Child abuse: Thoughts on doctors, nurses and prevention

It is obviously better if child abuse can be prevented in the first place. There are many problems in society which doctors and nurses and other health care professionals can hardly be expected to fix up, but there are many weaknesses in what we do which can and should be repaired. As a group we are weak in our appreciation of the demoralizing strain that an awkward or crying baby can bring upon a household, particularly that of the nuclear family. The media paint a mythical picture of parenthood, possibly unreal, and leading to the isolation of the mother who wants to complain that her child is very trying. As a group, doctors and nurses are more concerned about reassurances that a child is not seriously ill or else will outgrow his particular symptom and are not very good at bending their energies towards providing relief of the symptom. The sanity of many families has been preserved by the judicious use of safe analgesics and sedatives. Many people obtain these in spite of the physician and not through him.To turn to an even earlier phase of infancy, where hospital personnel are intensely involved and could well mend their ways often — in Western countries more and more babies are being born in hospital. Frequently, insufficient efforts are made to ensure that the labour and delivery are pleasant emotional experiences for the mother. In the name of safety, sterility and administrative needs, many of the emotional needs of the parents are unmet. It is now being shown that actual physical attachment between mother and baby in the time — hours and days — after the baby is born can be extremely important in developing the mother/child bond which is the child's greatest protection. In many countries including mine there have to be associations of mothers who want to breast feed their own children, and these mothers often find that their greatest difficulties are with hospital personnel.The very necessary scientific measures required to ensure the safety of low birth weight and premature infants can separate mother from baby even more and this is reflected in the well-known increase in later child abuse among babies who have spent their early weeks in intensive care units. If the hospital personnel really try, they can make the mother and father feel at home in these ultrascientific units. The staff must not merely permit but must actively invite the parents into the special nursery, explain the surroundings and equipment, show how to gown and hand wash, how to open the Humidicrib, touch the baby and take part in the nursing management from the earliest possible time — the second or first day. Explanations appropriate to the parental level of understanding must be given and repeated.Anything which will strengthen the bonds within the family must be welcomed as something that will prevent child abuse.