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Despite the growing numbers, awareness and reporting rates of male child sexual abuse (MCSA) are still well below the real values, especially in developing countries like Turkey. We examined MCSA to determine the predisposing factors, the characteristics of perpetrators and victims, and the consequences of sexual abuse in a Turkish sample. We retrospectively analysed the files and forensic reports of 51 MCSA victims aged between 6 and 18. The mean age of children was 13.6 ± 3.8 years, and the mean age at the time of abuse was 11.1 ± 3.52. The average exposure time for sexual abuse was 91 ± 226.8 days, and the frequency was 2.4 ± 2.47 times. 17.6 per cent of them had previously been sexually abused. Disclosure times until legal notification was 240.1 ± 552.25 days. Most (56.9 per cent) had suffered anal penetration, developed post traumatic stress disorder, and needed medical treatment. Most perpetrators (58.8 per cent) were strangers outside the family, reaching the children from the neighbourhood. In conclusion, although the number of our sample is limited, the results of our study will contribute valuably to the literature, given that there are few studies on MCSA. Further studies with large samples evaluating MCSA in multidimensional ways are needed to raise awareness and protect vulnerable children. [ABSTRACT FROM AUTHOR]

Violent child discipline is a widespread phenomenon that can have devastating short‐ and long‐term consequences for an individual's physical, mental and social wellbeing. Parents' beliefs and expressed ideas about child discipline, both violent and non‐violent, can differ from their practice. This study identifies which disciplinary methods Qatari mothers believe to be the most successful in changing their child's behaviour and compares them to the ones they report actually using. Using a cross‐sectional design, a representative sample of Qatari mothers completed an anonymous standardised questionnaire, the International Society for the Prevention of Child Abuse and Neglect Child Abuse Screening Tool for Parents. The majority (96.9 per cent) of Qatari mothers reported believing in non‐violent disciplinary methods (NVDMs) in changing their child's behaviour and those believing only in such methods are more likely to use only them compared to those mothers believing in a mixture of methods (30.9 vs. 6.7 per cent, chi‐squared value [휒2] = 83.5, P value <0.001). Still, 44.9 and 5.2 per cent of Qatari mothers believing in only NVDMs also used at least one moderate and one severe physical method, respectively. Much public education is needed to increase Qatari mothers' awareness in of the benefits of NVDMs, to foster a belief in their efficacy and to support using them. [ABSTRACT FROM AUTHOR]

In this article we explore a Finnish nationally representative self‐report survey (N = 155, 299) conducted in a school as a tool to advance the study of violence in alternative care. By analysing the survey, we were able to provide plausible prevalence and estimates of risk factors of violence in alternative care, suggesting that self‐report surveys conducted in schools are a useful and valid methodology for this type of research. Conducting the survey in a school setting enabled us to reach a nationally representative population of adolescents living in alternative care, which would be difficult to achieve in any other way. However, studying violence in alternative care with a school survey requires a large sample size. Even with quite a substantial dataset, detailed explanatory analyses were not possible due to the low number of observations. This emphasises the importance of other types of data in addition to survey data in explanatory analysis. Based on this study, we concluded that nationally representative self‐report surveys conducted in schools could provide a useful tool and possibilities for replicable research design, which could thereby develop the research field further. [ABSTRACT FROM AUTHOR]

Child abuse is a problem that needs to be addressed worldwide. This is a cross‐sectional study to estimate the prevalence of child abuse among children aged 3 to 6 years and its associated factors in southern Iran. In total, 5142 participants were selected using multi‐stage random sampling. The estimated prevalence rates of neglect and physical and verbal/emotional abuse among children were 26.4% (95% confidence interval [CI] 25.2–27.6), 59.4% (95% CI 58.1–60.6), and 63.9% (95% CI 62.6–65.1), respectively. The results of logistic regression models showed that the child's sex was associated with physical abuse (odds ratio [OR]boy/girl 1.25; 95% CI1.11–1.41) and verbal abuse (ORboy/girl 1.17; 95% CI 1.04–1.32). However, parents living together was inversely associated with physical abuse (OR 0.45; 95% CI 0.25–0.80), verbal abuse (ORboy/girl 0.46; 95% CI 0.25–0.84), and neglect (ORboy/girl 0.53; 95% CI 0.31–0.88). Mother's education (ORuniversity degree/illiterate 0.58; 95% CI 0.35–0.98) was also inversely associated with physical abuse. The prevalence of child abuse in southern Iran is significantly higher than in several other countries in the region and other parts of the world. Social and family factors, including mother's education and parents living together, are important in reducing child abuse and its related mental and physical disorders during childhood. It is essential to train parents of young children about abuse and its negative effects on the health and social performance of children. [ABSTRACT FROM AUTHOR]

