Child Abuse and Neglect: Can primary care doctors help?

A lack of research makes it impossible to recommend how primary care doctors can prevent abuse and neglect of children who show no signs or symptoms of maltreatment, according to a new U.S. Preventive Services Task Force statement on Prevention of Child Maltreatment.

"We know there are children suffering abuse who don't show obvious signs of mistreatment, and the task force wanted to learn more about what primary care practices can do to help them," task force member Dr. David Grossman said in a task force news release.

Child abuse and neglect affects more than half a million American children each year, according to the release.

About 680,000 children in the United States were abused or neglected in 2011 and more than 1,500 of these children died. Children aged 5 and under are at the most risk for abuse and death from abuse.

The task force analyzed studies released since 2004 and concluded that although child abuse and neglect is a serious problem, there is very little evidence to determine how primary care doctors can protect young victims who show no obvious signs or symptoms of maltreatment.

Due to the lack of information, the task force said it cannot make a specific recommendation for or against primary care doctors taking action to help these children. The statement appears online June 11 in the journal Annals of Internal Medicine.

"We critically need more research on how primary care clinicians can prevent maltreatment and protect their young patients when symptoms of abuse or neglect are not apparent," Grossman said.

The task force said areas where more research is needed include: how health care providers can help support families to prevent abuse and neglect; how to identify children who are being mistreated; ways to prevent abuse of older children; and whether interventions to prevent child abuse could cause unintended harm.

Virginia Moyer

"It will take action from every part of society, including families, schools and health care professionals, to build a future where every child can grow up healthy and safe from abuse and neglect," task force chair Dr. Virginia Moyer said in the news release.

"While we learn more about what primary care professionals can do to help children, all health care professionals must continue to remain vigilant for signs of abuse and neglect, and respond appropriately when they identify problems."

More information: The U.S. Children's Bureau outlines ways to prevent child abuse and neglect.

Specific changes in brain structure after different forms of child abuse

Scientists have found a correlation between specific forms of maltreatment and thinning of the cortex in precisely those regions of the brain that are involved in the perception or processing of the type of abuse. Credit: Fotolia 

Different forms of childhood abuse increase the risk for mental illness as well as sexual dysfunction in adulthood, but little has been known about how that happens.

An international team of researchers, including the Miller School's Charles B. Nemeroff, M.D., Ph.D., Leonard M. Miller Professor and Chair of Psychiatry and Behavioural Sciences, has discovered a neural basis for this association.

The study, published in the June 1 issue of the American Journal of Psychiatry, shows that sexually abused and emotionally mistreated children exhibit specific and differential changes in the architecture of their brain that reflect the nature of the mistreatment.

Researchers have known that victims of childhood abuse often suffer from psychiatric disorders later in life, including sexual dysfunction following sexual abuse.

The underlying mechanisms mediating this association have been poorly understood.

Charles B. Nemeroff

Charles B. Nemeroff and a group of scientific colleagues hypothesized that cortical changes during segments of mistreatment played a role.

To study these potential changes, the researchers used magnetic resonance imaging (MRI) to examine the brains of 51 adult women who were exposed to various forms of childhood abuse.

The results showed a correlation between specific forms of maltreatment and thinning of the cortex in precisely the regions of the brain that are involved in the perception or processing of the type of abuse.

Specifically, the somatosensory cortex in the area in which the female genitals are represented was significantly thinner in women who were victims of sexual abuse in their childhood.

Similarly, victims of emotional mistreatment were found to have a reduction of the thickness of the cerebral cortex in specific areas associated with self-awareness, self-evaluation and emotional regulation.

"This is one of the first studies documenting long-term alterations in specific brain areas as a consequence of child abuse and neglect," said Nemeroff, who is also Director of the Center on Aging.

"The finding that specific types of early life trauma have discrete, long lasting effects on the brain that underlie symptoms in adults is an important step in developing novel therapies to intervene to reduce the often lifelong psychiatric/psychological burden of such trauma."

Christine Heim

"Our data point to a precise association between experience-dependent neural plasticity and later health problems," said Christine Heim.

Jens C. Pruessner agreed that the "large effect and the regional specificity in the brain that corresponds to the type of abuse is remarkable."

The scientists speculate that a regional thinning of the cortex may serve as a protective mechanism, immediately shielding the child from the experience of the abuse by gating or blocking the sensory experience.

However, that thinning of the cortical sections may lay the groundwork for the development of behavioural problems in adulthood.

The results of this study extend the literature on neural plasticity and show that cortical representation fields can be smaller when certain sensory experiences are damaging or developmentally inappropriate.

Journal Reference:
Christine M. Heim, Helen S. Mayberg, Tanja Mletzko, Charles B. Nemeroff, Jens C. Pruessner. Decreased Cortical Representation of Genital Somatosensory Field After Childhood Sexual Abuse. Am J Psychiatry, June 1, 2013

UK Government Fails to Find A better way to prevent child abuse

New research at The University of Nottingham is calling for changes to a government scheme which engages community nurses in the prevention of child abuse and neglect in the home as part of a maternal and child health care programme.

