§ 2.17 p.m.
§ Miss Joan Lestor (Eton and Slough)In raising the question of what is called "the battered baby syndrome", I should like to make it clear that I am not a psychiatrist or a doctor, but that as someone who has been involved in teaching and caring for young children for some time I have a far greater interest in this subject than many laymen concerned with child welfare. I take the opportunity to raise this matter in the House because the House, as well as being a legislative body, is, I believe, a public forum in which matters of social interest with perhaps grave social implications can be raised and highlighted.
"The battered baby syndrome", as it is known in clinical circles, has come to light during the last few years. Some exceedingly young children suffer physical abuse from their parents, or, in some instances, from their parent sub- 2304 stitutes. These children are incredibly young. They are usually aged between a few weeks and three years. They are children who are incapable of speaking for themselves, as is often the case with older children who have been badly treated.
The attacks on these babies—and attacks they most certainly are—can take place at frequent or infrequent intervals. An estimate of between three and four times a year in some cases is given. It is so severe that, as a result of studies which have been made in America and work done in this country in the last two or three years, it is estimated that at least 10 per cent. of the babies who are attacked die. The figure may be as high as 20 per cent., because it is becoming clear that often a wrong diagnosis has been made. About 30 per cent. of these young children sustain permanent brain damage or permanent physical injury which cripples them for life. I am referring to cases which are now being diagnosed. Undoubtedly, over the years there have been cases which have not been diagnosed.
One of the reasons for the difficulty in diagnosis and the fact that this problem has not come to the attention of psychiatrists, doctors and social workers until recent years is fairly obvious. Very often the injuries inflicted on these babies are fairly consistent with the explanation which is given by the parents. In other words, doctors are frequently not sure that there has been a direct assault and attack upon the child.
This is understandable because few of us, whatever our occupations, would imagine that a parent or parents of a young baby would deliberately attack it physically. For this reason, the explanations of the physical injury have often been accepted by those involved in dealing with the children because there has been no plausible explanation to the contrary.
The danger arises that when the injuries of some of these babies have been attended to, more often than not in hospital, they are returned home, after being treated for, say, an alleged fall down stairs or a fall from a pram, to the very conditions in which there is mounting evidence to show that the attacks are repeated. Any doctor who may have had doubts in making a diagnosis and who 2305 has erred, understandably, on the side of the parents must sometimes, if a child again comes to his notice suffering in the same way, feel exceedingly guilty that he did not notice what was wrong before.
There is mounting evidence that several hundred children each year are abused in this way. That figure is based on cases which are known as well as on calculations for those which are not known but working back on case history reports which have come to notice.
One of the big difficulties about child abuse and baby maltreatment is that it is not a new problem. It has always affected a minority of older and younger children in every society, in some societies more than in others. It has always been a very difficult matter to establish. Without wanting to be unduly alarmist, I think that either the problem is increasing or it has always existed in this form but we are only now being to recognise it.
When using statistics in any science or relevant matter on a subject which has only recently come to light, it is difficult to say that the trouble is on the increase when we have nothing with which to make a comparison. I shall not, therefore, attempt to say that this problem is on the increase. All I know is that there are now many more cases which people recognise as battered babies than there were formerly.
Those of us who are concerned with the problem people who have worked with young children, and particularly parents, who would suffer, as I think they do, have found it utterly inconceivable that parents, often apparently loving parents—and not only apparently loving, because I believe that all of them are, in fact, loving parents—will, from time to time, under stress or through compulsion, abuse their babies in this horrifying way.
I do not want to cause alarm or to raise suspicions about the number of cases, but I raise this matter this afternoon because, however small the numbers may be, the tragic suffering in a baby thus abused remains with the child for the rest of his life. This is something which it is impossible to estimate without looking at what happens to children as they face the various problems confronting them as they grow up.
