Zusammenfassung
Methode und Ergebnisse
Von 01/2001–06/2007 wurden 59 Kinder und Jugendliche mit der gesicherten Diagnose Kindesmisshandlung im Kinderzentrum der Universität Leipzig stationär betreut (36-mal körperliche Misshandlung, 11 Vernachlässigungsfälle, 6-mal sexueller Missbrauch, 5 Kombinationsformen von Vernachlässigung und körperlicher Misshandlung, 1-mal Münchhausen-by-proxy-Syndrom). Deren Daten wurden retrospektiv mit einem Datenerfassungsbogen erhoben und mit Hilfe deskriptiver Statistik ausgewertet. Beide Geschlechter waren etwa gleich häufig betroffen, das Alter variierte stark. Bei 17% der misshandelten Kinder lag eine Entwicklungsstörung vor. In >91% (54 von 59) wurden keine regelmäßigen Früherkennungsuntersuchungen dokumentiert. Alkohol- oder andere Drogenprobleme bestätigten 17% der Elternteile. Alleinerziehend waren 53% der Mütter und 10% der Väter. Jeweils 7% der Väter und Mütter sowie 5% der Geschwister der misshandelten Kinder waren chronisch krank. Bei den 59 stationär behandelten Patienten wurden 108 konsiliarische Beurteilungen durchgeführt, nur in 20% wurde eine Fallkonferenz dokumentiert.
Schlussfolgerung
Drogenkonsum der Eltern, chronische Krankheiten in der Familie und Alleinerziehung stellen soziale Risikofaktoren für eine Kindesmisshandlung dar. Als kindlicher Risikofaktor zeigte sich v. a. eine Entwicklungsstörung. Erhebung und Dokumentation von Sozialanamnese, psychischen Auffälligkeiten der Kinder und Eltern sowie gemeinsamen Beurteilungen der involvierten Fachdisziplinen sind stark verbesserungsbedürftig.
Abstract
Background
Child abuse leads to acute and long-term physical and emotional harm to children and adolescents. Medical personnel have a special challenge and responsibility regarding early recognition, protection of the child, and support for the whole family. The aims of this study were to analyse the frequency and types of child abuse as well as the social backgrounds of the affected families and to evaluate the clinical management of the children treated at the Children’s Centre at the University of Leipzig.
Patients
Data were analysed for all 59 patients admitted to the Children’s Centre at the University of Leipzig with a confirmed diagnosis of child abuse between January 2001 and June 2007.
Methods
For the retrospective analysis, a data collection questionnaire with 91 items was developed, containing the main categories of sociodemographics, medical findings, and clinical case management. The data were evaluated using descriptive statistics (Excel and SPSS).
Results
The treated inpatients included 36 cases of physical child abuse, 11 of neglect, six of sexual abuse, five of combined physical abuse and neglect, and one of Munchhausen-by-proxy syndrome. The gender distribution was almost equal, but the age varied significantly (2.5 weeks to 15 10/12 years). Seventeen percent of the abused children showed symptoms of a developmental disorder. In 54 of the 59 cases, no routine medical checkups were documented. Seventeen percent of the parents had alcohol and drug problems, and 53% of the mothers and 10% of the fathers were single parents. Seven percent of the fathers and mothers and 5% of the siblings of the abused children were chronically ill. In the 59 children and adolescents, 108 consultations were performed at the Children’s Centre. In only 20% was an interdisciplinary case conference documented.
Conclusion
Child abuse is a problem of society and health care policy. The study at Leipzig showed that parental drug abuse, chronic disease in the family, and single parentage are social risk factors for child abuse. As a risk factor on the child’s side, developmental disorders were identified. Within the distribution of the types of child abuse, child neglect is certainly underrepresented. Data acquisition and documentation concerning the social history, the psychological conspicuity of children and their parents, and the concerted assessments of the professionals involved in patient care must be strongly improved.
