated with non-compliance to follow-up. Methods: A retrospective review of Suspected Child Abuse and Neglect (SCAN) cases attending an outpatient clinic at Hospital Universiti Sains Malaysia was performed. This was done using a standardized proforma to capture the demographic and clinical data from 2014 until 2020. Variables collected were gender, age at the time of the abuse, religion, education, school attendance, history of previous abuse, parental employment, parental relationship, domestic violence, parental criminal history, substance abuse, and household number. Children under the age of 18 years who were seen by the SCAN team in the emergency department (ED) or during hospital admission within the time frame were included. Results: Compliance rates are defined as the follow-up within the first recommended date given after hospital admission or encounter at the ED. The investigation comprised 311 cases and sexual abuse was reported in 261 cases (83.9%). During the study period, 191 (61.3%) children who were non-compliant with follow-up. Simple binary logistic regression revealed that the significant factors associated with non-compliance to follow-up after the SCAN team review was the patients’ age only. Multiple logistic regression revealed that there were no significant factors associated with failure to comply with outpatient clinic follow-up. Conclusion: This study provides a descriptive study of local child abuse cases. We could not identify any specific factors associated with non-compliance to follow-up.

Child neglect in Saudi Arabia: The neglected form of child maltreatment.

Objectives:To shed light on types, family profiles, risk factors, and outcomes of child neglect in Saudi Arabia.Methods:A retrospective chart review was carried out at King Abdullah Specialized Children’s Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. Cases of child neglect diagnosed by the Suspected Child Abuse and Neglect (SCAN) team were reviewed. Data were extracted from patients’ electronic charts and SCAN team records.Results:A total of 309 cases of child neglect were diagnosed between 2015-2019. Mean age of victims was 4.4±4.1 years, and 51.8% were male gender.Supervisory neglect was the most common form (63.1%), followed by medical neglect (39.2%), emotional neglect (6.8%), physical neglect (5.5%), and educational neglect (3.2%). Children between the ages of one and 3 years were 3.3 times more likely to be victims of supervisory neglect and girls were 4.5 times more likely to be victims of educational neglect. Children living with ≥4 siblings were 7 times more likely to be victims of physical neglect and 1.9 times of medical neglect. With regard to emotional neglect, children of unemployed fathers were 3.5 times more likely to be parentally neglected than children of employed fathers. Worsening of the underlying disease (30%) and internal injuries (23.5%) were the most common consequences of neglect. Mortality attributed to neglect was documented in 8 (2.6%) children.Conclusion:Although child neglect is common in Saudi Arabia, it has not been recognized as an important cause of morbidity and mortality of children. This implies the need for a national protocol that would help identify high-risk families for early detection and implementation of prevention programs.

Did Child Neglect Cause Severe Injuries in Nine Children?: Case series from a regional hospital in Oman.

Child abuse and neglect (CAN) is a global phenomenon that takes many forms, with child neglect being the most common. CAN comprises serious incidents with medicolegal implications for the caregivers. The recognition of CAN is still in its early stages in Middle Eastern cultures, including in Oman, where parental authority over children is traditionally sacrosanct. This case series presents nine serious incidents from a regional hospital in Oman from 2020-2021 that appear to fulfil the definition of child neglect. All cases were diagnosed by the Suspected Child Abuse and Neglect (SCAN) team. This article provides evidence that child neglect exists in Oman and has resulted in the death of some children while causing significant physical, psychological and social sequelae in others. It also addresses risk factors and provides recommendations for management. Furthermore, the experience of the SCAN team and limitations of the current Child Protection Services in Oman are highlighted.

Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence. To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic. This cross-sectional study used data from the Centers for Disease Control and Prevention's National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC. Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex. From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P < .001), and opioid ODs (n = 5502 vs 4168, P < .001); counts were significantly lower for IPV ED visits (n = 442 vs 484, P < .001) and SCAN ED visits (n = 884 vs 1038, P < .001). Median rates during the same period were significantly higher in 2020 compared with 2019 for all outcomes except IPV. These findings suggest that ED care seeking shifts during a pandemic, underscoring the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.

Experimental Biology 2020 Meeting Abstracts.

