Paediatrician calls for shake up in handling child abuse cases
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7382.180/a (Published 25 January 2003) Cite this as: BMJ 2003;326:180All rapid responses
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Editor,
‘Paediatrician calls for shake up in handling child abuse cases’
could be countered by ‘Public calls for shake up in the diagnosis of child
abuse’ following the release of Sally Clark.
One such diagnosis, of which I have the post-mortem report, concerned
a bruise “on the left side of the penis” of a child
attributed, along with other findings, to non-accidental injury.
Here are a few more causes of a bruise “on the left side of the
penis” of a toddler that Paediatricians can think of when faced with a
similar situation:
1.Infantile Scurvy or Barlow’s Disease.
2.Haemorrhagic Disease of the New Born
3.Alloimmune Thrombocytopenia
4.Congenital Platelet defects
5.Congenital Vascular defects
6.Acquired Vascular Defects
7.Infection followed by Disseminated Intravascular Coagulation
8.Iatrogenic Misadventure following Medication.
Michael Innis FRCPath; FRCPA
Competing interests:
None declared
Competing interests: No competing interests
Southall et al's proposal to organise child abuse interventions
around the motivation of the perpetrator is helpful and timely. There is
a clear moral distinction to be drawn between those who systematically
torture, rape or murder children for entertainment or profit, and those
who injure their children through desperation. The former group, which
should probably include rings of sexual abusers, child pornographers,
child slavers, and impressors of child soldiers, are criminals whose
activities are frequently organised and international. Furthermore, there
are several instruments of international law, which would allow agencies
to pursue them across differing national jurisdictions. Southall et al's
proposal for an interagency taskforce, if given an international
dimension, would provide an appropriate reservoir of skills for the
detection prevention of a particularly depraved class of crime that is
currently very difficult to combat. It would also help to remove stigma
from the much more numerous class of perpetrator, where the abuse is,
sadly, the best that the perpetrators can manage in some extremis. If
this latter group could be encouraged to ask for help before they harmed
their children much suffering could be averted. With less stigma, and
public ire directed towards those who deserve it, more might do so.
There are of course considerable practical difficulties in trying to
organise child protection services around a classification based on
motivation, as the true motivation for an episode of abuse may only be
apparent in retrospect, if at all. However, the examples I have
previously identified, if suspected, warrant an investigation that is
entirely different from everyday child protection procedures. As many
countries cannot afford to effectively investigate this class of crime
themselves, the establishment of such task forces could bring
international, as well as national benefits to abused children. At home,
the separation in training that such an approach would require might
improve those outside abuse teams in detection, as they would also be
forced to think "child protection" from a criminal, as well as a welfare
aspect.
Competing interests:
None declared
Competing interests: No competing interests
'A radical shake up is needed in the way child protection cases are
tackled, with a harder line being taken when professionals suspect
premeditated abuse, argue UK paediatricians in two articles in the latest
issue of Archives of Disease in Childhood (2003;88:101-4, 105-7).'writes
Lynn Eaton.
There is no doubt whatsoever that these authors are right about the
need for a shake up. Indeed, as the Government itself has said, root and
branch change is called for.
But I am perplexed that these authors are making this suggestion as
their methodologies and opinions and those of other colleagues in the
world of Munchausen Syndrome by proxy, have influenced
Government/legal/SSI/media and professional thinking and held sway for
many many years in our UK society and also spread abroad. Indeed, their
power and influence over every single influential agency has been
staggering and remarkable. If their theories and methods were correct, the
intensive and widespread influence and subsequent draconian interventions
should have lead to significantly fewer, not more cases of child death.
It has taken the further deaths of innocent children for us to reach
the point of public discussion about the failures of the system, instead
of the Government responding to the cries of individuals such as myself
for a public debate before more children and families were destroyed by
erroneous thinking.
In the shake up which I agree should happen, we need to look at the
errors of judgement right across the board in our responsibilities to
children, our future. This requires acknowledgment of the not unlikely
posssibility that whilst vast numbers of social workers were trained and
encouraged to have their heads up misty dead ends, real abuse was being
carried out under the glaring streetlight just up the road.
Limited resources, focus and energy have been diverted away from real
and terrible child abuse - in families where professionals were truly
scared to intervene, as in the Victoria and the Annilee cases - into
costly court cases and vast crowds of expensive professionals attending
numerous case conferences on little or no evidence against completely
helpless women and ill children.
And now, on the eve of the Government report on the gross failings of
our system in Victoria's case, we are being invited to do this even more.
The unpalatable truth is that the common denominator in false cases
and missed real cases is sheer incompetence and wrong headedness - and
many may be justified in feeling very angry that they have listened to
certain agendas, spent vast amounts of money - to end up being told they
have got it all wrong by the same people who have been advising them for
over a decade.
Competing interests:
None declared
Competing interests: No competing interests
The classification that they propose is excellent and readily
recognisable, and to any health care professional.
Will there be the political will to implement it though?.
Competing interests:
None declared
Competing interests: No competing interests
False Accusations of Child Abuse - a massive Iceberg.
The cases of Victoria Climbie’ and Sally Clarke are the two sides of
the same coin. In the first instance it was fortunately a rare event where
a child died as a consequence of the actions of abusive adults, but the
latter case, with that of Trupti Patel, is but the smallest tip of a
massive iceberg - false accusations of child abuse involve many thousands
of children and their families every year. All three cases graphically
illustrate the deeply flawed and highly dysfunctional state of child
protection services in the U.K.
It is notable that in the case of Victoria Climbie’ there has rightly
been a Public Inquiry to establish the reasons for what occurred but no
Public Inquiry has been ordered regarding either Sally Clarke or Trupti
Patel.
Inquiries into errors in child protection have been occurring since
at least 1946 (Dennis O’Neill) and invariably on each occasion failures of
the respective and responsible agencies have been highlighted. Those
agencies have consistently stated that they have changed their procedures
and have received considerable resource inputs and new powers to undertake
their duties and responsibilities. Those same agencies have consistently
claimed they have “Learnt important lessons from these events and from the
recommendations of these Inquiries ”. Clearly they have not learnt as the
same mistakes have been repeated over and over again.
As Lisa Blakemore-Brown has pointed out, most of the resources have
been used to pursue false accusations while serious cases of child abuse
have been ignored.
The recent government Green Paper – Every Child Matters, does not
begin to address the endemic dysfunctionalism of the child protection
system and does little more than repeat past errors of shuffling around
the responsibilities and throwing more resources at a system that is
already beyond resuscitation. It is tantamount to putting a sticking
plaster on a broken leg and the major purpose of the proposals appears to
be solely to provide an area of responsibility for the newly-appointed
Minister for Children.
The proposals of Southall et al appear to have little merit and
simply add to the chaos in the existing dysfunctional system and will
serve only to unnecessarily draw more innocent children and their families
into this system.
I support Lisa Blakemore-Brown’s demand for a full Inquiry into the
present child protection system but rather than such Inquiry being
dominated by agency representatives with vested interests to protect, the
key witnesses should be those children and their families who have
suffered severe and long-lasting emotional harm and irreparable
devastation to their family life, from being unnecessarily embroiled in a
child protection system by false accusations made for mistaken,
mischievous, malicious, and monetary reasons.
Competing interests:
None declared
Competing interests: No competing interests