Child maltreatment syndrome: demographics and developmental issues of inpatient cases

Abstract

INTRODUCTIONThis study aimed to describe the demographic, social, developmental and behavioural profile of children hospitalised for alleged child maltreatment syndrome (CMS). METHODSThis study was a retrospective review of the consecutive inpatient records of children (0-16 years) admitted to the National University Hospital, Singapore, for alleged CMS over a three-year period. Descriptive data on the demographic characteristics, alleged maltreatment, medical and developmental histories, and family background of these children were collected and analysed. Chi-square statistics were used to test whether family factors were associated with the type of maltreatment and the presence of developmental disorders.RESULTS A total of 89 children, who accounted for 90 admission cases, were studied. Physical abuse (70.0%) was the most common, followed by neglect (11.1%) and sexual abuse (7.8%). Child protection services had already been involved in 29.2% of the cases prior to the child's admission. Children who were victims of abuse were more likely to come from homes with a prior history of domestic violence (p = 0.028). Financial difficulty was found to be a risk factor for neglect (p = 0.005). Among the 89 children, 15.7% were found to have developmental disorders and 10.1% had mental health diagnoses. Children who had developmental disorders were more likely to have a parent with a mental health disorder (p = 0.002).CONCLUSION A sizeable proportion of the children admitted for alleged CMS had developmental or behavioural disorders.Clinicians have a role in ensuring that these children have appropriate follow-up plans. Children from high-risk families should be screened for maltreatment.

Validação de conteúdo de um instrumento para identificação de violência contra criança

“…The items were distributed in dimensions related to the four natures of the phenomenon, showing congruency between the analysis of experts and the literature. (4,12) In the dimension that analyzes children's behavioral signs, were considered the behavioral changes more often presented in health services care. Psychological violence usually coexists with other natures of the phenomenon, and is investigated by the child's behavior and relationship with parents/ caregivers.…”

“…Moreover, the delay in seeking care should be interpreted as a sign of neglect and/ or attempted concealment of violence. (1,2,4) In cases of Munchausen syndrome by proxy, the responsible person/caregiver simulates or creates signs or symptoms of diseases in the child. Although considered a form of physical violence for demanding that health professionals run a series of tests and painful investigations for the child, we chose to keep it as a dimension of the instrument because of the peculiarity of the phenomenon.…”

“…Many of these injuries do not result in death of the individual, but can harm the development of the victim. (3,4) Ill-treatment against children began to receive more attention from society in the late 1980s through the Federal Constitution and the Statute of Children and Adolescents. At that time, reporting cases of confirmed or suspected violence against children and adolescents became mandatory, and penalties were provided for doctors, teachers and responsible for health facilities and education who failed to report cases of their knowledge.…”

“…They are often the first people to identify the possibility of the child be suffering violence. (4,7,8) The role of multidisciplinary teams is essential for the prevention and early identification of aggression, abuse and maltreatment. In addition, they should ensure adequate monitoring, as well as the identification and monitoring of families at risk.…”

“…However, there is still great difficulty among professionals in relation to the identification of signs of violence. (4,9,10) In the literature, there are standardized and validated instruments to the Brazilian context investigating violence in children according to the observation of teachers or through reports of the own family. However, there is lack of validated and standardized instruments designed to be handled and directly completed by health professionals and/or teams.…”