2306 Those who have had anything to do with the National Society for the Prevention of Cruelty to Children, for example, know that for many years that society has stressed the need for the public at large to report cases of suspected cruelty to young children. The society has always stressed that it is far better to be wrong than to be doubtful and let a casualty go unnoticed and unchecked. Likewise, however, all of us have been reluctant to do so. We feel, perhaps, that it is nothing to do with us or we may have been willing, for understandable reasons, to accept a parent's explanation of how a child received injuries.
If we reject the explanation of a parent—and sometimes we may know the parents—we are led to other conclusions and to consider other explanations which are too horrifying for many of us to contemplate. I believe that this attitude has militated a great deal against us in this country—and, perhaps, people in other countries, too—in being able to understand what goes on in many homes and what compulsions some parents, who themselves are deprived, are suffering and taking out on their very young children.
It is, therefore, understandable that doctors, social workers and others readily accept a parent's explanation. In my view, however, and that of the N.S.P.C.C. over the years, it is far better wrongly to accuse and to be found that one is wrong than to leave a doubt uninvestigated. To miss a danger spot and the possibility of finding out what the situation was all about must leave people who have ever been faced with these problems with feelings of guilt and worry.
One of the things which has impressed me, and on which I hope that my hon. Friend the Under-Secretary will comment, is some of the work which has been done in the United States in terms of the child abuse laws and how, in one or two States, experiments have been conducted rather to change the emphasis whereby doctors and others may complain or may report injuries on children, even if they are almost sure that the explanation which is given is satisfactory.
The difficulty is that a child of these tender weeks, months or years is utterly incapable of giving an explanation, and 2307 we have to remember this when dealing with this exceedingly young age group. In looking at some of the work which has been done in the United States—it is not conclusive and I would not suggest that it is—one of the things which has commended it, to me at least, is that if a doctor, a hospital or social worker has a child of these tender years brought to his notice and finds that it has sustained injury—certainly where there is the slightest doubt whether the injury has been acquired as a result of deliberate abuse—it is incumbent upon him to report the fact to the local authority or the medical authority for investigation. Doctors are protected if their accusations prove to be unfounded, and investigations are carried out into every case which is reported.
From the evidence, which, I repeat, is not conclusive, the obvious objection to this does not seem, to me at least, to be valid—that is, if parents know that injuries to their children might be reported and investigated fear of reprisals might deter them from taking a child to a hospital or clinic.
Evidence in the States on this is that it is not happening, but there have been no fewer cases of battered babies since this took place; moreover, that, if anything, more have been discovered as a result of investigating most cases of injuries to babies some of which have been found to be perfectly consistent with the explanation offered by the parents, while others have been found to be cases of what is called child abuse.
I think I can say that this argument about the reluctance of parents is not supported so far by the evidence. I would still have thought that parents themselves who are innocent would understand the necessity that somebody should report an instance such as this, and I would have thought that most parents would be willing to have the background situation investigated when there is evidence of a baby having been injured.
It seems to me that this is something we should look at and that perhaps my hon. Friend could have some discussion with those concerned with research into this, and who are doing valuable work, to see in what way the Home Office and 2308 others can help to try to deal with this very difficult problem.
The overwhelming case for looking at this in this way and of tightening the situation in relation to reporting instances is that it removes from the doctor or the social worker the terrible responsibility of having to decide whether or not there has been child abuse. If a doctor has to make that decision himself it must be extremely difficult for him. He is not sure, no social worker can be absolutely sure, of the consequences if he fails to make a report of cases which come to his notice. By this means we should not be placing on their shoulders a responsibility which many of them do not want and which it is not fair they should have.
The other side of the matter which we must stress is that we are always left with the danger of sending a child back to circumstances in which it received injury, and doing so because we have been reluctant to ensure whether the case should be reported, and there is evidence in this country and in America and other parts of the world that many of the children who are reported do suffer further attacks and that it is not until there have been several that people are alterted to the true facts. So I think that the argument is very strong that more attention should be given by the Government to this problem.
Another side to the matter I want to raise, very briefly, is the question of the parents who inflict this sort of damage on their very young children. I know the feeling which all of us have, which there is in every civilised society, the feeling of outrage and, therefore, of indignation against parents who injure their children in this way, and it tends to blind us to the plight of the parents themselves.
