Hurme T, Alanko S, Anttila P, Juven T, Svedström E
Department of Pediatric Surgery, University Hospital Turku, Turku, Finland.
Eur J Pediatr Surg. 2008 Dec;18(6):387-91. doi: 10.1055/s-2008-1038922. Epub 2008 Nov 14.
We examined the risk factors and injuries in physical child abuse between November 2003 and February 2007.
The uptake area of the University Hospital of Turku, Finland, consists of about 700 000 inhabitants. Forty-eight cases of physical child abuse were examined. The median age of the abused children was 2.2 years, for children with skull fractures it was 0.5 years. The incidence of child physical abuse increased during the study period; it was 0.6/month in 2004 and 1.7/month in 2006. Mortality in the study group was 2.1 %.
Depression, overactivity, crying and prematurity were risk factors in the physically abused children. Parental risk factors were alcohol and drug abuse. Most often the perpetrator was the father or stepfather; when the perpetrator was unknown, the children were mostly in their mothers' care. The average delay of 3 weeks until starting the investigation into abuse was mostly due to delays by health centers or homes. Radiographs were the cornerstones of the medical examination but magnetic resonance examinations were essential for the examination protocol.
All levels of public health services, day care facilities and schools must be aware of possible physical child abuse and initiate an investigation as soon as possible by contacting the authorities. Physically abused children and their families must be followed up and supported for a sufficiently long period by social pediatric outpatient wards. The general information on child maltreatment provided to the public needs to be increased to prevent abuse. A child welfare report must be made to social workers in every maltreatment case examined in hospital, and in most cases the offence must also be reported to the police. Nevertheless, in certain cases even permanent custody of the child cannot be avoided.
我们调查了2003年11月至2007年2月间儿童身体虐待的风险因素及伤害情况。
芬兰图尔库大学医院的服务区域约有70万居民。对48例儿童身体虐待案例进行了调查。受虐儿童的中位年龄为2.2岁，颅骨骨折儿童的中位年龄为0.5岁。在研究期间，儿童身体虐待的发生率有所上升；2004年为0.6例/月，2006年为1.7例/月。研究组的死亡率为2.1%。
抑郁、多动、哭闹和早产是受身体虐待儿童的风险因素。父母的风险因素是酗酒和药物滥用。施暴者大多是父亲或继父；当施暴者不明时，儿童大多由母亲照顾。虐待调查开始前平均延迟3周，这主要是由于健康中心或家庭的延误。X线片是医学检查的基础，但磁共振检查对检查方案至关重要。
各级公共卫生服务机构、日托设施和学校必须意识到可能存在的儿童身体虐待情况，并尽快联系当局展开调查。受身体虐待的儿童及其家庭必须由社会儿科门诊病房进行足够长时间的随访和支持。需要增加向公众提供的关于儿童虐待的一般信息，以预防虐待行为。对于医院检查的每一例虐待案件，都必须向社会工作者提交儿童福利报告，而且在大多数情况下，还必须向警方报告该罪行。然而，在某些情况下，甚至无法避免永久剥夺儿童的监护权。
