[The abused and neglected child in Switzerland]

Pediatricians form part of children's and young people's most important extra-familial relations. They are thus especially well placed: first, to discover abuse of any kind, and second to put in motion the first years of measures of assistance for the children and their families. The first years of life are decisive for effective prevention of abuse and neglect, and for the development of a healthy personality. In this part of life, pediatricians are virtually the only "social outposts". Nevertheless, in Swiss pediatrics the concept of child protection is still in the initial stages. While we should warmly welcome the fact this problem was at last the main theme of an annual meeting, it must be remembered that this was only the first time. For a long time now no one has doubted that in our, thus far socially privileged country, a frighteningly large number of children and adolescents are victims of abuse. Since the publication of the report "Mauvais traitements des enfants en Suisse" (1992) a representative questionnaire to parents has shown that in this country and now, as before, over a third of parents use corporal punishment on their children. It has been calculated that e.g. 21,800 babies aged between 0 and 2.5 years are beaten, 4800 of them even with implements. There are no data on psychological and sexual maltreatment. Despite this shocking incidence of abuse, only a total of 72 cases (6% of all recorded cases) were reported over one year by pediatric practitioners in the "1989 prospective study". We cannot accept that this reflects a lack of social concern. Many other shortcomings appear to be involved: lack of briefing on the problems of child abuse during medical training, post-graduate and continuing studies, inadequate arrangements for interdisciplinary work, discouragement and early delegation to pseudo-experts, distrust of the efficacy of available aids (but sometimes overestimation of one's own possibilities) and last but not least, a still highly idealized image of the family which prompts one to reject the possibility of abuse. The Swiss Pediatric Society is urgently called upon to focus closer attention on this subject, and in so doing to take advantage of the increasingly widespread concept that child abuse must be regarded as resulting from a disturbance of the child's social network. Here the pediatrician can find an effective, decisive and also--above all--preventive role.