This annual report - Taranaki District Health Board

INJURIES ARISING FROM THE ASSAULT, NEGLECTOR MALTREATMENT OF CHILDRENIntroductionChild maltreatment has been defined as any act of commission or omission by a parent orother caregiver that results in harm, potential for harm, or threat of harm to a child [285]. Itincludes neglect, physical, sexual and emotional abuse, and fabricated or induced illness,and is linked to harmful short-term and long-term effects [286]. Physical abuse can resultin disability and death.The psychological effects of maltreatment, which can persist into adulthood, includeanxiety, depression, substance misuse, and self-destructive, oppositional or antisocialbehaviours. In adulthood, childhood exposure to maltreatment has been linked todifficulties in forming or sustaining close relationships, sustaining employment andparenting capacity. There is significant overlap between the occurrence of child abuse andpartner abuse in families and these issues cannot be addressed in isolation [199].Child maltreatment is associated with a complex interaction of predisposing, perpetuatingand precipitating risk factors [195]. Predisposing factors relate to the parent or caregiversearly history and include parental exposure to a violent or abusive environment as a child.Perpetuating factors include the wider social context, such as poor housing andovercrowding, socioeconomic inequality, social and cultural norms that promote violenceand physical punishment of children, and social isolation; the family context, such asunintended pregnancy, lack of attachment, large family size, financial deprivation, andintimate partner conflict; parent or caregiver characteristics, such as alcohol and substanceabuse, mental health problems, and poor parenting skills; the characteristics andbehaviour of the child, such as being unwanted, disabled or high needs. Precipitatingfactors are events that directly trigger abuse, including incessant crying, soiling,aggressiveness by the child, or a crisis event for the parent.A UNICEF report on child maltreatment deaths, from 1994 to 1998, placed New Zealandnear the bottom for deaths in the OECD, at number 24 out of 27 countries [287]. Themortality rate for New Zealand was 1.2 deaths per 100,000 children under the age of 15years, compared to the OECD median of 0.6 deaths per 100,000 children. A recent studypublished in the Lancet found no clear evidence of a decrease in child maltreatment inNew Zealand over the past two decades [288]. Between 2006 and 2010 there were 36deaths due to assault among children aged 28 days to 14 years [289]. Between 2006 and2010 there were 13.9 per 100,000 hospital admissions for injuries arising from assault,neglect or maltreatment of girls aged 0 to 14 years, and 24.3 per 100,000 for boys [153].The rate of hospitalisation increased with increasing socioeconomic deprivation (RR 5.59,95% CI 4.22–7.41 for NZDep deciles 9–10 vs. deciles 1–2), with rates of hospitalisation forMāori (39.1 per 100,000) and Pacific children (24.4 per 100,000) being significantly higherthan for NZ European children (11.8 per 100,000).The following section reviews hospital admissions and mortality from injuries arising fromthe assault, neglect or maltreatment of children aged 0–14 years using information fromthe National Minimum Dataset and the National Mortality Collection.Assault, Neglect or Maltreatment of Children - 309