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Primary prevention: We have concentrated on signs of impending battering. In monthly
lunch time working seminars Doctors and Health Visitors have discussed early symptoms. It
is therefore interesting to note that the cases which have come to light during the last year
appear to be of a less damaging nature to the child than in previous years. Some may already
have been prevented as Health Visitors and Doctors are identifying stress situations in families
which might have escaped observation previously, and is reflected in the number of "threatened"
injured and the action taken.
Secondary prevention: Hospital staff. General Practitioners and Local Authority staff from
Health and Social Services Departments have established good links and suspected cases of wilful
injury receive immediate attention in the Health Department, whose Deputy Medical Officer
of Health is the co-ordinating Officer. Immediate help to parents is made available by admitting
the child to hospital, by making a Social Worker or Health Visitor available for intensive work
with the family, and/or by calling in other supportive services. Thus, rehabilitation of the family
is carried out as a team effort.
An analysis of the twenty-one cases reported shows that:
In six cases no actual injury was inflicted on the child, but injury was threatened and
reported to General Practitioners, Health Visitors or Social Workers, and the help given consisted
of rehousing, foster care and later adoption, intensive visiting by a Health Visitor and Social
Worker and in three cases psychiatric treatment of the mother. In four cases reported with
scalds or burns (none of severe degree): one was established as accidental, one older sibling
was admitted to E.S.N. School, one was taken into care and one is receiving more intensive
visits by the Health Visitor. In four cases reported with bruising or scratches: one only needed
intensive family counselling and three were cleared during follow-up as accidental and needed
no further treatment or advice.
In six fractures reported by clinics or hospital staff: one was cleared on X-ray, one needed
intensive counselling by the Senior Medical Officer and Health Visitor, as the mother suffered
from a rare muscular weakness and lacked insight into her own condition before she was able
to guard against injury to her child. One child conceived before marriage, whose parents are
only 18 years old, was adopted by the grandparents after a greenstick fracture which healed
under their care without residual handicap. In one case, with parents of low ability, mother
was sterilised and the child taken into care. One unsupported mother stopped work and was
put on Social Security and rehoused and appears to be doing well. One remains under intensive
supervision by Health Visitor and Social Worker.
One death was reported by the mother, whose child was admitted and died in hospital,
while she was on a visit to her maternal grandmother. The mother is unsupported but no previous
shortcomings in the child's care had been observed. Enquiries from the hospital established sudden
death from brain haemorrhage and a blood disorder which could have caused this. The mother
appeared very anxious for reassurance.
All the children reported, except two, were under the age of 2 years. Of the ten confirmed
as having had wilful injuries inflicted all were under the age of two.
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