Withdrawal: Ivanoff, A., Einstein, G. and Tulp, O.L. (2020) A Review for Medical Students and Student Doctors on Detecting and Reporting Suspected Child Abuse and Neglect (SCAN) from Clinical and Forensic Observations. The FASEB Journal,34:S1. https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fasebj.2020.34.s1.07600/. The above abstract, published online on April 22, 2020 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the authors, FASEB, and Wiley Periodicals Inc. The withdrawal has been agreed due to a request made by the authors.

The Suspected Child Abuse and Neglect (SCAN) Programme in Malaysia: From Inception to Present

Issues on child abuse are very critical considering the many incidents of abuse and violence against children. Experiencing abuse in childhood has lifelong impacts on the health and well-being of children, their families and communities. Suspected Child Abuse and Neglect (SCAN) service is centralised, multidisciplinary team management in the government hospital and serve as a supportive service or programme to children, families and hospital staff. This paper outlines the history and the SCAN service available in Malaysia.

Barriers that inhibit reporting suspected cases of child abuse and neglect among nurses in a public hospital, Jeddah, Saudi Arabia.

Child maltreatment is considered a global problem that has serious consequences for a victim's physical and mental well-being. Nurses interact with children and their families at different levels of health care. All nurses must be able to identify children who are at risk of harm or abuse, and act accordingly. The purpose of the study was to investigate barriers that inhibit reporting suspected cases of child abuse and neglect by nurses at King Abdulaziz Medical City, Jeddah, Saudi Arabia. The study was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia. One hundred and forty-five nurses from all paediatric settings participated in the study using non-probability "convenience" sampling technique and a descriptive design was used. A structured self-report data collection method was applied to elicit data about the participants' knowledge and circumstances that prevent them from reporting child abuse. It was found that only one fifth (20.7%) of nurses had attended either a lecture or workshop on child abuse and neglect (CAN). Two fifths (40.7%) of participants had a knowledge score on CAN more than 75% while one third (33.1%) had a knowledge score ranging from 50% to 75% with a median score of knowledge of 63.10 ± 25.48. Furthermore, more than half (51%) of participants were aware of the Suspected Child Abuse and Neglect (SCAN) team in the hospital. When participants were asked about the circumstances when they would not report suspected CAN cases, "I was not certain that the child was abused" was reported by 78.6%. Other barriers that inhibit reporting of child abuse and neglect are ignorance about how to report, in addition to having previous negative experiences after reporting. The findings of the current study indicated that there exist barriers for not reporting suspected cases of child abuse and that availability of training and educational programmes are needed. Establishment of a clear and structured child protection policy to enable nurses to report abuse victims is recommended.

Pediatric deceased donation and SCAN(Suspected Child Abuse and Neglect) issue in Japan

Pediatric deceased donation and SCAN(Suspected Child Abuse and Neglect) issue in Japan

Teaching future dentists to detect and report suspected child abuse and neglect

Child abuse and neglect often presents with signs onthe head and neck, which dental professionals examine on a regular basis. If educated on how to detect and report it in their schools, they can help in solving the problem of under‐reporting. Although, some curriculums have been developed for educating dental students and a lot of stress has been laid on the issue through continuing education, still a lot of cases go unnoticed each year. There is one elaborate, robust and comprehensive curriculum with a multi ‐ disciplinary approach reported in the literature, which was recently developed at the University of Tennessee. This article is a summary of the same. This curriculum has four phases, which are spread out in four years of education of the DDS students. The students are sequentially introduced to the findings of Suspected Child Abuse and Neglect (SCAN), they are shown case scenarios, they work with medical and law students to understand their professional and ethical duties, and are required to deal with a simulation case at the end. Future studies should assess the effects of this curriculum and its overall impact in the long run.

Young female survivors of sexual abuse in Malaysia and depression: What factors are associated with better outcome?

