Elsevier

Child Abuse & Neglect

Volume 24, Issue 7, July 2000, Pages 939-950
Child Abuse & Neglect

Perinatal complications and child abuse in a poverty sample

https://doi.org/10.1016/S0145-2134(00)00148-4Get rights and content

Abstract

Objective: Perinatal medical illness has been associated with child maltreatment. Using a Child Protective Service (CPS) report as the defining event, this study explores to what extent perinatal morbidity is a risk factor for maltreatment.

Method: Medical charts of 206 children ages 0–3 years were reviewed. Data regarding birth history were collected and analyzed in three groups of children: children whose medical record indicated a report to CPS based on prenatal findings (Early Maternal Inadequacy group [EMI]), children whose medical record indicated a report to CPS based only on postnatal findings (Child Maltreatment group [CM]), and a control group without CPS report (NM).

Results: Compared to the CM and the NM groups, children in the EMI group showed significantly lower birth weight and higher neonatal morbidity as measured by Apgar scores, frequency of oxygen requirement and intubation at birth, frequency of admission to Neonatal Intensive Care unit, and frequency of neonatal medical problems. There was no significant difference between the CM and the NM groups in birth weight, gestational age, and other measures of morbidity.

Conclusion: The results of the study suggest that perinatal complications are associated with prenatal maltreatment. Previously reported strong associations between neonatal morbidity and child abuse are more likely a result of antecedent prenatal maternal behaviors (early maternal inadequacy). Early maternal inadequacy, a clinically and demographically distinct phenomenon, is important due to serious health, development and financial implications and deserves further exploration.

Résumé

Objectif: La maladie périnatale, au sens médical, a été associée avec les maulais traitements. En utilisant le signalement à un Service de Protection de l’Enfance (CPS) comme événement déterminant, cette étude explore jusqu’où la morbidité périnatale constitue un facteur de risque pour les mauvais traitements.

Méthode: 206 dossiers médicaux d’enfants de 0 à 3 ans ont été revus. Les données concernant l’histoire de la naissanace ont été collectées et analysées en trois groupes: Enfants dont le dossier faisait état d’un signalement au CPS basé sur des éléments prénataus, (Insuffisance maternelle précoce, EMI), enfants dont le dossier médical indiquait un signalement au CPS basé uniquement sur des données postnatales (groupe des enfants maltraités, CM) et un groupe de contrôle sans signalement au CPS (NM).

Résultats: Comparés aux groupes CM et NM, les enfants du groupe EMI (Insuffisance maternelle primaire) ont montré de façon significative un poids de naissance inférieur et une morbidité plus élevée mesurée avec les scores APGAR: fréquence du besoin d’oxygène et d’intubation à la naissance, fréquence de l’admission à l’unité de soins internsifs pour nouveaux-nés et fréquence de problèmes médicaux de la néonatalité. Il n’y a pas eu de différence significative entre les groupes CM et NM pour le poids à la naissance, le temps de gestation ni pour d’autres mesures de morbidité.

Conclusion: Les résultats de cette étude suggèrent que les complications périnatales sont associées avec la maltraitance prénatale. Ce qui a été précédemment rapporté comme de fortes associations entre morbidité néonatale et mauvais traitements est en fait plus vraisemblablement un résultat de comportements maternels antérleurs (incapacité maternelle precoce). L’incapacite maternelle prècoce, un phénomène cliniquement et démographiquement distinct, mérite d’être plus explorée à cause des implications sérieuses présentées en ce qui concerne des aspects sanitaires, développementaux et financiers.

Objectivo: La enfermedad médica perinatal ha sido asociada con el maltrato a los niños.Utilizando un reporte del Servicio de Protección Infantil (CPS) como evento básico, este estudio explora hasta que punto la morbilidad perinatal es un factor de riesgo para el maltrato.

Método: se revisaron 206 registros médicos de niños de 0–3 años de edad. Los datos relacionados con el historial del nacimiento fueron recolectados y analizados en tres grupos de niños: niños cuyo record médico indicaba un reporte al CPS basado en hallazgos prenatales (grupo de inadecuación maternal temprana, EMI), niños cuyo record médico indicaba un reporte al CPS basado solo en hallazgos postnatales (grupo de niños maltratados, CM), y un grupo control sin reporte al CPS (NM).

Resultados: Los niños en el grupo de EMI, al compararlos con los grupos CM y NM, mostraron significativamente más bajo peso al nacer y mayor morbilidad neonatal medida por puntajes APGAR, frecuencia de requerimiento de oxı́geno e intubación al nacer, frecuencia de admisión a la Unidad de Cuidados Intensivos Neonatal, y frecuencia de problemas médicos neonatales. No se obtuvo una diferencia significativa entre los grupos CM y NM en peso al nacer, edad de gestación, y otras medidas de morbilidad.

Conclusión: Los resultados de este estudio sugieren que las complicaciones preinatales están asociadas con el maltrato prenatal. Las fuertes asociaciones reportadas previamente entre la morbilidad neonatal y el abuso a los niños parecen ser el resultado de conductas maternales prenatales anteriores (inadecuación materna temprana). La inadecuación materna temprana, un fenómeno demográfica y clı́nicamente distinto, es importante debido a sus serias implicaciones de salud, desarrollo y financieras, y merce más investigación.

Section snippets

Background

RETROSPECTIVE STUDIES HAVE consistently found a high incidence of neonatal medical problems, premature births and low birth weights in abused children Creighton 1985, Famularo et al 1992, Fontana 1973, Goldson et al 1976, Klein and Stern 1971 that led to a common notion that these problems place a child at a higher risk for maltreatment. Several explanations of this association have been proposed. The early separation hypothesis suggests that separation from the parents due to neonatal disease

Method

Two hundred and six medical charts of the children ages 0–3 years who were born at the Lucile Packard Children’s Hospital and have had public medical insurance were reviewed retrospectively. Data regarding prenatal course, birth history, and maltreatment (report to CPS) were collected and analyzed. The reviewers were trained by the first author to gather the information from the medical charts.

Medical nature of the presentation in most child maltreatment cases as well as high sensitivity of the

Results

Analysis of the CPS reports in our sample is summarized in Table 1. There were two or more reasons for the CPS reports in many of the cases. The majority of the CPS reports in the EMI group were due to prenatal drug use and lack of medical care during pregnancy. Four of the women who did not have prenatal care stated that they were not aware of being pregnant; one of them realized that she was pregnant at 5 months of gestational age; the other three did not know until delivery. In one case the

Discussion

The findings demonstrated strong association between neonatal morbidity and CPS reporting of prenatal abuse in our sample. Our data also showed that the children who have been reported to CPS from our Hospital postnatally did not have significant neonatal morbidity compared to the control group. These results suggest that previously reported association between neonatal morbidity and child abuse might be a result of negative prenatal maternal behaviors and understandably high neonatal morbidity

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    This research was supported by the NIMH 5 T-32 grant (MH 19908) and Human Service grant M01–RR00070, General Clinical Research Center of Stanford, NIH.

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