Child abuse and neglect

Child abuse and neglect (child maltreatment) is a combination of a consensus about what comprises unacceptable child rearing/care, together with what children have a right to be free from. This is made explicit in the United Nations Convention on the Rights of the Child, which sets out basic rights and standards for judging children's welfare, including, but not limited to, maltreatment. It incorporates both maltreatment of children within families and that arising from wider social influences, including child labour and sexual exploitation, and children in war zones. Maltreatment affects the healthy and normal course of development. It causes deviation from an expected trajectory, preventing the developing child's negotiation of sequential tasks and disrupting normal transaction between different facets of development. Therefore maltreatment is the very antithesis of adequate child care and rearing, posing a major public health threat. Adequate rearing of the young is such a fundamental activity that the state must be concerned with the overall welfare of children within its society; in family settings where they are normally brought up, and in schools, hospitals, and residential settings. While the Convention provides a framework, several states have developed a children's ombudsman, with wide-ranging powers to oversee the status of children's welfare and to tackle obstacles to it. There are laws within each society to regulate the care and welfare of children, specifying the consequences if children are maltreated. In England and Wales, the Children Acts 1989, and 2004 address the overall welfare of children, including those deemed in need of extra help and support, and provide a legislative structure for those children who are at risk of, or are actually being, significantly harmed (child maltreatment). Countries vary in their response to child maltreatment. In the United States, any professional who has reason to suspect that a child is being maltreated is legally required to inform the local child welfare agency (mandatory reporting). Some countries in Europe (e.g. Belgium and Holland) have a system whereby child-maltreatment concerns are dealt with confidentially, through health and social care supportive systems, rather than through primarily legal methods. The United Kingdom lies between these extremes, but relatively closer to the United States model than to the ‘confidential doctor’ system. Whatever system is in place, it is clear from the scope of the problem of child maltreatment that multidisciplinary working is a core requirement. A developmental-ecological model is the most useful conceptual framework, which draws together the various factors known to contribute or be associated with the predisposition, occurrence, course and effects of child maltreatment. It incorporates individual and interpersonal factors, family influences, immediate neighbourhood ones, together with broader social influences on child rearing and care. However, these layers of increasing social complexity, which surround the individual child, are not static. In addition to transactions between factors, there are important influences historically, and subsequent to any maltreatment, which have an impact on outcome. This inclusive conceptual framework enables genetic and environmental factors to be integrated in a manner that can inform clinical assessment and intervention.