Doctors may miss child abuse over ‘outdated ideas’

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Child abuse could go undetected by doctors because they may have outdated ideas about how many bruises are normal in physically active children.

Consultant paediatrician Dr Emma Curtis told a seminar it was considered normal 20 years ago for the average young child to have 12 bruises at any given time from the rough and tumble of play and minor falls.

But she said while that figure and the research it came from was still referred to in medical circles, she regarded two to three bruises as more realistic today.

"I think children are not as active any more. Maybe they’re not climbing walls and riding bicycles as much. So we need to be careful when assessing bruises as a possible indicator of abuse," she said.

Dr Curtis, who works at the National Children’s Hospital, Tallaght, was addressing a seminar to mark the launch of a professional body for people working in child protection and related fields.

The British Association for the Study and Prevention of Child Abuse and Neglect yesterday opened its Irish branch. The name of the organisation is to be changed to reflect the wider membership.

Dr John Devaney, the group’s chairman, said the organisation provided a valuable means for professionals to network and share information and experiences.

"Children are kept safe and families are better supported when professionals are able to work across their different organisational and disciplinary boundaries and have a mechanism for sharing their ideas, their expertise, and their shared enthusiasm and motivation to make things right," he said.

Dr Helen Buckley of Trinity College Dublin, who chairs the National Review Panel on deaths of children known to the child protection services, echoed that view. Dr Buckley pointed out that child protection was the direct or indirect responsibility of many professionals including social workers, doctors, teachers, gardaí, probation officers, housing officers, and family support workers.

She said the only visible work in terms of official records was that carried out by social workers, and that led to people working in an information vacuum as the outcomes of other interventions were not recorded.

While some 40,000 reports flagging concerns about children were made to the statutory services each year, Dr Buckley said: "We have very little valuable data available."

"A lot of work goes on but unfortunately we don’t know what that work is because nobody collects any data on it and it is rather frustrating for policymakers and those of us who want policy to be made in a particular way that we are not more led by that kind of valuable information."

The Government-appointed special rapporteur on child protection, Geoffrey Shannon, also called for better recording of data; better research into data; and a greater sharing of results.

He said too often, discussion around child protection in Ireland was based on experiences in other countries.

"You hear it all the time. New Zealand does this and Australia does that. It becomes sort of exhausting when you’re asking, ‘What do we do?’

"There continues to be a lack of empirical research particularly in this jurisdiction informing policy. We need to redouble our efforts to ensure that the legislation we draft is informed by quality empirical research."