Early Indicators of Child Abuse and Neglect: A Multi-Professional Delphi Study

This study used the Delphi technique (basically many rounds of questionnaires) to seek consensus about possible early indicators of child abuse and neglect. In this study they gave questionnaires to a variety of professional people who have something to do with child protection work, not just child protection social workers.

Consensus about the early indicators of child abuse was achieved on the following topics:

‘Physical indicators’:

• Unexplained patterns of minor injuries.
• Recurring minor injuries.
• Frequent admissions to hospital with all tests negative.
• Recurring and unexplained episodes of cyanosis.
• Failure to thrive.

‘Behavioural and developmental indicators’:

• Self-harm.
• Eating disorders.
• Inappropriate sexualized behaviour.
• Undue fear of adults.
• Running away.
• Foraging / hoarding food.
• Cruel to animals.
• Sudden changes in behaviour / progress.
• Withdrawn or wary.
• Encopresis (Encopresis is the soiling of underwear with stool by children who are past the age of toilet training. Because each child achieves bowel control at his or her own rate, medical professionals do not consider stool soiling to be a medical condition unless the child is at least 4 years old).
• Head banging / rocking.
• Aggressive to peers.
• Miserable child.

‘Parental factors’:

• Failure to ensure that the child receives medical treatment for illness or injury.
• Failure to ensure that the child receives basic health care (e.g. developmental assessments / immunizations).
• Domestic violence in pregnancy.
• Use of excessive punishment.
• Inability to meet basic needs of the child.
• Frequent negativity about a child.
• Parents who put their own needs first.
• Lack of provision for safety.
• Substance abuse.
• Substance abuse in pregnancy.
• Extreme anger.
• Acute mental health needs.
• Alienation of support network.
• Failure to book for antenatal care.
• Unrealistic expectations of child.
• Unwanted pregnancy.
• High levels of conflict with agencies / people in authority.

and ‘other’:

• A clustering of signs.