Heed the three warning signs of child neglect or cruelty

Ed Rowe urges healthcare professionals to remain alert to children living amid domestic violence, substance misuse and parental ill-health – the three factors most connected to cases of child maltreatment

Those familiar with the television drama series Breaking Bad may recall series two, episode six: Peekaboo.

One particularly grim strand of this episode centres on a neglected child. Spending his days either lying on a filthy mattress or staring at a broken TV while his parents are out of the house or out of their minds on drugs, the child, who has no name and I guess is around five years old, seems to have no words and no idea how to interact with other people.

The cruelty and neglect that some children experience is distressing, but sadly not uncommon. Writing in this week’s issue of Nursing Standard, Taylor and Bradbury-Jones report that one in four people claim a history of child maltreatment.

This abstract fact is in itself shocking, but the real-life story of poor Daniel Pelka, retold in Taylor and Bradbury-Jones’s article, is even more so. Daniel, who lived in the West Midlands, was tortured, starved and finally beaten to death by those that should have loved and cared for him. He was four years old when he died.

What does this have to do with nurses? The authors suggest that it’s the duty of all healthcare professionals to be vigilant for signs of child maltreatment.

The risk factors for abuse include living with domestic violence, parental ill health and parental substance misuse. Two of these factors are present in more than a third of cases where children are killed, the authors say.

Children who are mistreated often do not know any different or they may have communication difficulties – the disclosure that they need so desperately to make requires outside help.

But often the signs are missed, or the response of adults who do have suspicions is inappropriate or insufficient, perhaps because they don’t know what to do or fear being wrong.

A lack of response, whatever its cause, may soon be legally indefensible. Pressure to introduce a ‘Daniel Pelka Law’, which would make it mandatory to report suspected abuse, is growing.

For Taylor and Bradbury-Jones, mandatory reporting misses the point and could make things worse for the children at the centre of it. ‘It could create a culture of over-reporting or discourage young people from disclosing because of fears of a hostile and complicated legal process. It would be much better if we put efforts into stopping abuse before it happened,’ they say.

Nurses are in an ideal position to interpret the signs and symptoms of abuse. Taylor and Bradbury-Jones provide a useful summary not only of these features, but also of steps you can take if you suspect child mistreatment. Most importantly, they say, nurses should be prepared to report their concerns. The worst thing you can do is stay silent.

From the outside, the house where the neglected child in Breaking Bad lived looked perfectly normal. The quiet house on a quiet road, with the whistling post office worker walking by, gave no signs of the horrors that lurked within.

Recent high-profile cases of abuse and neglect highlight this all too well, with vulnerable children falling prey to people who were well regarded and in the public eye. In hindsight, it appears that the clues were there for those who wished to see them. There seems to have been many, including nurses, who had their suspicions about Jimmy Savile and about Daniel Pelka’s treatment, but stayed silent.

Taylor and Bradbury-Jones titled their article Child maltreatment: every nurse’s business. It’s well chosen – and a message that no nurse can afford to ignore

About the author

Ed Rowe is a clinical editor for Nursing Standard

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Child maltreatment: every nurse's business