Beyond the specific child What is ‘a child's case’ in general practice?

A simple approach to improve recording of concerns about childmaltreatment in primary care records: developing a quality improvement intervention

“…36 The importance of recording parental risk factors is supported by a Danish study where half of the 70 'child in need' cases initially presented with a problem related to the parent(s) or parent-child interaction. 5 The low levels of recording in children aged ≥5 years contrast with evidence from community-based studies, which indicate higher rates of maltreatment in children of school age and adolescents. 5,15,37,38 Potential explanations include the fact that older children present less often to GPs, 3 GPs may fail to ask relevant questions, or they may recognise maltreatment but code it as something else.…”

“…3 As GPs often see multiple family members, they can detect stressors -such as violence, parental depression, drug or alcohol abuse -that put children at risk of maltreatment. [4][5][6] They hold the continuous health record, making them a key resource for sharing information about maltreatment-related concerns. 4,7,8 Child maltreatment is common and often chronic but many affected children only occasionally, or never, reach the threshold for investigation or intervention by child protection services.…”

Child neglect: what does it have to do with general practice?

“…The article in this issue by Hølge-Hazelton and Tulinius 14 suggests that GPs construct their understanding from everyday interactions with children and their parents, and tend to focus on predominantly parental factors. The family is the GP's 'unit of analysis.'…”

“…Adoption of a common conceptual framework, such as the 'Solihull approach' to infant mental health, 25 is a good starting point and training is currently being offered in Glasgow as part of its developing comprehensive parenting support strategy. Supervision groups for GPs, as described by Hølge-Hazelton and Tulinius 14 could also prove valuable in establishing a shared understanding within the profession. We need clarity about which information can and should be shared with other agencies.…”

“…Hølge-Hazelton and Tulinius present a series of vignettes illustrating some of the ways in which this knowledge can be used by GPs to identify 'the child in need'. 14 Families are adaptive systems and parent-child interactions are at least partially determined by economic and cultural factors. For example, in circumstances of extreme external threat to the integrity of the family, such as poverty, war, or transnational flight, sensitive parenting may be particularly difficult.…”