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Background: In 1988, the first survey of child abuse in Japan was conducted in Osaka Prefecture as a joint effort between medical, health and welfare agencies. Ensuing surveys in 1988 revealed that infant abuse had a death rate of 10% in Health Center. Methods: In 1996 and 1999, surveys were performed on 130 and 215 abused children under 18 years of age. They were studied in terms of their activity of Health Center, including help, means of involvement by health visitors. Results: Fifty-five percent of children were detected via health centers. In 69% of cases, health visitors listened to parents and promptly contacted other agencies. Ninety-five percent of cases had home visits. The concerted effort of the health centers with allied disciplines in Osaka Prefecture yielded the following changes: the mortality rate decreased from 9.8% in 1988 to 2.3% in 1996, and institutionalized cases tripled from 13.7% in 1988 to 39.5% in 1999. The rate of admission to day care centers increased from 22.4% in 1988 to 58.7% in 1999. Along with the constant support of health visitors, day care centers provided secure support and protection for parents and infants. Conclusions: Effective prevention and treatment become possible only when treatment of the child’s physical and psychological health, mental care for parents and tangible support for childrearing and daily life were undertaken in a concerted way. To this end, a systematic commitment of all child agencies, child guidance centers, as well as medical, health educational, welfare and other allied disciplines is required.

Cases of child abuse identified by a hot-line telephone service and by a survey of health and welfare agencies are reported. Many consultations to the telephone hot-line were from mothers concerned about maltreating their own children. In such cases, the extent of abuse was often mild to moderate, and many of those mothers were troubled about child care in the relatively segregated context of the nuclear family. In only a few cases did the callers indicate that the children's life was in danger. In the administrative survey, however, deaths occurred in 5% of the cases, and the abused children frequently had physical and psychological symptoms. There were also more frequent and more serious family problems in the administrative survey compared to the telephone consultation cases. The findings of these surveys suggest that many children and parents are suffering from child abuse in Japan, that many cases are currently not being identified by health and welfare agencies, and that a wide range of measures, from protection of severely abused children to prevention of abuse, are necessary.

According to Health and Welfare Ministry figures (1985), 95% of pregnant women wished to breast-feed their baby, and the number of breast-fed newborns is increasing annually. Nevertheless, the Ministry reports that only 49.5% of one-month-old babies are still being breast-fed. In 1977, Ina Health Center established Mother-Baby Clinics, offering education about breast-feeding. The Center also started research in 1983, with the cooperation of the Kami-Ina Public Health Nurses' Association, into infant feeding styles. Since then, the local breast-feeding rate has risen well above the national average. This paper presents practical guidance toward encouraging successful breast-feeding. First, timely advice must be offered to pregnant women, to establish a correct understanding of the importance of breast-feeding. The mother's strong intention is a major factor, as is support from people around her--family, employer, health care professionals. The most important period for establishing breast-feeding is the first three months. Adequate milk secretion, good breast condition, and proper sucking are also crucial. Education and further research are still needed.