Research and evidence
There is a growing body of evidence which can help specialists in Safeguarding and Child Protection to decide on the aetiology and underlying pathophysiology of abuse. Whilst it will not generally be up to the attending anaesthetist to provide advice at this level, colleagues particularly maintaining level 3 competencies may find these references useful:
In particular the excellent work done formally by the University of Cardiff (Cardiff Child Protection Systematic Review Project) is now incorporated into the Royal College of Paediatrics and Child Health (RCPCH): Child Protection Evidence Systematic Reviews. An internationally recognised methodology for systematically reviewing the world literature with regard to child abuse and neglect.
The effects of abuse may result in long term serious effects on health and wellbeing. The evidence for this has been increasing steadily over the last 10–15 years and is now considerable. The following are a selection of publications and further sources of reference from centres in the UK and worldwide.
The NSPCC has a suite of excellent resources which includes research and statistics.
Harvard Center for the Developing Child
Ensuring that young children have safe, secure environments in which to grow and learn creates a strong foundation for both their futures and a thriving, prosperous society. Science shows that early exposure to maltreatment or neglect can disrupt healthy development and have lifelong consequences. When adult responses to children are unreliable, inappropriate, or simply absent, developing brain circuits can be disrupted, affecting how children learn, solve problems, and relate to others.
The Science of Neglect – Working Paper
University College London
Maltreated children show same pattern of brain activity as combat soldiers
Unicef
Early moments matter for every child
Open University
Developing Brains – Early childhood in focus (series edited by Martin Woodhead and John Oates)
University of East Anglia
Child Protection and Family Support
Lancet Child Maltreatment series 2008
The Lancet collaborated closely with the Royal College of Paediatrics and Child Health in 2008 to provide this excellent series of articles which are free to read on line or download.
Lancet Long Term Trends
Long Term Trends in Child Maltreatment In England and Wales 2016
Patterns of bruising in preschool children—a longitudinal study
Kemp AM, et al. Arch Dis Child 2015;0:1–6. doi:10.1136/archdischild-2014-307120
What this study says:
Bruising affects a small proportion of babies who cannot roll over.
- Rare sites for bruising: ears, neck, genitalia, hands, in any child and buttocks and front trunk in early and premobile children.
- Nine per cent of children have twice as many bruises as would be expected for their developmental stage.
Evidence from the Child Death Overview process
This is available locally and is provided by the LSCBs in England and a nation review is also published annually alongside various serious case reviews. There is a triennial review of serious incidents. The latest results of child death reviews in England can be found here.