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Childhood Neglect: Improving Outcomes for Children Presentation P4 Childhood Neglect: Improving Outcomes for Children Presentation Children's health, including.

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Presentation on theme: "Childhood Neglect: Improving Outcomes for Children Presentation P4 Childhood Neglect: Improving Outcomes for Children Presentation Children's health, including."— Presentation transcript:

1 Childhood Neglect: Improving Outcomes for Children Presentation P4 Childhood Neglect: Improving Outcomes for Children Presentation Children's health, including mental health What I need to grow up

2 Childhood Neglect: Improving Outcomes for Children Presentation P4 Learning outcomes To recognise signs and symptoms of children and young people who are, or may be, being neglected P4 Children's health, including mental health2

3 Childhood Neglect: Improving Outcomes for Children Presentation P4 Nutritional neglect Indicators 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. P4 Children's health, including mental health3

4 Childhood Neglect: Improving Outcomes for Children 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. P4 Children's health, including mental health4

5 Childhood Neglect: Improving Outcomes for Children 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. P4 Children's health, including mental health5

6 Childhood Neglect: Improving Outcomes for Children Presentation P4 Environment and hazards Exposure to hazards Safety hazards. Smoking. Weapons. Unsanitary household conditions. Lack of car safety restraints. P4 Children's health, including mental health6

7 Childhood Neglect: Improving Outcomes for Children 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) P4 Children's health, including mental health7

8 Childhood Neglect: Improving Outcomes for Children 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) P4 Children's health, including mental health8

9 Childhood Neglect: Improving Outcomes for Children 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. P4 Children's health, including mental health9

10 Childhood Neglect: Improving Outcomes for Children 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) P4 Children's health, including mental health10

11 Childhood Neglect: Improving Outcomes for Children 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) P4 Children's health, including mental health11

12 Childhood Neglect: Improving Outcomes for Children Presentation P4 Clinical presentation 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) P4 Children's health, including mental health12

13 Childhood Neglect: Improving Outcomes for Children Presentation P4 Clinical presentation 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. P4 Children's health, including mental health13

14 Childhood Neglect: Improving Outcomes for Children Presentation P4 Clinical presentation 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. P4 Children's health, including mental health14

15 Childhood Neglect: Improving Outcomes for Children 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) P4 Children's health, including mental health15

16 Childhood Neglect: Improving Outcomes for Children Presentation P4 P4 Children's health, including mental health16

17 Childhood Neglect: Improving Outcomes for Children 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. P4 Children's health, including mental health17

18 Childhood Neglect: Improving Outcomes for Children Presentation P4 An introduction to brain development and neglect P4 Children's health, including mental health18 Brain plasticity. Neurobiology. The Romanian orphanage studies. Perry and the Child Trauma Academy.

19 Childhood Neglect: Improving Outcomes for Children 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. P4 Children's health, including mental health19

20 Childhood Neglect: Improving Outcomes for Children 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. P4 Children's health, including mental health20

21 Childhood Neglect: Improving Outcomes for Children 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. P4 Children's health, including mental health21

22 Childhood Neglect: Improving Outcomes for Children Presentation P4 Neurobiology Structures tend to be fixed by birth, but the connections and functions carry on being sorted until early adulthood. P4 Children's health, including mental health22

23 Childhood Neglect: Improving Outcomes for Children Presentation P4 Chugani et.al. (2001) Romanian Orphans. Persistent specific behavioural and cognitive deficits. Brain glucose metabolism. Significantly decreased metabolism. P4 Children's health, including mental health23

24 Childhood Neglect: Improving Outcomes for Children Presentation P4 P4 Children's health, including mental health24

25 Childhood Neglect: Improving Outcomes for Children 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 P4 Children's health, including mental health25

26 Childhood Neglect: Improving Outcomes for Children Presentation P4 Perry (2002) Cumulative Impact Sequelae Risk taking behaviours Environment and parenting Early trauma and abuse P4 Children's health, including mental health26

27 Childhood Neglect: Improving Outcomes for Children 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 P4 Children's health, including mental health27


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