Jane Wynne

Abuse of children in foster and residential care

OBJECTIVE There have recently been many debates in the UK about how to provide good care for children placed away from home. Professionals have realized that the level of child abuse in foster care and childrens homes is high. This research examines the characteristics of physical and sexual abuse of children in foster and residential care in a city in England. The number of cases of abuse reported by pediatricians in this group was compared to the number reported by the same pediatricians for the population of Leeds as a whole. METHOD This is a retrospective study of 158 children, fostered or in residential care who were involved in 191 episodes of alleged physical and/or sexual abuse assessed and reported by pediatricians over a 6 year period from 1990 to 1995 in Leeds, England. Details of the child including the reason for placement in care, their physical and mental health, abuse characteristics, including perpetrator and case management were studied. RESULTS (see Table 1): 158 incidents of abuse in 133 children in foster/residential care are described. In foster care, 42 children were physically abused, 76 were sexually abused, and 15 experienced both forms of abuse. In residential care, 12 children were physically abused, 6 were sexually abused, and 6 experienced both forms of abuse. In foster care 60% of sexual abuse involved girls and 60% of physical abuse involved boys. In residential care almost twice as many boys as girls were reported to be abused. Foster carers perpetrated the abuse for 41%, natural parents on contact for 23%, and children 20% of incidents. A significant proportion of abuse was severe with 1 death, 8 children with burns, 18 with genital, and 34 with anal penetration. Long-standing emotional, behavioral and learning difficulties were common. Most children (80%) had been abused prior to entry into care. Foster children were 7-8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population. CONCLUSIONS Children in foster or residential care form an at risk group for maltreatment. Their special needs include additional measures to protect them from abuse.

Controversy: Is the Children Act failing severely abused and neglected children?

Is the Children Act failing severely abused and neglected children? The simple answer to this question in our opinion is an emphatic “Yes”. The press carries articles almost daily concerning the plight of children in our society.1 2 Most paediatricians we have approached who have a special commitment to child protection work admit to feelings of near despair about the current state of child protection in this country. They feel that things are getting worse rather than better, and lay much of the blame for this on the Children Act and on the interpretation being put on this act by social workers, guardians ad litem, and the courts. We have received comments to the effect that the Children Act can be regarded as “A charter for abusive parents” or “A charter for abusive parents, lawyers and medical experts”! While these comments are anecdotal, impressionistic, and subjective we believe they deserve to be acknowledged as reflecting the deep sense of disillusion that exists, much of which we share. It is perhaps unfair to expect perfection from any system or legislation in such a difficult and complex field as child abuse, and no developed society we are aware of has ever approached perfection. However, in this country we are entitled to expect that 27 years after the death of Maria Colwell we are entitled to legislation that would improve child protection significantly rather than make things worse. In our opinion it is the latter that has happened. Before the Children Act, legislation and practice placed a stronger emphasis on protection of the child and insistence that abuse should stop. Early intervention was potentially firmer and more decisive. This protection was still far from perfect, as evidenced by the long list of children murdered while within the child protection system, each of …

Breast-feeding in Practice.

This multiauthor textbook, written mainly by the staff of the Indianapolis department, covers the differential diagnosis and management of neonatal lung disease. After introductory chapters on cardiopulmonary physiology there are excellent and practical chapters on resuscitation at birth, hyaline membrane disease, pneumothorax and other disorders of air dissection, surgical problems, congential heart disease, and neonatal apnoea. I particularly liked the practical approach to resuscitation and the emphasis on history taking in infants with respiratory disease. The chapter on radiology benefits from the excellent quality of reproduction of the x-rays. There is comparatively little on aspiration syndromes and pneumonia, though the prevention of lung infection in ventilated infants and the problems of differentiating early onset group B streptococcal disease are adequately covered, if slightly difficult to find in the text. The practicalities of managing severe hypoxaemia in these illnesses is to some extent covered in the one really disappointing and confusing chapter in the book, that on persistent foetal circulation (PFC). In that chapter it is not clear precisely which groups of babies they are discussing-is it just infants with isolated PFC, or are they also describing infants with neonatal lung disease who have severesecondarypulmonaryhypertension? The only thing that was clear from the chapter was that PFC is much more common in Indianapolis than in Britain; is there a message there? The second part of the book deals with the general medical management of infants in respiratory failure; blood gas analysis and monitoring; and the techniques and equipment used in ventilatory support. As in the first part of the book, the chapters are all clear and straightforward. There are only two problems: one is that much of it is written for the respiratory therapist-a subgenus of paramedic, that does not exist in Britainwith the result that the chapters on oxygen therapy and ventilators in particular contain far too much detail for the British market on the insides of bag and mask units, nebulisers, and ventilators; the other is that not only is there too much of this detail, but it does not deal with ventilators or apparatus widely used in Britain, such as that manufactured by British Oxygen, Vickers, and Draeger. Nevertheless, this is a useful book, clearly written by people who are obviously still in at the sharp end of neonatal respiratory care. Why the babies are ill, and what to do with them is clearly and concisely laid out, well referenced, and easy to find from the index. The book could, with advantage, be on the bookshelf of all neonatal intensive care units and be read and kept for reference by all paediatricians working in these.