Effects of prenatal and infancy nurse home visitation on surveillance of child maltreatment.

OBJECTIVE

To examine the effects of prenatal and infancy nurse home visitation on the surveillance of child abuse and neglect by examining differences in the health, living conditions, and maltreatment characteristics of nurse-visited and comparison children who had been identified as maltreated in the first 4 years of life.

DESIGN

Randomized controlled trial.

SETTING

Carried out in a semirural community in upstate, New York. Families dispersed throughout 14 other states during 2-year period after children's second birthdays.

PARTICIPANTS

400 primiparous women registered before 30th week of pregnancy, 85% of whom were either teenaged (< 18 years at registration), unmarried, or from Hollingshead social class IV or V. Maltreated subsample consisted of 56 families in which children had a state-verified report of child abuse or neglect during the first 4 years of the children's life.

INTERVENTION

Nurse home visitation from pregnancy through the second year of the child's life.

MAIN RESULTS

During the two-year period after the program ended, nurse-visited maltreated children lived in homes with fewer observed safety hazards for children; their homes contained more intellectually stimulating toys, games, and reading materials; their mothers were less controlling; and the children paid 87% fewer visits to the physician for injuries or ingestions, and 38% fewer visits to the emergency department.

CONCLUSIONS

Children who were identified as maltreated and who were visited by nurses during pregnancy and the first two years of life had less serious expressions of caregiving dysfunction. This is likely to be a reflection, in part, of earlier and more comprehensive detection of child maltreatment on the part of nurse-visited families.