Traumatic experiences during childhood are common and often lead to chronic mental health conditions such as posttraumatic stress disorder (PTSD). The primary aim of this study was to determine whether a well‐validated screening tool for PTSD administered in frontline services effectively identifies diagnosable PTSD in young people with a history of maltreatment. In total, 141 young people in community care settings were screened using three screening instruments (Child Revised Impact of Events Scale‐8; Generalised Anxiety Disorder‐2; Patient Health Questionnaire‐2). Participants described a range of adverse life events: 110 of the 141 participants reported at least one adverse life experience (mean number for the total sample was 2.8), with 44.2 per cent (n = 46) experiencing at least one form of interpersonal trauma; and 102 participants (72.3 per cent) screened positively for probable PTSD and subsequent mental health assessments confirmed this condition in 64.7 per cent of these participants. Further, 36.9 per cent (n = 52) and 46.8 per cent (n = 66) met the threshold for probable depression and anxiety, respectively. Three items were associated with positive PTSD screens: a history of being on the child protection register, previous mental health contact and interpersonal index trauma. Interpersonal traumas were also associated with higher risks of offending. It seems feasible to use screening measures effectively within frontline social care services if staff are provided with appropriate training and support to identify young people with PTSD who may benefit from evidence‐based mental health therapies. Key Practitioner Messages: There is strong evidence of the link between childhood adversities and poor mental health, including PTSD.This study found that a short instrument can be embedded within social care services to screen children and young people for PTSD.It is important that frontline staff have the necessary training and tools to understand the effects of trauma and screen children's mental health in order to facilitate access to effective therapies at an early stage. [ABSTRACT FROM AUTHOR]

Effective prevention of abusive head trauma (AHT) requires the identification of potential perpetrators. Current evidence suggests that infant shaking, as a mechanism of AHT, produces immediate symptoms, allowing for the dating of the event based on clinical symptoms. Determining precisely when symptoms occurred may help law enforcement to identify the perpetrator. We retrieved written legal statements and medical records from birth to age at diagnosis of 100 infants consecutively diagnosed with AHT through shaking (2011–17), using forensic expertise files. Timing of abuse allowed for the identification of perpetrators in 91 cases. All abusive events occurred inside a home (parent's or nanny's), never outdoors or in a public place, and always in the presence of only one adult. Approximately one‐third (n = 32) of the perpetrators were males (31 fathers) and two‐thirds (n = 59) were females: 49 of them were the infant's nanny and ten were the infant's mother. Infants were not described as crying habitually. Better knowledge of the context of AHT events and risk situations, including recent implementation of a new or unusual modality of childcare, and being the only adult in a home with an infant, should facilitate prevention, including targeted training and avoidance of situations associated with risk. Key Practitioner Messages: Abusive events occur in the presence of a single adult, within the privacy of a home.First signs of abuse most commonly occur in a recent, therefore unusual, form of childcare.With rare exceptions, the perpetrator is either the nanny or one of the parents.Identification of the perpetrator and better knowledge of the context of abuse should allow improving targeted prevention. [ABSTRACT FROM AUTHOR]

Child homicides are rare occurrences, but when they occur, they often cause significant outrage. This paper examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases. Focusing on 533 cases of child homicide between 1985 and 2012 in Ontario, Canada, characteristics of intrafamilial and extrafamilial cases, biological and step/foster parents, and maternal and paternal perpetrators are compared. Results show that characteristics of the child homicide vary depending on the degree of intimacy between victims and perpetrators, including: perpetrator and victim age, weapon use, suicide following the offence, sexual violence and use of excessive force. These findings provide support for developmental victimology and a routine activities theoretical perspective. Suggestions for future research and policy implications are also discussed. 'Examines the role of varying degrees of intimacy between victims and perpetrators in determining characteristics in child homicide cases' Key Practitioner Messages: Younger children are at a greater risk of homicide from family members, while older children are at a greater risk of homicide from individuals outside the family.Developmental victimology and routine activities theory can contribute to a better understanding of the dynamics between victims and perpetrators in child homicide.Collaboration should take place between researchers, child death review committees, mental health services, social services and policymakers to improve child homicide prevention and intervention initiatives. [ABSTRACT FROM AUTHOR]

