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Hard heads v soft hearts

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Mark Easton | 17:07 UK time, Wednesday, 3 December 2008

There is something about the photograph of a child who has died which has a poignancy every time you look at it. There's the mixture of innocence, the trust in their eyes, the vulnerability and neediness, and above all the realisation that we couldn't offer the protection to see a child safely through to adulthood.

Baby PA few faces have affected the British public like that - Baby P, Victoria Climbie, James Bulger in the last decade or so. So powerless in life, so influential in death - their young features have moved mountains.

Such tragedies gnaw away at our trust in humanity which, in recent years, has resulted in wide-ranging political and legislative responses.

But are we really serious about reducing child suffering? Because if we are, surely the politicians should be reacting with the same vigour to the findings contained in as they did to the scandal of Baby P.

The scale of maltreatment of children in the UK suggested by the studies sounds incredible. "Every year, in the region of one in 10 children (about one million children in the UK) are maltreated but official statistics indicate that less than one tenth of this burden are investigated and substantiated by child protection services", one report indicates.

Young girl sitting on stairsIncluded in the definition of maltreatment is physical abuse - "hitting with an implement, punching, beating or burning" - assaults which injure the child. The occasional light smack would not count but being belted or caned would.

If a child is bruised or injured in the previous 12 months as the result of deliberate abuse on at least one occasion, he or she is deemed to have suffered maltreatment.
The 'abuser' in these cases is most likely to be a parent.

The definition also includes sexual abuse. Analysing large-scale anonymous surveys conducted in a number of countries including the UK, the researchers conclude that between 5 and 10% of all girls and up to 5% of boys will experience the most serious sexual abuse at least once during their childhood.

Including non-contact abuse such as exposure sees the figures rise to at least 15% for girls and 5% of boys.

The most common perpetrators for this kind of abuse are close relatives and family friends.

The Lancet reports also assess emotional abuse which "affects around 10% of children each year". This form of maltreatment includes persistently being made to feel worthless, unwanted or scared to the extent that it damages a child's emotional development.

And the last and largest category is neglect, defined as a persistent lack of care for a child's safety: not enough food, warmth, education or love. "Neglect is at least as damaging in childhood and adult life as are physical or sexual abuse" the evidence suggests. Although neglect accounts for 44% of child maltreatment reported to agencies in Britain, it "fails to capture the attention of the press, the public, or researchers". Neglect is neglected.

These figures paint a thoroughly depressing picture of the way we routinely treat children in our society. I was struck by the evidence of the long-term damage such abuse does.

"In addition to feeling considerable pain and suffering themselves, abused and neglected children are at increased risk of becoming aggressive and inflicting pain and suffering on others, often perpetrating crime and violence. One paper on the cycle of violence reported that being physically abused or neglected as a child increased the likelihood of arrest as a juvenile (31% arrested v 19% of community-matched controls) and as an adult (48% v 36%)."

The research finds that maltreated children are more likely to suffer mental health problems, to commit suicide, to have drug or alcohol problems, to be obese and to be involved in prostitution.

The studies suggest a causal link with some negative outcomes: "maltreatment has damaging effects on educational achievement, school attendance, and behaviour in childhood and adolescence. Maltreatment in early childhood is particularly damaging for behaviour, but repeated maltreatment has cumulative effects" they say.

As if this wasn't serious enough, the research concludes that little research has been done as to what interventions actually work to stop abuse. "Although a broad range of programmes for prevention of child maltreatment exist, there is still uncertainty about which programmes are effective."

One controversial finding, however, suggests we are too slow to take some at-risk children away from abusive families. "Placing children in foster care and not reunifying them with their biological parents can lead to benefits for maltreated children", the report argues.

This wealth of international academic research, peer-reviewed and published in a reputably medical journal, poses some stark questions for our country and for our government.

If we are really serious about protecting children from suffering, don't we need to look at the big picture? Recognise the common-place nature of child neglect and cruelty? Fund research into what works? Invest heavily in schemes we know are effective? Not allow the beseeching face of an individual child to blind us to the scale of the real challenge?

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