AbstractIntroductionResearch in the field of child sexual abuse is lacking in Malaysia. The aims of this study are to identify the association between sociodemographic factors and depression among sexually abused females.MethodsA cross‐sectional study was conducted among 51 young sexually abused female attendees at the Suspected Child Abuse and Neglect (SCAN) clinic of Hospital Kuala Lumpur, a tertiary referral centre. Upon obtaining informed consent from participant and guardian, participants were screened for depression using the Strength and Difficulty Questionnaire (SDQ) and interviewed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K‐SADS) for depressive disorders and K‐SADS‐PL (Present and Lifetime version) to diagnose depression. Sociodemographic data and details of the abuse were also obtained.ResultsOf the survivors, 33.3% were depressed. Univariate analysis showed significant association between legal guardianship, living environment and duration of abuse with depression, however, multivariate analyses later showed that the sole predictor for depression was living environment. Respondents who lived with others were 23‐times more likely to be depressed as compared to those who lived with their parents.DiscussionDepression is common among young survivors of sexual abuse. Those who lived with parents appeared to have a better outcome. Thus, further research to explore possible protective factors associated with living with parents is vital. This will help clinicians develop strategies to empower parents and families help these young survivors get back on track with their lives despite the abuse.

Femur Fractures in the Pediatric Population: Abuse or Accidental Trauma?

BackgroundChild abuse represents a serious threat to the health and well-being of the pediatric population. Orthopaedic specialists will often become involved when child abuse is suspected as a result of the presence of bony injury. Distinguishing abuse from accidental trauma can be difficult and is often based on clinical suspicion.Questions/purposesWe sought to determine whether accidental femur fractures in pediatric patients younger than age 4 could be distinguished from child abuse using a combination of presumed risk factors from the history, physical examination findings, radiographic findings, and age.MethodsWe searched our institution’s SCAN (Suspected Child Abuse and Neglect) and trauma databases. We identified 70 patients in whom the etiology of their femur fracture was abuse and compared that group with 139 patients who had a femur fracture in whom accidental trauma was the etiology.ResultsA history suspicious for abuse, physical or radiographic evidence of prior injury, and age younger than 18 months were risk factors for abuse. Patients with no risk factors had a 4% chance, patients with one risk factor had a 29% chance, patients with two risk factors had an 87% chance, and patients with all three risk factors had a 92% chance of their femur fracture being a result of abuse.ConclusionsClinicians can use this predictive model to guide judgment and referral to social services when seeing femur fractures in very young children in the emergency room.Level of EvidenceLevel III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Child Abuse and Neglect in Saudi Arabia: Journey of recognition to implementation of national prevention strategies

Objectives To describe increased child abuse and neglect (CAN) reporting and the characteristics of the reports in the context of the development of a system of intervention for one of the hospital-based child protection centers in Riyadh, Saudi Arabia aligned with the United Nations Convention on the Rights of the Child (CRC) Article 19. Methods A retroprospective collection of data on all children evaluated by the Suspected Child Abuse and Neglect (SCAN) team in King Abdulaziz Medical City for the National Guard from 2000 to 2008. The cases were further divided into 3 subgroups corresponding to the years 2000–2004, 2005–2006, and 2007–2008 parallel to the stages of development of the national child protection system. Results During the study period, there were a total of 188 referrals to the SCAN team. Of these 133 (70.7%) were further investigated as CAN cases. The total number of referred cases increased 10-fold from 6.4 cases per year in the first period to 61.5 cases per year in the third period. The mean age was 5 years, evenly represented by males and females. Physical abuse was the most common form of abuse in the first (2000–2004) period at 61% and second (2005–2006) period at 76%, which changed to neglect (41.6%) as the most common form of maltreatment in the third (2007–2008) period. Parents were the perpetrators in 48.9% of cases throughout the 3 periods. Overall fatality rates were 4.4%, 14.3%, and 7.9% in the first, second, and third periods respectively. Conclusion Recognition of CAN is expanding in Saudi Arabia. This is due to the successful adoption of a system of intervention consisting of child protection centers in the medical facilities, in conjunction with mandatory reporting and data collection strategies. In addition, the changes in public attitudes towards a better understanding of CAN enhanced further recognition and reporting of neglect and milder forms of abuse. We believe that the number of reported CAN cases in Saudi Arabia will continue to rise, hence adequate multi-sectoral services for the abuse victims require further development and improvements throughout the country.