To our knowledge, there are no recent national epidemiological studies in France on abusive head trauma (AHT). The objective of this study was to quantify cases of AHT as a result of child abuse admitted to French hospitals, based on the French hospital discharge database (PMSI) from 2015 to 2017. Among infants aged between one and 11 months who were hospitalised for subdural haematoma or traumatic subarachnoid haemorrhage, we distinguished probable cases (stays with International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes suggestive of child abuse or retinal haemorrhage) from possible cases (all other children), in order to make comparisons and estimate hospital incidence rates. We identified 512 probable cases and 703 possible cases. The incidence was 22.1 cases (20.2–24.0) per 100 000 live births for probable cases, and 52.4 cases (49.5–55.4) per 100 000 live births for combined probable and possible cases. The overall median age was four months with a male predominance. Among probable cases, lesions suggestive of abuse were more frequent, and there were fewer skull fractures and accidental falls than in possible cases. This exploratory analysis shows that it is complicated to determine precisely the number of cases of AHT from PMSI data. The implementation of a specific code for AHT in this database would identify these cases more accurately. Key Practitioner Messages: Among probable cases, lesions suggestive of abuse were more frequent, and there were fewer skull fractures and accidental falls than among the possible cases.Implementation of a specific code for AHT in hospital discharge databases would identify these cases more accurately. [ABSTRACT FROM AUTHOR]

Previous studies of abusive head trauma (AHT) suggest that incidence may vary by geographic location, and there is limited information regarding population‐based risk factors for this form of child maltreatment. This study provides new knowledge regarding these two aspects using the population of the US State of Washington born between 1999 and 2013. We used a linked administrative dataset comprising birth, hospital discharge, child protective services (CPS) and death records to identify the scale and risk factors for AHT for the state population using quantitative survival methods. We identified AHT using diagnostic codes in hospital discharge records defined by the US Centers for Disease Control and Prevention. A total of 354 AHT hospitalisations were identified, and the incidence for the state was 22.8 per 100 000 children under the age of one. Over 10 per cent of these children died. Risk factors included a teenaged mother at the time of birth, births paid for using public insurance, a child's low birth weight and maternal Native American race. The strongest risk factor was a prior CPS allegation, a similar finding to a California study of injury mortality. The practice and policy implications of these findings are discussed. Key Practitioner Messages: A prior CPS report is a risk factor for AHT, regardless of the findings of the CPS report.Two peaks of AHT were found, one at two months and another at eight months.Prevention programming can target sociodemographic information available on birth records including teenaged mothers, low birth weight and births paid for with public insurance. [ABSTRACT FROM AUTHOR]

Abusive head trauma (AHT) in infants is thought to be triggered by caregiver frustration with persistent crying. The Period of PURPLE Crying (POPC) is designed to educate parents about normal infant crying, strategies to use when infants cry and the dangers of shaking in an effort to decrease AHT. Studies evaluating the POPC have measured changes in parent knowledge and behaviour regarding infant crying. Our objective was to evaluate the POPC's effect on caregiver frustration with infant crying compared to standard discharge information (SDI). We taught paediatric interns and medical students rotating in the newborn nursery to deliver the POPC and discuss infant crying. New parents were pseudo‐randomised to receive SDI or the POPC plus SDI. Parents were contacted five‐to‐eight weeks after discharge and asked knowledge questions about infant crying as well as the number of times that they were frustrated by their infant's crying in the preceding week. Of 271 parents who consented to participate, 164 (61%) completed the survey. The POPC group answered two of the knowledge questions correctly more often than the control group (score differences: 17%, 95% confidence interval (CI) 3–32% and 21%, 95% CI 7–36%). However, parents reported frustration due to infant crying at similar rates between the control (55/80, 69%) and POPC (60/84, 71%) groups. Our results support previous findings that the POPC improves caregiver knowledge concerning infant crying. The POPC does not appear to affect caregiver frustration with crying. 'Our objective was to evaluate the POPC's effect on caregiver frustration with infant crying compared to standard discharge information' Key Practitioner Messages: Instructing new parents about normal infant crying and the dangers of shaking an infant remains an important part of anticipatory guidance.The POPC is not more effective at reducing caregiver frustration with infant crying than standard discharge instructions.Future investigations should specifically aim to include male caregivers as recipients of the programme. [ABSTRACT FROM AUTHOR]