The very phrase "battered baby" itself, which I personally do not like, expresses our revulsion at those attitudes towards their children by these parents so that there is a tendency to call for their punishment, for severe penalties, severe treatment against the parents. I do not believe that it is the way to deal with this. There is no evidence to suggest that treating the symptom, in other words, treating the parent in this way, gets down to the root of the problem. I do not think that a great deal is yet 2309 known about the parent who behaves in this way. What is known is that prison sentences, harsh penalties, have in no way stopped attacks on the children.
I cannot help but feel that if the criminal law is used in these cases, in many instances it certainly can destroy a child's whole family life and the parents' family life and the relationships between them, so that it may become impossible to rebuild them, and, surely, the rebuilding of those relationships is what we all want. I do not want, because of my feelings, or because of the feelings which we all have, about the behaviour of parents and others who behave in this way to very young children, to suggest that we must at this stage take further action against people who behave in this way.
I do not believe that we can produce the results we want by punishing people; we do not know enough yet on the small amount of evidence which is available about people acting under compulsions which they themselves do not understand and cannot control.
All that I would say on this—because there are one or two things which are absolutely obvious—is that practically all the cases which have been studied in this country and in the States show, no matter the pyschological terms which are used to describe the parents, that they are psychotic, that they are neurotic, or that they are something else, that there is one thing which has emerged as common to them all, and that is that these parents themselves had a grossly unhappy and grossly deprived childhood.
This is the common fact among all of those parents who have come to the notice of those dealing with this problem. By deprivation, I do not mean deprivation of the sort we often mean when we talk about the deprived home—not poverty, not material deprivation. In these cases this is not the common factor. The deprivation here was emotional deprivation, often emotional neglect; it was deprivation of a psychological nature, which cannot be compensated for by material factors.
It is because this is the one single matter which runs through all the cases which have come to notice that it is one which, I think, needs examination and not only in terms of the parents them- 2310 selves but in the terms of the children themselves who are, perhaps, by themselves being deprived, being brought up to become parents who behave in this way and who appall us, and will themselves become inadequate parents.
I raise this matter here today because it is important that we in this House, who are occupied with all sorts of other things, and do not know a great deal about this matter—I do not know a great deal about it—are able here to bring these matters to public attention. Moreover, I firmly believe that the various Government Departments should give all the assistance and help and advice and co-operation they can to those people who are engaged in research and trying to find the solution to the problem and methods of treatment both to help the babies involved and also to help the parents involved.
Even though here we may not know the solutions, I believe that we have a duty to find out what this is all about, and have a duty to bring these things to the notice of one another and to help the social workers engaged in this field so that we may all, and the public, too, be alerted—not to be suspicious of one another, but to be conscious of the problem, and that we may come across cases which require investigation.
§ Mr. Deputy Speaker (Mr. Harry Gourlay)I would remind the House that this debate should end at 3 o'clock and that the Minister has still to speak.
§ 2.38 p.m.
§ Mr. William Wilson (Coventry, South)All hon. Members of the House will be grateful to my hon. Friend the Member for Eton and Slough (Miss Lestor) for having drawn the attention of the House to this question. I shall not detain the House very long, but I can say from my own professional knowledge that the complexity and the mystery of this problem is almost beyond understanding at the moment. I have known of more than one family in which several children are properly looked after so that no one could raise any possible complaint as to their treatment, and yet one child, a child just a few months old, suffers injuries the explanation of which, and of how they came to be inflicted, is seemingly beyond understanding—except 2311 by the explanation of ill-treatment by one or other of the parents.
One cannot say that it is the deprivation of the parent in childhood that has brought it about. If that were the explanation, one would expect all the children of the family to be treated in this way. The medical profession is mystified. A doctor, in giving evidence, said that there was not really any explanation for the injuries suffered by the child. This problem is slowly but surely coming to light and we have not yet begun to find out the explanation. I hope that the abilities within the Home Office will be devoted to trying to find a solution in the way of guiding and helping the parents.
