childhood neglect: improving outcomes for children presentation p4 childhood neglect: improving...

Childhood Neglect: Improving Outcomes for Children

Presentation P4P4Childhood Neglect: Improving Outcomes for Children

Presentation

Children's health,including mental health

What I need to grow up


Presentation P4

P4 Children's health, including mental health 2

Learning outcomes• To recognise signs and symptoms of

children and young people who are, or may be, being neglected


Presentation P4


Nutritional neglectIndicators

• Begging for or stealing food.

• Frequently hungry.

• Rummaging through rubbish bins for food.

• Gorging self, eating in large gulps.

• Hoarding food.

• Obesity.

• Overeating junk food.


Presentation P4


Medical neglect• Denial of health care.

• Delay in health care.

• Indicators of poor health

• drowsiness, easily fatigued

• puffiness under the eyes

• frequent untreated upper respiratory infections

• itching, scratching, long existing skin eruptions

• frequent diarrhoea

• bruises, lacerations or cuts that are infected

• untreated illnesses

• physical complaints not responded to by parent.


Presentation P4


Mental health

• Neglected children have an increased risk of developing PTSD.

• BUT other variables also play a part.

• Neglected children are at increased risk for early behavioural problems and conduct disorder.

• Effects on lifestyle and behaviour may expose individuals to higher risks.


Presentation P4


Environment and hazards

Exposure to hazards

• Safety hazards.

• Smoking.

• Weapons.

• Unsanitary household conditions.

• Lack of car safety restraints.


Presentation P4


Disability and neglect

• International research shows that disabled children are more likely to be maltreated than others.

• Disabled children are 3.8 times more likely to be neglected.

• Parenting capacity may be diminished.

(Sullivan and Knutson 2000)


Presentation P4


Disability and neglect

• There is a lack of general awareness of disabled children’s vulnerability.

• Growth, behaviour and other problems may be seen to be the result of the disability.

• Professionals need to be vigilant about feeding regimes.

(Sullivan and Knutson 2000)


Presentation P4


Weight faltering(Previously known as) Failure to thrive (FTT)

• Organic/nonorganic debates.

• Failure to meet expected weight and growth norms or developmental milestones.

• 5% of all children have faltering growth; 25% of children who are abused or neglected have faltering growth.

• Routine growth monitoring is important: height, weight, BMI and head circumference.

• Health visitors are the crucial first link. Dietetic and paediatric assessment next.


Presentation P4


Child death related to neglect

NB! Under-reporting and under-recognition of neglect in child death are both common

• Lack of supervision (most deaths occur from this category).

• Malnutrition or poor care can lower resistance to infection.

• Failure to respond to illness in child - sudden infant death.

• Failure to use preventive health care; for example, immunisation.

• Parental use of drugs - intoxicated adult/lack of supervision, accidental ingestion.

(Brandon, Bauley and Belderson 2010)


Presentation P4


Clinical presentation

• Severe and persistent infestations (for example, scabies or lice).

• Consistently inappropriate clothing.

• Persistently dirty and smelly.

• Faltering growth because of inadequate or inappropriate diet.

(NICE 2009)


Presentation P4



• Home reports which indicate a poor standard of hygiene, which will affect the child’s health.

• Inadequate provision of food and living environment unsafe for child’s developmental age.

• Parent/carers fail to seek medical advice for their child to the extent health and wellbeing are compromised, including if the child has ongoing pain.

(NICE 2009)


Presentation P4



• If explanation of injury suggests a lack of appropriate supervision (for example, sunburn, ingestion of harmful substance).

• Repeated failure by parents/carers to administer essential prescribed treatment.

• Repeated failure by parents/carers to attend essential follow-up appointments.


Presentation P4



• Repeated failure by parents/carers to engage with relevant health promotion programmes; for example, immunisation, screening and health and development reviews.

• If parents/carers have access to, but persistently fail to obtain NHS treatment to their child for dental tooth decay.


Presentation P4


The ACE study(Adverse Childhood Experiences)

• Adverse Childhood Experiences and their relationship to Adult Health and Wellbeing.

• Child abuse and neglect.

• Growing up with domestic violence, substance abuse, mental illness, crime.

• 18,000 participants.

• 10 years.(Anda et.al. 2008)


Presentation P4



Presentation P4


Some findings so far...

• Increased risk of: • lung cancer

• auto immune disease

• prescription drug use

• chronic obstructive airways disease

• poor health-related quality of life.


Presentation P4


An introduction to brain development and neglect

• Brain plasticity.

• Neurobiology.

• The Romanian orphanage studies.

• Perry and the Child Trauma Academy.


Presentation P4


Brain plasticity• During the development of the brain, there are critical

periods during which certain experiences are expected in order to consolidate pathways – for example, the sensitivity and regularity of the interaction which underpins attachment with the caregiver.

• Negative experiences, such as trauma and abuse, also influence the brain’s final structure.

• In cases of severe emotional neglect some pathways will die back.

• The child’s brain will be smaller.


Presentation P4


Neglect and the brain

• The ‘new neurobiology’: traumatology (especially PTSD) and developmental neuroscience.

• Neurobiological treatment goals.

• Brain plasticity.

• Differences between neglect and abuse (Glaser 2000).

• Genetic and environmental modifications.


Presentation P4


Neglect and the brain

• Developments in neuroscience have given us a greater understanding of the developing brain and the impact of abuse and neglect.

• Genetic and environmental modifications.

• Our brains expect to have experiences.

• Our brains are experience dependant.


Presentation P4


Neurobiology

Structures tend to be fixed by birth, but the connections and functions carry on being sorted until early adulthood.


Presentation P4


Chugani et.al. (2001)• Romanian Orphans.

• Persistent specific behavioural and cognitive deficits.

• Brain glucose metabolism.

• Significantly decreased metabolism.


Presentation P4



Presentation P4


Child Trauma Academy• The Child Trauma Academy (Perry et al.).

• The Child who was Reared as a Dog (Perry & Szalavitz 2007).

• Neglect: the absence of critical organising experiences at key times during development.

• Non-human animal studies.

• Institutional deprivation.

• Recovery after safe placement.

• Corroboration: Romanian orphans.

• Brain scans.

(see www.childtrauma.org)


Presentation P4


Perry (2002)

Cumulative

Impact

Sequelae

Risk taking behavioursEnvironment and parenting

Early trauma and abuse


Presentation P4


Possible points of intervention(A public health approach?)

Mortality Morbidity &Injury

Risk indicators

Neighbour-hood

Institutional power

Social inequalities

Downstream(tertiary intervention)

Midstream(secondary prevention)

Upstream(primary protection)

Poverty, housing

Lobbying

Community based primary prevention

Educational initiatives

Risk reduction programmes

Parenting support

Trauma recovery programmes

childhood neglect: improving outcomes for children presentation p4 childhood neglect: improving...

Documents