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officer is seconded on an appropriate academic course in the techniques of developmental
paediatrics is being implemented and the present methods by which health visitors assist in the
assessment of potential hearing and vision defects are being actively reviewed.
The programme of Health Centre building to which the Council is now committed will give
an added impetus to these developments since by providing appropriate specialist knowledge
readily available to the general practitioner the Department is assisting the integration of all child
health services to the ultimate benefit of both mother and child.
(Child Health Centre Statistics—see pages 158 & 159.)
OBSERVATION REGISTER
The table on page 160 gives details of the children whose names have been placed on the
observation register. They have been listed under the "at risk" categories suggested by the
committee of Medical Officers of Health of the London Boroughs. Where more than one factor
is applicable an attempt has been made to assess the major factor so that no child is included
more than once.
Details of handicapped children under the age of 5 years are recorded on page 134.
Both sets of figures are similar to those of previous years. There is a tendency for the total
number on the Observation Register to increase slightly, but the number of handicapped is a
little lower than in 1969. Some abnormalities are amenable to medical treatment, e.g. congenital
dislocation of the hip and some heart defects; some are re-assessed and some move into or out
of the Borough, so that precise comparisons from year to year are not possible. The Register
provides a valuable method of concentrating limited manpower resources on children who are
more likely to have a permanent handicap.
THE "BATTERED BABY" SYNDROME
Early in 1970 the Department of Health and Social Security issued Circular No. 2/70 asking
for local discussions to take place between those likely to be involved in this difficult problem.
The Medical Officer of Health in Hillingdon convened a meeting attended by medical officers,
health visitors, social workers from the Children's, Health and Welfare and Education Departments
in addition to local voluntary organisations. Hospital specialists in paediatrics and child psychiatry
also attended as well as a general practitioner, probation officers, police representatives, hospital
social workers, day nursery matrons, domiciliary midwives and representatives from the Housing
Department and the local office of the Department of Health and Social Security.
There has been increasing interest in this syndrome since its first description drew attention
to the possibility of sustained and long term physical abuse of the child by parents. The picture
of a young child who suffers a series of injuries—bruises, abrasions or broken bones—in incompletely
explained circumstances is now familiar to field workers. The syndrome may occur in any
social group and is thought to be related to parental immaturity and reaction to stress rather than
to low income or intelligence, although both of these may be an additional hazard. The true
incidence is not known but a recent survey of health visitors working in Greater London suggested
that each day there may be up to 200 individual consultations taking place into aspects of child
cruelty in the conurbation.
A solution to the problem is not immediately evident. At the meeting there was considerable
discussion about the action to be taken when there was suspicion that a child was being ill-treated.
Those present fully recognised that in addition to urgent action to protect the child which might
indeed include its physical removal from the environment the parents also needed help and
support. Any of the workers involved in the case could give such assistance, and it would not
be appropriate for a single type of worker always to be introduced into the situation. Much depends
upon the chances of personality and of "being in the right place at the right time". The handling
of the situation must be flexible and tailored to the needs of the moment, but the aid is always
protection of the child both in the short and long term. It is important to remember that both
parents are always involved. Even if only one is guilty of the physical abuse the other must of
necessity condone it. Thus, whenever a "battered baby" is found, the Children's Officer should
be informed and he would be ready to act as the case requires.
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