§ 2.40 p.m.
§ The Under-Secretary of State for the Home Department (Mr. Merlyn Rees)My hon. Friend the Member for Eton and Slough (Miss Lestor) has a great knowledge of young people and often raises in the House matters concerning young children. We are indebted to her for raising the question of the "battered baby syndrome", which is a well-known topic in specialised circles. As she says, the more it is publicised the better.
During recent years the term "battered baby syndrome" has been given to symptoms and signs of repeated injuries which have occurred in this way, and the syndrome has received increasing attention from doctors, social workers and others. We cannot be sure whether such cases have become more frequent, or whether an increasing awareness of the syndrome has brought cases to light which might formerly have been accepted as resulting from accidents, from falling downstairs, and so on. It seems likely that we are dealing with an old problem which in the past was to some extent hidden by the lack of facilities for skilled diagnosis.
Hon. Gentlemen will accept, I know, that it was not until the introduction of the National Health Service that people had access consistently to the medical profession. There is reluctance, in the absence of positive proof, to attribute injuries to the action of parents.
My hon. Friend raised the aspects of psychology and psychiatry, and one needs 2312 to have knowledge of these subjects before one can understand this matter. We could probably all offer suggestions as to what might be involved. Speaking personally, I feel that it was in the 20th century that the concept of romantic marriage first appeared. The whole of communications, the Press, women's magazines, films and television concentrate on the idea of marriage being romantic, but do not go beyond the point of marriage. The disappointment afterwards, when one finds that marriage involves wandering around in the middle of the night carrying a child, comes as a shock, because the popular song does not mention that part of it. Earlier marriage may also be a factor.
The State seeks to protect children in several ways. First in point of time—and my hon. Friend saw the limitations of this—is the criminal law, which makes it an offence deliberately to injure a child, as indeed a person of any age. It is also an offence, under Section 1 of the Children and Young Persons Act, 1933, wilfully to assault, neglect, or ill-treat a child, although the kind of injuries with which we are concerned this afternoon are often sufficiently grave to constitute offences under the general law. But the prosecution of the parents, after the event, is no protection for the child. Nor is the fear of prosecution a very strong protection against injuries which are often inflicted under stress, or in ignorance of the ease with which it is possible to cause injuries to young children.
Second, the law enables a child who is ill-treated to be brought before the juvenile court as being in need of care, protection or control, and empowers the court to remove him from his parents or to make a supervision order. The Children and Young Persons Bill, now before Parliament, makes similar provision, and, in another place, the Government introduced an Amendment which will enable the juvenile court to act in relation to other children in the household where injury to one child raises a probability that others may similarly be injured. My hon. Friend said that often only one child in the family is so treated. Here again, this is action after the event so far as the injured child is concerned.
Third, there are the various services concerned with young children. We have 2313 health visitors, clinics, general practitioners and the children's department of local authorities. If these services are able to identify the children who are at risk they may he able to take action before the child sustains serious injury.
There are two problems here: identifying families whose children may be at risk; and identifying at an early stage an injury which is not accidental, so that action may be taken before a further injury is caused. Both of these problems present difficulties. As I have said, one child only may be treated in this way, the others being perfectly properly treated.
The great majority of injuries to small children are accidental, and it is not always easy for a doctor or hospital to decide whether the parents' account of a purely accidental injury is true or not. It may be that even if the injury was caused only by clumsiness in handling the baby the parents will have a sense of guilt and present a misleading story.
With a view to giving guidance on the recognition of cases of suspected deliberate injury, the British Paediatric Association, in consultation with the Home Office and the then Ministry of Health, prepared a memorandum, which was printed in the British Medical Journal in March, 1966. If my hon. Friend has not seen this, I will make a copy available to her. Copies of this memorandum were circulated by the Home Office and the Ministry to local authorities, hospitals and chairmen of medical committees. The memorandum gave guidance on the medical, social and legal aspects; on the problems involved in identifying cases; and on the action to be taken where it was suspected that an injury was not accidental.