&lt;p&gt;Health of Aboriginal and Torres Strait Islander children in remote Far North Queensland: findings of the Paediatric Outreach Service&lt;/p&gt;

Aim: To describe the pattern of disease and other health problems in children living in remote Far North Queensland (FNQ).&#x0D; Design, Setting and Participants: Retrospective review of the FNQ Paediatric Outreach Service's Medical Director database for the period June 2001 to February 2006. Three subpopulations were compared: children from predominantly Aboriginal communities, predominantly Torres Strait Islander communities, and other communities. All children referred to the service during the study period were reviewed.&#x0D; Main Outcome Measures: Number of children seen and common diagnoses.&#x0D; Results: 3562 children were referred during the study period, and a total of 3932 diagnoses were made; 56% of the paediatric population of the Aboriginal communities and 23% of the paediatric population of Torres Strait Islander communities were seen. Of 40 separate diseases/health problems reviewed, the three most common reasons for presentation were chronic suppurative otitis media, suspected child abuse and neglect, and failure to thrive. In the paediatric population of Aboriginal communities, the prevalence of fetal alcohol spectrum disorder was at least 15/1000 (1.5%), and in Torres Strait Islander children, rheumatic heart disease prevalence was at least 6/1000 (0.6%). Rheumatic fever rates were among the highest in Australia.&#x0D; Conclusion: Rates of preventable complex and chronic health problems in Aboriginal and Torres Strait Islander children in remote FNQ are alarmingly high. Areas requiring urgent public health intervention include alcohol-related conditions and rheumatic fever.&#x0D; Published courtesy of:Med J Aust. 2007; 186: 519-521

Interagency collaboration between child protection and mental health services: Practices, attitudes and barriers

Objective The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. Method A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers, 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). Results Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. Conclusions Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level.

Lichen sclerosus mistaken for child sexual abuse

A 3‐year‐old girl presented to the primary care clinic at King Abdulaziz Medical City (KAMC) with asymptomatic white discoloration of the vulva of 3 months’ duration. Dysuria, genital itching, and vaginal discharge followed 2 months later. The discharge was yellowish‐greenish in color and occasionally associated with blood‐tinged staining of the underwear. The mother had noted that the genital skin changes had worsened in the last 2 weeks and that the genital itching and dysuria had become more frequent. There was no history of trauma, behavioral problems, abnormal sexual behaviour, encopresis, or any underlying disease. On questioning the mother, the possibility of sexual abuse could not be ruled out as she reported that the father was drug and alcohol dependent and behaved inappropriately when under the influence of these factors. Because of this possibility, the girl and her parents were referred to the suspected child abuse and neglect (SCAN) team at KAMC for further evaluation.The physician, social worker, and child psychiatrist interviewed the girl, her three older brothers, and the parents separately. The girl and her siblings denied any abnormal touching by an adult. The mother reported that she and the father had been separated for 1 year; however, the couple had been reunited for the last month and were currently living together. The mother linked the appearance of the genital changes to the time the father returned; however, no definite history of sexual abuse was obtained. The father denied any sexual or other abnormal encounter with the child. On examination, the child was well developed and well nourished, cooperative, and showed no abnormal fear of genital or anal examination. Genital examination revealed sharply demarcated, hypopigmented, atrophic plaques symmetrically surrounding the labia majora (Fig. 1). Three sharply demarcated, 0.5 cm, nonpalpable, reddish purpuric macules on the medial aspect of both the labia majora and the base of the clitoris were noted (Fig. 2). Two sharply defined healing erosions were noted on the left side distal to the introitus. The hymenal ring could not be seen, but the hymenal orifice was not dilated. The introitus and the anus appeared normal. Because of the genital findings and the mother's concerns, the possibility of sexual abuse was contemplated. Extensive laboratory testing for sexually transmitted diseases, including syphilis, chlamydia, human immunodeficiency virus, and gonorrhea, were negative. Urine analysis and culture were negative. Routine vaginal culture grew group B β‐hemolytic streptococcus, and the patient was treated with amoxicillin‐clavulanate orally for 10 days. Due to a lack of evidence of sexual abuse, the SCAN team decided to follow up the child and to investigate further before reporting to the protective agency.Photograph of the vulva showing atrophic, hypopigmented, sharply defined plaquesimagePhotograph of the vulva showing three sharply demarcated purpuric macules on both the labia majora and the base of the clitorisimageAn arranged dermatology consultation concluded that the findings were diagnostic of lichen sclerosus (LS). A skin biopsy obtained from the right labia majora showed atrophic epidermis with follicular plugging. Homogenized eosinophilic amorphous collagen replaced the papillary and upper reticular dermis. These findings were also diagnostic of LS. A 4‐week course of twice‐daily mometasone furoate 0.1% ointment (Elocom, Scherring, USA) was given with a dramatic resolution of all symptoms. At a 4‐week follow‐up visit, the signs had greatly ameliorated with the disappearance of bruising and atrophy. Only mild hypopigmentation persisted.

