A clinical basis for identifying child abuse
A pioneering research programme for more reliable clinical assessments of child abuse and neglect.
Ten years ago there were no evidence-based standards or clinical guidelines to inform clinical assessments of suspected child abuse or neglect. When cases went to court, expert medical opinions were provided by a handful of clinicians who relied on their clinical experience, rather than scientific evidence.
Clinicians were accused of misrepresenting the evidence and being instrumental in the wrongful prosecution of mothers for causing the deaths of their babies. Media and legal criticism led to a lack of confidence in and amongst clinicians working in child protection.
Providing a scientific basis
Our researchers developed the world's first research programme to provide the scientific basis for more reliable clinical assessments of child abuse and neglect. The team completed 21 systematic reviews critically appraising the world literature relating to the recognition and investigation of child abuse. The group has published 28 peer reviewed papers.
Some of the most significant findings into clinical approaches and practices regarding suspected cases of child abuse and neglect related to bruising and fractures. For example:
- it is not possible to age bruises in children accurately with the naked eye
- it is possible to age fractures within broad time frames
- in non-mobile infants bruises over soft tissue areas that carry the imprint of an implement are indicators of abuse, as are multiple bruises of uniform shape
- rib fractures, fractures to the shaft of the humerus in infants and femoral fractures in non-mobile babies have a high probability of being caused by abuse
Our research programme was the first to provide the scientific basis for more reliable clinical assessments of child abuse and neglect.
Informing the nation
The research directly informed five national clinical guidelines, the National Child Protection training program and the first NICE guidance on child maltreatment. Through the CORE INFO website, the evidence base created by the research team is accessed each year by 100,000 users.
A recent survey of child protection paediatricians in the UK and Australia found that CORE INFO is used by 60 per cent of these professionals to inform clinical decisions, provide continuing professional development and education material, inform legal reports and give scientific validation to expert opinion.
- Kemp, A. M. et al. 2008. Patterns of skeletal fractures in child abuse: systematic review. BMJ 337 a1518. (10.1136/bmj.a1518)
- Maguire, S. A. et al. 2005. Can you age bruises accurately in children? A systematic review. Archives of Disease in Childhood 90 (2), pp.187-189. (10.1136/adc.2003.044073)