Identification of children who may be at risk presents an even more difficult problem. It is necessary to pick out those children whose situation is such that it seems likely that they may be injured, and on whom a close watch should be kept.
The Medical Research Council is conducting at the London Hospital, under the direction of Professor Camps, some research into this question, and into the related question of how doctors can be helped to detect non-accidental injuries. We should not however, assume that research will provide us with rule of 2314 thumb answers. If, for example, it were established that an unwanted child, or the youngest child—which is sometimes the same thing—or the child of young parents, is more at risk, these are such large categories as to be not particularly useful for identification purposes. Nevertheless, it is desirable that we should build up, by research and by other means, as much information as possible to guide those who have to take decisions.
The National Society for the Prevention of Cruelty to Children has launched a research project based on cases referred by two London teaching hospitals. An important aim of this project is remedial, to discover methods of working with families so as to avoid any repetition of injury to the child. The Association of Children's Officers collects regularly from its members case histories of cases arising in their areas, and these are circulated to all members of the association. The aim is to disseminate among children's officers a wide amount of information about situations which may occur only infrequently in any one local authority area.
Where the doctors are satisfied that a child's injuries were not accidental, the question arises what action should be taken. I think it will be agreed that the primary aim should be to protect the future welfare of the child and of other children in the family. The memorandum concluded that the doctor's first concern must be the safety of the child and recommended that he should report to the children's officer of the local authority, although it recognised that there might be circumstances where the doctor would feel obliged to inform the police.
It suggested that in some cases a joint meeting between the children's officer, the hospital consultant, the family doctor, and the health visitor and others would be appropriate. A number of courses have to be considered: whether the case can be dealt with by informal supervision and guidance by the children and health departments of the local authority; whether the child should be received into care; whether the child should be brought before the juvenile court with a view to committal to care or a supervision order; whether the parents should be prosecuted. The appropriate course needs to be decided in the light of the 2315 circumstances of each case and it is not possible to lay down hard and fast rules.
Prosecution may not always be desirable in the long-term interests of the child, particularly where the injuries have been inflicted under stress or in ignorance of the harm that, for example, shaking a very young child can do. Even if the child is committed to the care of the local authority it may be desirable when he is older to work towards his restoration to the parents, under supervision.
Moreover, the evidence is often not clear cut and a prosecution which fails may make other action more difficult. Sometimes there is no evidence sufficiently strong to justify any kind of court proceedings, but the parents may none the less be willing to accept help. The building up of a body of information about the action taken in particular cases and its results should help those who have to take these decisions.
My hon. Friend mentioned experience in the United States. As with all that she said, the matter will be looked at by the appropriate Department. The laws in some American States do not require all injuries to be reported, but only those where the doctor has reasonable cause to believe that an injury is not accidental. I could argue that that is what already happens in this country, although it does not have the force of law.
There is one other difference, although I do not want to over-play this argument, principally because of lack of knowledge of the law in this respect or, indeed, the background. There is the fact that the American doctor is in a different contractual relationship with his patient than that which has developed in this country over the years because of the nature of our Health Service and the development of local authority services over the years, which are of a different pattern from those in the United States.
It might be that the legal pattern in parts of the United States, however desirable it may or may not be there, would not be applicable to this country. In any event, if one relieves the doctor of the decision, somebody has to take it. If it is a matter of medical evidence, it comes back to the doctor ultimately.
2316 The greatest need is for everybody concerned to be aware that a small number of young children are injured in this way, to be on the look out for signs that an injury may not have been accidental and to recognise that the object must be to take action most likely to protect the child and other children in the family. I think that as a result of the memorandum to which I have referred, and of discussion in this question in the medical and lay press, there is now a much greater awareness of the problem among doctors, social workers and others.
We will certainly do all we can to support and further all these efforts and discussions. My hon. Friend by raising this matter in the House today, has furthered that discussion. This House is a sounding board, a public forum, and I hope that the words of my two hon. Friends and myself will do something to add to the general knowledge and to bring to a wider public the nature of the problem. We hope that this debate will be a step nearer towards its solution.