APPENDIX 49
Letter from the Policy Adviser NSPCC to
the Chairman of the Committee (MS 62)
I understand that you are chairing the Health
Select Committee's forthcoming Inquiries into the Provision of
Maternity Services, Inequalities in Maternity Services and Choice
in Maternity Services, and I write about a number of issues which
the NSPCC should like the Committee to consider as part of these
Inquiries.
Overall, we should like the Committee to be
cognisant of the fact that infants (children under the age of
one) are statistically most at risk of abuse and neglect, and
also more likely to be victims of homicide than any other group
in the population:
— At 31 March 2001, the most recent date for which
figures are available, there were 4,200 registrations of babies
under one on child protection registers. This is the highest rate
for any age, three times the average for all ages, and is over
15% of all registrations[74]
— One baby is killed every fortnight[75]
and infants under one are four times more likely to be killed
than any other group in the population, and nine times more likely
to be killed than any other age of child.
This raises important issues for the training
and practice of professionals working in the maternity services.
The NSPCC's specific concerns centre on the following:
SHAKEN BABY
SYNDROME
Shaking babies causes brain damage resulting in
long-term disability and death. This brain damage has been detected
in one in 4,000 infants[76]
Crying babies are particularly difficult to cope with and mothers
and carers may feel inadequate if they are unable to pacify them.
The most common reason given for shaking a baby is that "it
wouldn't stop crying".
The NSPCC is concerned that parents do not currently
receive adequate advice about the dangers of shaking their baby.
We should like all parents of newborn babies to be educated as
a matter of routine about appropriate physical handling of babies,
and the dangers of shaking them. It would be very helpful to ascertain
current practices and arrangements in the maternity services for
educating parents about the dangers of shaking.
POSTNATAL DEPRESSION
AND SUPPORT
FOR NEW
PARENTS
Postnatal depression is experienced by 12-15% of
mothers[77] and
may affect the development of secure attachments between a baby
and their mother, with significant longer-term consequences, both
for their relationship and for the child's emotional and cognitive
development[78]
It is important that midwives and health visitors should be able
to identify and respond to postnatal depression, yet a clinical
review in the BMJ in 1998 found that postnatal depression is commonly
missed by primary care teams, despite the fact that reliable detection
procedures have been developed[79]
The same review found that antenatal personal and social factors
were most relevant to the development of postnatal depression
in mothers, and that effective prevention interventions should
be developed.
However, there are indications that support for
new mothers is diminishing. The number of postnatal home visits
by midwives and health visitors has declined by a quarter in the
last decade[80]
An NSPCC survey of 2,100 people who had recently had babies found
that 46% of them did not feel they had enough support in times
of stress. Of those who suffered—or whose partner suffered—postnatal
depression, 52% felt they did not get enough extra support from
health professionals[81]
We are concerned that universal health and support
services, such as health visiting, should continue to be a priority,
and that services should be adequately staffed and should aim
to support parents and promote helpful, non-violent parenting
practices, as well as babies' healthy physical development. A
survey of the mothers of one-year-olds found 75% had already hit
their children. Fourteen per cent of these incidents were classed
as being more than "mild"[82]
There is much anecdotal evidence, from the experience
of our own services and from others, that the government's targeted
initiatives, such as Sure Start, are drawing key staff, such as
midwives and health visitors, away from core universal services.
This is of great concern to us, as in effect it means a reduced
service to parents who do not receive the targeted service, with
implications for their needs for advice and support, and their
babies' needs for safe and appropriate care and protection.
ANTENATAL CARE
AND EDUCATION
CLASSES
We are concerned that here should be effective
outreach services to reach parents, especially mothers, who are
not attending routine antenatal appointments and classes. Their
lack of engagement with services does not necessarily mean they
do not need support—in fact they may be in greater need
of such support, and require more individual help with their situation.
Engaging with such parents is obviously important for the healthy
development of their babies, both before and after birth. In some
areas, antenatal health visiting takes place, so that health visitors
are able to identify and work with mothers who need extra support,
which in turn is beneficial for their babies.
The NSPCC believes that antenatal classes should
include more advice and information for prospective parents on
the emotional aspects of having a new baby, the importance of
bonding and attachment, and coping with the challenges that such
a life change presents.
TRAINING
It is clearly crucial that all health professionals
working with children and their parents should be fully trained
in understanding, preventing, recognising and reporting child
maltreatment in accordance with the recommendations of the Victoria
Climbié Inquiry[83]
and government guidance contained in Working Together to Safeguard
Children[84]
As further background information I enclose
a copy of "Setting the Context", the first chapter of
the Reader that accompanies our Fragile: Handle with Care—Protecting
babies from harm training resource for health professionals,
together with our leaflets for professionals and parents about
protecting babies and positive parenting.
I hope this material is helpful for your Inquiries.
Please don't hesitate to contact me if we can provide you with
other relevant information or be of further assistance.
4 March 2003
74 Based on most recent national figures: England: Children
and Young People on Child Protection Registers in England, Year
ending 31 March 2001, Department of Health, 2001; Northern
Ireland: Key Indicators for Personal Social Services for Northern
Ireland, DHSSPSNI, 2001; Wales: Local Authority Child Protection
Registers: Wales 2001, National Assembly for Wales, 2001) Back
75 Criminal Statistics: England and Wales 1999 (2001). London:
TSO. Back
76 Jayawant, Rawlinson, Gibbon, Price, Schulte, Sharples, Sibert,
and Kemp, Subdural haemorrhages in infants: population based
study; British Medical Journal 317, 1998. Back
77 Cox, Murray, Chapman, "A controlled study of the onset,
duration and prevalence of Postnatal Depression" Br J of
Psychiatry 163, 1993. Back
78 Cooper, Peter J. and Murray, L. Postnatal Depression.
British Medical Journal (1998) 316 1884-1886 20 June. Back
79 Ibid. Back
80 Community Maternity Services Summary Information for England
1999-2000, Department of Health, 2000. Back
81 NSPCC Survey conducted May 2000. Back
82 Smith, A Community Study of Physical Violence to Children
in the Home and Associated Variables, 1995. Back
83 The Victoria Climbié Inquiry (2003). London: The Stationery
Office. Back
84 Working Together to Safeguard Children (1999). Department
of Health, Home Office, Department for Education and Employment,
Home Office. London: The Stationery Office.
Back
| 
