Pippa Belderson

Fatal child maltreatment in England, 2005-2009

OBJECTIVE This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England. METHODS Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment). RESULTS A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death. CONCLUSIONS Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.

School breakfast clubs, children and family support

School breakfast clubs are a form of before school provision serving breakfast to children who arrive early. This paper explores their potential to provide support for families at risk of social exclusion. A national evaluation of a Department of Health pilot initiative suggests that their provision can afford valued support to families coping with varying degrees of difficulty in their material, environmental, relational and social circumstances. Many parents regarded clubs as successful in encouraging children to eat breakfast, reducing pressures in the morning and providing an additional source of affordable, trusted child care to those in work, studying or seeking employment. Copyright

Does breakfast-club attendance affect schoolchildren's nutrient intake? A study of dietary intake at three schools

Lack of breakfast has been implicated as a factor contributing to childrens poor diets and school performance. Breakfast-club schemes, where children are provided with breakfast in school at the start of the school day, have been initiated by the Department of Health in schools throughout England, UK. The aim of the present study was to compare the energy and nutrient intakes of schoolchildren who attended breakfast clubs (attendee subjects) with those who did not (control subjects). Three different schools were studied, involving a total of 111 children aged between 9 and 15 years. There were fifty-nine attendee and fifty-two control subjects. The two groups were matched for eligibility for school meals. All subjects completed a 3 d weighed food diary for estimation of nutrient intake. Height and weight were measured and BMI calculated. Nutrient intake data were analysed using a general linear model with age as a covariate. The demographic and anthropometric characteristics of the attendee and control subjects were similar. Children who attended breakfast clubs had significantly greater intakes of fat (% energy), saturated fat (% energy) and Na than control subjects. Thus, in these schools breakfast-club participation was not associated with superior nutrient intake or improvements in dietary pattern.

Fatal child maltreatment in england

Aims This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England. Methods Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of five broad groups of maltreatment deaths: severe physical assaults; overt homicide; infanticide and covert homicide; extreme neglect; deaths related to but not directly caused by maltreatment. Findings A total of 276 cases were recorded giving an incidence of 0.63 cases per 100 000 children (0–18) per year. 246 cases could be classified based on the data available. Descriptive data suggest particular class characteristics of the different categories of death (table 1). The commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death. A large number of deaths appeared related to but not directly caused by maltreatment, these included sudden unexpected death in infancy where the cause of death was considered natural but in which there were associated concerns. Other related deaths included teenage suicide with evidence of previous maltreatment and accidental and natural deaths with evidence of poor parental care. Conclusions These data provide a first attempt to systematically classify and describe characteristics of fatal maltreatment in England. Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.

Healthcare utilisation by children fatally or seriously injured following child maltreatment: analysis of national case series 2005–7 for England

Aims To determine patterns of universal and secondary healthcare use in children seriously or fatally harmed from maltreatment in England Methods The authors analysed recorded use (and lack of use) of universal and secondary healthcare for children subject to a serious case review (SCR) in England 2005–2007. SCRs occur when a child ≤17 years dies or is seriously harmed, maltreatment is (suspected to be) a factor, and there are lessons for interagency working. Our purposive sample (N=40) was regionally representative and similar (in ethnicity, gender and type of incident) to all SCRs in England 2005–2007 (N=189). The authors used standardised templates and multiple layered readings to extract data from the 40 SCR overview reports. Results Two-thirds of children were ≤5 years at the time of the incident (toi) (N=26/40) Half (N=20) were boys. Seventy per cent died (N=28/40) and 30% were seriously harmed. Eighty percent of children (N=32/40) were recorded as using/being registered with ≥1 universal care service, of which a third (N=10) had full recorded use of all age-relevant universal care (antenatal care, vaccinations, general practitioner registration, health visitor/midwife/school nurse); 28% (N=9/32) only had recorded contact with a midwife/health visitor/school nurse; and 40% (N=13/32) had missed appointments. Two-thirds (N=25/40) had ≥1 of the following recorded: known chronic conditions (N=16); secondary care follow-up (N=21); admission (N=12). Four out of five families were known to childrens social care (CSC) (N=31/40), of whom a third (N=10/31) had no recorded health problems/admissions or secondary healthcare. Six children (15%) were not recorded as known to either CSC or secondary healthcare, of whom three were young babies and two older teenagers. There was much missing data. Conclusion Primary care services, particularly midwives, health visitors and school nurses, were important for these children but missed appointments were common. Chronic conditions and/or secondary healthcare were common and CSC knew most of these families. SCRs cannot assess unmet healthcare needs because of poor quality data. Data linkage between SCRs and healthcare databases would improve understanding of the contribution of health to the care of children who die or are seriously harmed and would release professional time for reflection about the case.