Child sexual abuse: Psychosocial aspects of 101 cases seen in an urban Malaysian setting

This paper describes a case note and interview study of a cross sectional sample comprised of all children seen and confirmed as being sexually abused between June 1985 and December 1990 by the Suspected Child Abuse and Neglect (SCAN) Team of Kuala Lumpur General Hospital. A total of 101 cases, which represented 18.% of all child abuse cases, were seen together with their accompanying adults. Information about ethnicity, socioeconomic status, family constellation, relationship of perpetrator to the child, and reported psychosocial factors that could have contributed towards the abuse were recorded. The Indian ethnicity group was found to be overrepresented. The mean age of children was 6–8 years, SD 4.1, with age ranging 1.5–16 years. Forty-one and one-half percent were in the age range 5–9 years. Among the important associated psychosocial factors found were the absence of another adult at home, unemployment, and history of drug abuse among the perpetrators.

Childhood deaths from physical abuse

This paper gives a detailed account of 30 cases of childhood deaths caused by physical abuse, detected by the Suspected Child Abuse and Neglect (SCAN) team, General Hospital, Kuala Lumpur. They consisted of 12 Malays, 6 Chinese, 9 Indian, and 1 Indonesian child. Three cases could not be ascertained as to their ethnic origin. There were 13 male and 17 female children. The average age of the abused children was 2 years 5 months. The most frequent causes of death were intracranial hemorrhage and intraabdominal trauma. Of the 17 cases of intracranial hemorrhage, only four had X-ray evidence of skull fracture. This suggests the possibility of whiplash injuries with/without the abuser suspecting that he/she had injured the child. Of the 22 abusers who could be identified, there was no sex differentiation. Fathers formed the largest group of perpetrators, followed by mothers and childminders. Fifteen of the natural parents of the abused children were married, four were divorced and four were never married. Five of the abusers had aggressive personalities and three were drug addicts. Only one abuser was found to be an alcoholic even though a few were also under suspicion. For most cases, trigger factors could not be identified.

Social factors in relation to physical abuse in Kuala Lumpur, Malaysia

Available evidence has shown that the type of abuse perpetrated on children depends considerably on the social and other factors inherently faced by these children. A total of 119 cases of physical abuse was detected by the Suspected Child Abuse and Neglect (SCAN) Team of General Hospital, Kuala Lumpur in 1991. Eighty-two cases were categorized as mild and 37 as severe. The average age of those mildly abused was 7.9 years, for those severely abused the average age was 4.2 years. The perpetrators of those mildly abused were often their own parents. However, among those severely abused, the child-minder was the most frequent abuser. Ninety-two of all cases were in families of social classes IV and V. In 47 cases, there was definite evidence of family disharmony or disruption. Among the 37 severely abused, the parents were either divorced or separated in 14 cases. There was a personality disorder in seven of the cases. Six of the abusers were also using drugs and nine were alcoholics. This paper shows that, even in a developing country, the social milieu is important in the type of abuse inflicted.

SCAN: A method of community collaboration

Recent research has highlighted the complexity of the battered child syndrome. Clinical experience suggests that treatment of troubled families is a long-term process, draining financial resources of agencies and emotional resources of professionals. The need to provide support and case consultation to professionals working in the area of child abuse and neglect evolved in the establishment, in 1968, of the Suspected Child Abuse and Neglect (SCAN) Program at Children's Hospital, Pittsburgh, Pennsylvania. This program provides an effective method of intervention through identification, consultation, referral and follow-up of at-risk families. Weekly meetings offer multi-disciplinary case coordination, treatment recommendations, and a channel of communication for representatives of community agencies. This paper traces the history and present status of the SCAN Program, as well as the role of SCAN as a force for change of community attitudes.