The study, published online by the Journal of Public Health, has found that despite being set up to help reduce the numbers of child abuse cases, the £10 million Family Nurse Partnership will only be able to tackle around 10% of families involved in child maltreatment.

And, the researchers say, by using different, less common risk factors to identify vulnerable children, the scheme could reach three times the number of abusive families using a similar number of health visitors.

The research was carried out by Professor Kevin Browne, Professor of Forensic Psychology and Child Health, and Vicki Jackson, Lecturer in Forensic Psychology, at the University's Centre for Forensic and Family Psychology.

Professor Browne said: "The claims made about FNP to reduce child maltreatment in England have been over exaggerated.

Careful consideration needs to be given to other prevention programmes that are tailored to the needs and vulnerabilities of the family".

The Family Nurse Partnership (FNP) was an American idea adopted by the past two UK governments who invested £10 million in a pilot scheme in ten areas of England.

It was a response to the increasing numbers of children being maltreated or neglected. A year ago nearly 170,000 children in England were registered as 'children in need' because of abuse or neglect.

The scheme is designed to offer disadvantaged new parents tailored help and support from a specialist nurse in the home in the weeks and months after childbirth.

The aim has been to give many more vulnerable children across the country a better start in life and to teach new parents the skills to cope with parenthood and childrearing.

The Government recently published a national review on health visiting and families at risk, as well as revisions in primary health-care services to promote child health and welfare.

The report, Early Intervention: The Next Steps, authored by Nottingham North MP Graham Allen, acknowledged that a proactive approach is crucial to the prevention of child abuse and neglect.

He championed the use of the American-style FNP on the basis that in the States there was evidence to suggest that it leads to a reduction in child abuse and neglect and improves outcomes for children in vulnerable families.

Professor Browne added: "It is vital that families with a history of domestic violence are not ignored by health professionals as it regularly presents the highest relative risk for child maltreatment. It is also cited in 46% of child abuse and neglect referrals to police child protection units."

More information: The paper, Community Intervention to Prevent Child Maltreatment in England: Evaluating the Contribution of the Family Nurse Partnership by Professor Kevin Browne and Dr Vicki Jackson, is available online on the website of the Journal of Public Health.

UK Child Protection Process reduces children's protection rights

UK Social workers should spend less time filling in forms and more time talking to children, the head of an independent review into child protection in England said today.

Professor Eileen Munro also wants to strip Ofsted of the power to evaluate reports into the deaths of abused or neglected children.

And the regulator should scrap making pre-planned checks on children's services in favour of unannounced visits, the review found.

Prof Munro's report also stresses the importance of having a management and inspection process that monitors whether children are getting the help they need, rather than being a "tick-box exercise".

She said: "Everyone in the profession can think of meetings and forms that don't actually make a child safer.

"Whilst some regulation is needed, we need to reduce it to a small, manageable size.

"Professionals should be spending more time with children, asking how they feel, whether they understand why the social worker is involved in their family, and finding out what they want to happen.

"Placing a timescale on completing a form puts pressure on professionals which can distract from making decent quality judgments."

Her second interim report found that experienced social workers should be kept on the front line to supervise more junior staff.

It also stressed the importance of giving health, police and family support professionals easier access to social work advice when they have concerns about abuse and neglect.

The Munro Review of Child Protection was created following a number of high-profile cases in recent years that have highlighted failings in the protection of young people.

Baby P died aged 17 months in August 2007 having sustained more than 50 injuries at the hands of his abusive mother, her boyfriend and their lodger.

Children's Minister Tim Loughton said: "Professor Munro has identified areas where professionals' time is being wasted and children's needs are not being properly identified.

"I welcome her approach to getting help to the neediest children and families as early as possible, and recognising that child protection is not just the responsibility of social workers."

Prof Munro will submit her final report in April.

Shaken-Baby Cases Rising During the Recession

Shaken-Baby Cases Rising During the Recession - TIME

The stressful effects of a faltering economy, skyrocketing unemployment and precarious personal finances can be dire. People take up smoking or use alcohol to cope, they become depressed or suicidal, and they develop stress-related illnesses like heart disease.

Now researchers report that the harm may be spreading to children too, when parents' stress leads them to injure their children, inadvertently.

Presenting May 1 at the Paediatric Academic Societies annual meeting in Vancouver, a team of researchers led by child-abuse expert Dr. Rachel Berger at Children's Hospital of Pittsburgh reported a significant increase in cases of shaken-baby syndrome, in which youngsters are shaken violently by an adult, since the start of the current recession.

Researchers analysed data on 512 cases of head trauma in the children's centers of four hospitals (in Pittsburgh, Pa.; Cincinnati, Ohio; Columbus, Ohio; and Seattle) and found that the number of cases had increased to 9.3 per month as of Dec. 1, 2007, compared with 6 per month prior to that date — a rate that had held steady since 2004.

Read more: http://www.time.com/time/health/