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Stressed parents,fragile babies

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Chris Cloke, BSc, MSc.

Head of Child Protection Awareness, NSPCC, London; Vice-President, Community Practitioners' and Health Visitors' Association

Unfortunately, babies are particularly vulnerable to abuse and neglect - they are two-and-a-half times more likely to be put on child protection registers than other children, with more than 4000 added each year (DoH, 1999). Infants under 12 months are four times more likely to be murder victims than the rest of the population (The Stationery Office, 2000).

Unfortunately, babies are particularly vulnerable to abuse and neglect - they are two-and-a-half times more likely to be put on child protection registers than other children, with more than 4000 added each year (DoH, 1999). Infants under 12 months are four times more likely to be murder victims than the rest of the population (The Stationery Office, 2000).

Identifying parents under stress
Studies show that postnatal depression is experienced by 12-15% of mothers, which can have a devastating effect on babies (Cooper and Murray, 1998; Cox et al, 1982). Coping problems may be more common among teenagers than older parents (Wilson, 1995).

However, US research has shown that programmes of pre-natal and early home visiting by nurses can reduce the incidence of child abuse and neglect (Olds et al, 1990). This and other research (Gilardi, 1991) points to the importance of the role of community nurses and health visitors in child protection.

Nursing problems
Donna Kinnair, health visitor and children's commissioner for Lambeth, Southwark and Lewisham Health Authority in London agrees that child protection is often a thorny issue, particularly for the community nurses, health visitors and midwives who deal directly with parents and carers before and after the baby is born. She says: 'They feel they need to be able to get on with parents and find it difficult to raise child protection concerns with the families.

'Currently it's possible to train as a nurse in this country and have next to no child protection training at all. Nurses who are properly trained are less anxious around child protection. Many nurses, particularly midwives and community nurses, would argue that they are left making decisions they are ill equipped to make. We need to have child protection as part of all nurse-training curricula.'

Targeting staff
Evender Harran, NSPCC project co-ordinator, said: 'We're targeting health professionals because they are well placed to identify carers who are finding it difficult to cope, largely because they provide a universal, non-stigmatising service to all carers.'

When researching previous materials providing advice and guidance on looking after babies for parents, the NSPCC consulted widely with parents and health-care professionals. From this research it became clear that there was a gap in the provision of training for professionals on protecting babies. Some health workers felt they lacked knowledge and experience of the particular vulnerability of babies and the implications for child protection. Other professionals felt there was a need for greater understanding of child development.

Early detection
In response to these needs, the NSPCC has launched Fragile: Handle with care - a training pack for health professionals.

The pack is aimed at all health staff, especially those in contact with pregnant women and families with babies: midwives, health visitors, GPs, community and hospital paediatricians, paediatric nurses, obstetricians and A&E doctors and nurses.

The pack focuses on the fragility of infants of up to 18 months and aims to teach staff how to detect early signs of stress and difficulties in carers before these problems escalate into full-scale abuse.

Support
Fragile: Handle with care has been designed around the needs of health staff who may not have the resources to take long periods of time out for training or who need access to specific information. The pack is made up of a video, a trainer's guide with exercises and activities, as well as summaries of relevant theory and research. Because it is modular in design the sections can be photocopied to provide handouts while experiential exercises are included to explore values and attitudes.

The video begins with a documentary-style introduction, stating research findings into the particular vulnerabilities of babies, including medical professionals who present some of the real case dilemmas they or their colleagues have faced. This is followed by three scenarios that follow the structure and themes of the training material - the prebirth stage, the first 18 months of the baby's life and keeping babies safe. There are trigger points in the video for viewers to stop and reflect on the medical and social factors that they would need to consider in each of the cases presented.

Fragile: Handle with care stresses that it is equally important that health professionals promote positive parenting and offer advice on support and information parents can get from friends and family or from local voluntary and statutory organisations.

The pack follows previous NSPCC materials and activities to protect babies from harm, including a successful public education campaign last year as part of the NSPCC Full Stop campaign.

- The pack costs £160 (incl p&p) from 0116-234 7223.

Cooper, P., Murray, L. (1998)Postnatal depression. British Medical Journal 316: 1748, 1884-1886.

Cox, J.L., Connor, Y., Kendell, R.E. (1982)Prospective study of psychiatric disorders of childbirth. British Journal of Psychiatry 140: 111-117.

DoH. (1999)Child Protection Register Figures, 1999 (England/Wales/ Northern Ireland). London: The Stationery Office.

Gilardi, J. (1991)Child protection in a south London district. Health Visitor 64: 7, 225-227.

Olds, D.L., Kitzman, H. (1990)Can home visitation improve the health of women and children at environmental risk? Pediatrics 86: 1, 108-116.

The Stationery Office. (2000)Criminal Statistics 1998 for England and Wales. London: The Stationery Office.

Wilson, J. (1995)Maternity policy. Caroline: a case of a pregnant teenager. Professional Care of Mother and Child 5: 5, 139-140.

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