Diagnosis of abusive head trauma (AHT) is challenging; clinical signs are non‐specific and perpetrator confessions are rare. Moreover, many infants sustain multiple episodes of abuse before presenting to medical practitioners. The objective of this study was to quantify the incidence of prior presentations with features of brain injury in AHT, and to compare these figures to those in non‐abusive head trauma (non‐AHT). Data on children under the age of two years who were assessed for AHT by the Child Protection Unit of Sydney Children's Hospital between 2008 and 2017 were collected, and AHT cases were compared with non‐abusive cases. Of the 167 cases assessed for head trauma, 26 per cent had at least one prior presentation to medical care. This was 42 per cent of the AHT cases, and 11 per cent of the non‐AHT cases. Odds ratio calculations revealed infants with AHT were 5.7 times more likely to have had a prior presentation than children with non‐AHT (CI = 2.4–13.17, p < 0.001). Infants with AHT are much more likely than infants with non‐AHT to have presented previously to medical practitioners. This difference suggests that there is an early diagnostic window within which abuse can be detected before it continues or escalates. Careful evaluation of an infant is of paramount importance, and may save a life. '[Aims] to quantify the incidence of prior presentations with features of brain injury in AHT, and to compare these figures to those in non‐abusive head trauma' Key Practitioner Messages: Medical practitioners should consider the possibility of brain injury in a child presenting with non‐specific symptoms, and consider that this brain injury could be abusive in nature.Suspicions of abusive head trauma should be increased if the child has presented with signs consistent with brain injury before.Suspicions of abusive head trauma should be increased if there is no mechanism of an injury provided by the child's carer. [ABSTRACT FROM AUTHOR]

This two‐stage study aimed to develop and validate a paediatric abusive head trauma (AHT) awareness questionnaire for healthcare professionals. In stage one, an item pool was created for the AHT awareness questionnaire. Four experts assessed the content validity. Test–retest reliability and internal consistency were examined using a pilot study of 24 healthcare professionals. In stage two, 302 healthcare professionals from a medical centre in southern Taiwan were recruited to establish the questionnaire's psychometric properties. The final version of the questionnaire comprised 81 items, including demographics, attitudes towards childrearing and four sub‐concepts on AHT awareness (infant crying, soothing skills, clinical manifestations and consequences of AHT, and risk factors of AHT). The content validity of the questionnaire was satisfactory with a score of 0.91 to 1.0 for the scale content validity index. The test–retest reliability was 0.51–0.71. Cronbach's alphas for the final sample were 0.52–0.93 for the four subscales. Exploratory factor analysis extracted two factors as risk factors of AHT with a total explained variance of 55.9 per cent. This questionnaire is useful in understanding AHT awareness with identified aspects among healthcare professionals and other professionals working in child protection fields. Items and subscales of the AHT awareness questionnaire could act as a reference guide for future training programmes. 'This two‐stage study aimed to develop and validate a paediatric abusive head trauma (AHT) awareness questionnaire for healthcare professionals' Key Practitioner Messages: We developed and validated a questionnaire to assess healthcare professionals' awareness of paediatric AHT.This is the first instrument developed to measure healthcare professionals' awareness of paediatric AHT with acceptable psychometric properties for use in Taiwan.The questionnaire can be used to understand healthcare professionals' awareness of paediatric AHT.This questionnaire may also be used to explore other professionals' awareness of paediatric AHT and to design related education programmes. [ABSTRACT FROM AUTHOR]

