Inflicted Head Injury in Infants: Outcome of Referral to Statutory Authorities

Author

Dr Patrick Kelly, Dr Judith MacCormick

Speaker

Dr Judith MacCormick, Dr Patrick Kelly

Organisation

Starship Childrens Hospital, Auckland

Aim:To describe the outcome of referral to statutory authorities for inflicted head injury in infants aged under 2 years.

Methods:Retrospective review of information from multiple sources concerning children under 2 years of age admitted to Auckland Hospital with subdural and retinal haemorrhage, over a 10-year period from 1988 to 1998. Records reviewed included hospital records, records held by the Department of Child Youth and Family Services and Police files.

Results:Forty-one infants under 2 years sustained subdural and/or retinal bleeding as a consequence of child abuse in the period reviewed. Twenty-six infants were Maori. Six infants died in hospital and 1 died a year after discharge. All were referred to the Department of Child Youth and Family Services and most were referred to the Police. Interagency case conferences took place in 18 cases. Informal processes were followed to monitor safety in 18 cases. Family Group Conferences took place in 16 cases. Charges were laid in 20 cases, with a variety of outcomes. Permanent placement outside the home occurred in 9 cases. Factors relevant to risk assessment will be presented in detail.

Conclusions:"Shaken baby syndrome" is a condition associated with significant mortality and permanent handicap in New Zealand children. Issues of safety and prosecution are often extremely complex, because the infant is usually looked after by multiple caregivers, and confessions are uncommon. Spurious explanations for the injuries are often advanced, and often accepted too readily both by family members and by professionals. Proposals for better interagency management are discussed.

Presentation

Paper

Biography

Dr Patrick Kelly FRACP is a consultant Paediatrician at Starship Children's Hospital, Auckland. He has been Clinical Director of Te Puaruruhau (previously Whakaruruhau), the team within the Auckland District Health Board which deals with suspected child and youth abuse and neglect, since 1996.

This team is now located within Puawaitahi, Australasia's first interagency "child advocacy centre". Dr Kelly is also an Honorary Clinical Senior Lecturer in Paediatrics at the University of Auckland School of Medicine and Health Sciences. He teaches extensively on child abuse and neglect, and is co- author of the Ministry of Health training package for General Practitioners on child abuse. Dr Kelly has worked in the field of child abuse since 1992, is Chairperson of the Special Interest Group on Child Abuse and Neglect of the Paediatric Society of New Zealand, and was until recently a member of the National Child Mortality Review Committee.

Dr Judith MacCormick is an advanced trainee in Paediatrics at Starship Hospital in Auckland. She graduated with MBChB from the University of Auckland in 1998 and completed a Diploma in Paediatrics in 2001. She is currently working as the Child Protection Registrar in Te Puaruruhau.