Literatur
Afifi T, Brownbridge D, Cox B, Sareen J (2006) Physical punishment, childhood abuse and psychiatric disorders. Child Abuse Negl 30:1093–1103
Bundeskriminalamt (2006) Polizeiliche Kriminalstatistik 2005 – Bundesrepublik Deutschland. BKA, Wiesbaden, www.bka.de/pks/pks2005/download/pks-jb_2005_bka.pdf
Dubowitz H, Bennett S (2007) Physical abuse and neglect of children. Lancet 369:1891–1899
Edwards V, Holden G, Felitti V, Anda R (2003) Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry 160:1453–1460
Frank R (1995) Kinderärztlich-kinderpsychiatrische Untersuchungen an misshandelten und vernachlässigten Kindern und deren Familien. Habilitationsschrift, Ludwig-Maximilians-Universität München
Frank R, Krauss-Haas M, Versmold H (2007) Kindesmisshandlung. In: Kiess W, Merkenschlager A, Pfäffle R, Siekmeyer W (Hrsg) Therapie im Kindes- und Jugendalter. Elsevier, München, S 1266–1271
Freisthier B, Needell B, Gruenewald P (2005) Is the physical availability of alcohol and illicit drugs related to neighbourhood rates of child maltreatment? Child Abuse Negl 29:1049–1060
Herrmann B (2002) Körperliche Misshandlung von Kindern. Somatische Befunde und klinische Diagnostik. Monatsschr Kinderheilkd 150:1324–1338
Herrmann B (2005) Vernachlässigung und emotionale Misshandlung von Kindern und Jugendlichen. Z Kinder Jugendpsychiatr Psychother 36:1–7
Hogan T, Myers B, Elswick R (2006) Child abuse potential among mothers of substance-exposed and nonexposed infants and toddlers. Child Abuse Negl 30:145–156
Johnson C (2004) Child sexual abuse. Lancet 364:462–470
Kaplan S, Pelcovitz D, Labruna V (1999) Child and adolescent abuse and neglect research: a review of the past 10 years. Part I: Physical and emotional abuse and neglect. J Am Acad Child Adolesc Psychiatry 38:1214–1222
Kellogg N (2007) Committee on child abuse and neglect. Evaluation of suspected child physical abuse. Pediatrics 119:1232–1241
Kendall-Tackett K, Lyon T, Taliaferro G, Little L (2005) Why child maltreatment researchers should include children’s disability status in their maltreatment studies. Child Abuse Negl 29:147–151
Klein R (2007) Teilnahmeraten bei der Kinder-Früherkennung – DGSPJ fordert eindeutige Regelungen. Kinderarztl Prax 78:224
Kromeyer-Hauschild K, Wabitsch M, Kunze D et al (2001) Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatsschr Kinderheilkd 8:807–818
Kupferschmid C (2006) Pflichtuntersuchung oder Frühwarnsystem? Kinder Jugendarzt 37:777
Lane W, Rubin D, Monteith R, Christian C (2002) Racial differences in the evaluation of pediatric fractures for physical abuse. JAMA 288:1603–1609
May-Chahal C, Cawson P (2005) Measuring child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. Child Abuse Negl 29:969–984
Otte H (1993) Krisenintervention und Beratung bei sexuellem Kindesmissbrauch. Kinderarzt 24:131–140
Rodrigo M, Maiguez M, Correa A et al (2006) Outcome evaluation of a community center-based program for mothers at high psychosocial risk. Child Abuse Negl 30:1049–1064
Schnitzer P, Ewigman B (2005) Child deaths resulting from inflicted injuries: household risk factors and perpetrators characteristics. Pediatrics 116:687–693
Sidebotham P, Heron J, ALSPAC Study Team (2006) Child maltreatment in the „children of the nineties“: a cohort study of risk factors. Child Abuse Negl 30:497–522
Stirling J (2007) Committee on child abuse and neglect. Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting. Pediatrics 119:1026–1030
Teicher M, Samson J, Polcari A, McGreenery C (2006) Sticks, stones and hurtful words: relative effects of various forms of childhood maltreatment. Am J Psychiatry 163:993–1000
US Department of Health and Human Services (2006) Child maltreatment 2004. US Government Printing Office, Washington, DC
Weltgesundheitsorganisation Europa (2003) World report on violence and health. WHO, Genf
Wu S, Ma C, Carter R et al (2004) Risk factors for infant maltreatment: a population-based study. Child Abuse Negl 28:1253–1264
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Mirjam Landgraf und Lena Zahner tragen gemeinsame Erstautorenschaft.
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Landgraf, M., Zahner, L., Nickel, P. et al. Kindesmisshandlung . Monatsschr Kinderheilkd 158, 149–156 (2010). https://doi.org/10.1007/s00112-009-2129-0
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DOI: https://doi.org/10.1007/s00112-009-2129-0
Schlüsselwörter
- Kindesmisshandlung
- Kindeswohlgefährdung
- Sexueller Missbrauch
- Vernachlässigung
- Münchhausen-by-proxy-Syndrom