When suspicions of physical abuse arise, children are referred for a child protection medical evaluation, which occurs in a variety of health settings by a variety of clinicians. This comparative vignette survey was performed among a cross‐section of medical professionals engaged in child protection in Sweden, Ireland, the UK and the Netherlands between April and July 2016. Three vignettes describing different probabilities of physical abuse were included. Components of child protection medical evaluations across the four countries were analysed. A total of 236 physicians responded (113 UK, 49 the Netherlands, 39 Sweden, 35 Ireland). Of these, 62 per cent were female (there were more females in the UK, Sweden and the Netherlands). More variation in practice than similarities was found. Similarities: experience level, confidence level and management approach (vignettes 1 and 3). Cross‐country differences: decision to investigate, adherence to national guidelines, experience versus specialism and subsequent management post‐assessment. These findings suggest the need for further exploration of practice between countries including specific and regular training, availability of support for non‐specialists and use of national and international clinical guidelines to promote best practice and reduce variation. More consideration of the human and financial cost to the healthcare system of unnecessary investigations and the length of hospital admission may be warranted. Key Practitioner Messages: There is a lack of uniformity in the clinical management of physical abuse between these four European countries.Specific and regular training included in professional development plans and discussed at appraisal will promote clinician confidence in assessments.Expert support should be easily available to non‐specialists undertaking these assessments.National and local clinical guidelines are important tools in promoting best practice and reducing variation across and within countries. [ABSTRACT FROM AUTHOR]

Sweden and Finland were the first countries to ban corporal punishment 30 years ago. Since then, the prevalence of attitudes supporting the use of corporal punishment and the practice itself have decreased. This study examines the current frequencies of corporal punishment and other humiliating upbringing practices in Finnish and Swedish families. The analysis is based on survey data among 3170 Finnish and 1358 Swedish parents with children from newborn to 12 years of age. Data were analysed using univariate tests (chi-square) and logistic regression. According to the analysis, a larger proportion of Finnish parents, and especially mothers, use humiliating upbringing practices compared to Swedish parents. This difference is not found with regard to corporal punishment. A larger proportion of Finnish parents push their children compared to Swedish parents, while a larger proportion of Swedish parents shake their children. In both countries, corporal punishment is more frequently used by fathers, boys are more often victimised than girls, toddlers are more often exposed to corporal punishment and school-age children are more often subjected to psychologically abusive practices. Corporal punishment and other humiliating upbringing practices are strongly correlated in both countries. The differences found between countries were not explained by socio-demographic factors. Key Practitioner Messages Use of corporal punishment is still quite common among Finnish and Swedish parents., Parents use corporal punishment more often towards children aged two to six years while other humiliating upbringing practices are used more often towards children above age six., The differences between Finland and Sweden in the use of corporal punishment and other humiliating upbringing practices are not explained by traditional socioeconomic characteristics, nor by the parents' own experiences. [ABSTRACT FROM AUTHOR]

Three two-year datasets of ano-genital signs were collected for comparisons of the injuries seen with accidental trauma and child sexual abuse in children less than 16 years of age: (1) Those attending a regional children's emergency department (South East Scotland) (n = 146) for injuries to the ano-genital area; (2) all admissions to hospital in Scotland for straddle injury (n = 56); and (3) all children attending a regional child abuse and neglect service for assessment of suspected child sexual abuse (n = 98). Accidental injury types were combined for comparison with abusive injuries. In South East Scotland, 1:1785 children under 16 years will attend an emergency department and 1:9305 will be admitted annually for an ano-genital injury. In boys, penile and scrotal injuries were only seen following accidents; anal injury was more frequent following suspected abuse (36%) than after accidents (5%). In girls, injuries to the perineum and labia were more frequent after accidental trauma (32% and 74%, respectively, compared to 2% and 11% following suspected abuse), while hymenal injuries were more frequent after sexual abuse (19% compared to 1% in the accident group). Acute injuries to the posterior fourchette were common from both causes, (17% accidents and 10% abuse) and vaginal injuries were uncommon in both groups (5% accidents and 2% abuse). The sites of injury may assist in the differential diagnosis of the cause in ano-genital injuries. Copyright © 2017 John Wiley & Sons, Ltd Key Practitioner Messages Hymenal or vaginal injury is very unlikely in accidental ano-genital injury unless there are indications of significant impalement., Perineal and labial injuries are very common in accidental ano-genital injury., Injuries to the posterior fourchette poorly differentiate abusive and accidental ano-genital injuries., In boys, penile and scrotal injuries are more common following accidental injury, whereas anal/perianal injuries are more likely abusive. [ABSTRACT FROM AUTHOR]