The Children's Social Health Monitor New Zealand

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Injuries Arising from the Assault, Neglect, or Maltreatment of Children

Introduction

Child maltreatment has been defined as any act of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child [1]. It includes neglect, physical, sexual and emotional abuse, and fabricated or induced illness, and is linked to harmful short–term and long–term effects [2]. Physical abuse can result in disability and death.

The psychological effects of maltreatment, which can persist into adulthood, include anxiety, depression, substance misuse, and self–destructive, oppositional or antisocial behaviours. In adulthood, childhood exposure to maltreatment has been linked to difficulties in forming or sustaining close relationships, sustaining employment and parenting capacity. There is significant overlap between the occurrence of child abuse and partner abuse in families and these issues cannot be addressed in isolation [3].

Child maltreatment is associated with a complex interaction of predisposing, perpetuating and precipitating risk factors [4]. Predisposing factors relate to the parent or caregiver's early history and include parental exposure to a violent or abusive environment as a child. Perpetuating factors include the wider social context, such as poor housing and overcrowding, socioeconomic inequality, social and cultural norms that promote violence and physical punishment of children, and social isolation; the family context, such as unintended pregnancy, lack of attachment, large family size, financial deprivation, and intimate partner conflict; parent or caregiver characteristics, such as alcohol and substance abuse, mental health problems, and poor parenting skills; the characteristics and behaviour of the child, such as being unwanted, disabled or high needs. Precipitating factors are events that directly trigger abuse, including incessant crying, soiling, aggressiveness by the child, or a crisis event for the parent.

A UNICEF report on child maltreatment deaths, from 1994 to 1998, placed New Zealand near the bottom for deaths in the OECD, at number 24 out of 27 countries [5]. The mortality rate for New Zealand was 1.2 deaths per 100,000 children under the age of 15 years, compared to the OECD median of 0.6 deaths per 100,000 children. A recent study published in the Lancet found no clear evidence of a decrease in child maltreatment in New Zealand over the past two decades [6]. Between 2006 and 2010 there were 36 deaths due to assault among children aged 28 days to 14 years [7]. Between 2006 and 2010 there were 13.9 per 100,000 hospital admissions for injuries arising from assault, neglect or maltreatment of girls aged 0 to 14 years, and 24.3 per 100,000 for boys [8]. The rate of hospitalisation increased with increasing socioeconomic deprivation (RR 5.59, 95% CI 4.22–7.41 for NZDep deciles 9–10 vs. deciles 1–2), with rates of hospitalisation for Māori (39.1 per 100,000) and Pacific children (24.4 per 100,000) being significantly higher than for NZ European children (11.8 per 100,000).

The following section reviews hospital admissions and mortality from injuries arising from the assault, neglect or maltreatment of children aged 0–14 years using information from the National Minimum Dataset and the National Mortality Collection.


 

Data Source and Methods

Definition

1. Hospitalisations for injuries arising from the assault, neglect or maltreatment of children aged 0–14 years

2. Deaths from injuries arising from the assault, neglect or maltreatment of children aged 0–14 years

Data Source

1. Hospital Admissions

Numerator: National Minimum Dataset: Hospital admissions for children (0–14 years) with a primary diagnosis of injury (ICD–10–AM S00–T79) and an external cause code of intentional injury (ICD–10–AM X85–Y09) in any of the first 10 External Cause codes. As outlined in Appendix 2, in order to ensure comparability over time, all cases with an Emergency Department Specialty Code (M05–M08) on discharge were excluded.

Denominator: NZ Statistics NZ Estimated Resident Population (projected from 2007)

2. Mortality

Numerator: National Mortality Collection: Deaths in children (0–14 years) with a clinical code (cause of death) of Intentional Injury (ICD–10–AM X85–Y09).

Denominator: NZ Statistics NZ Estimated Resident Population (projected from 2007)

Interpretation

The limitations of the National Minimum Dataset are discussed at length in Appendix 2. The reader is urged to review this Appendix before interpreting any trends based on hospital admission data.

New Zealand Distribution and Trends

New Zealand Trends

In New Zealand during 2000–2011, hospital admissions for injuries arising from the assault, neglect or maltreatment of children declined gradually, while mortality during 2000–2009 remained relatively static. On average during 2000–2009, eight children per year died as a result of injuries arising from assault, neglect or maltreatment (Figure 1).

 

Figure 1. Hospital Admissions (2000–2011) and Deaths (2000–2009) due to Injuries Arising from the Assault, Neglect or Maltreatment of New Zealand Children 0–14 Years

Source: Numerator: Admissions: National Minimum Dataset; Mortality: National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population (projected from 2007); Note: Death Numbers are per two year period

 

Figure 2. Hospital Admissions (2007–2011) and Deaths (2005–2009) due to Injuries Arising from the Assault, Neglect or Maltreatment of New Zealand Children by Age and Gender

Source: Numerator: Admissions: National Minimum Dataset; Mortality: National Mortality Collection; Denominator: Statistics NZ Estimated Resident Population (projected from 2007)

 

New Zealand Distribution by Age and Gender

In New Zealand during 2007–2011, hospital admissions for injuries arising from the assault, neglect or maltreatment of children exhibited a U–shaped distribution with age, with rates being higher for infants less than one year and those over eleven years of age. In contrast, mortality was highest for infants less than one year, followed by those aged one and two years. While the gender balance for admissions was relatively even during infancy and early childhood, admissions for males became more predominant as adolescence approached (Figure 2).

New Zealand Trends by Ethnicity

In New Zealand during 2000–2011, hospital admissions for injuries arising from assault, neglect or maltreatment were consistently higher for Māori and Pacific children than for European/Other children. While rates for European/Other children declined during this period, rates for Māori children increased during the early to mid 2000s, but declined during 2010–2011. In contrast, admissions for Pacific children declined during the early to mid 2000s, but increased during 2010–2011 (Figure 3).

 

Figure 3. Hospital Admissions for Injuries Arising from the Assault, Neglect or Maltreatment of Children 0–14 Years by Ethnicity, New Zealand 2000–2011

Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population (projected from 2007); Note: Ethnicity is Level 1 Prioritised

 

Table 1. Hospital Admissions for Injuries Arising from the Assault, Neglect or Maltreatment of Children 0–14 Years by Ethnicity and Gender, New Zealand 2007–2011

Assault, Neglect or Maltreatment Admissions
Children 0–14 Years
Variable Rate RR 95% CI Variable Rate RR 95% CI
European/Other 11.13 1.00   Female 13.80 1.00  
Māori 36.03 3.24 2.80–3.75 Male 23.64 1.71 1.49–1.97
Pacific 25.18 2.26 1.83–2.80  

Source: Numerator: National Minimum Dataset; Denominator: Statistics NZ Estimated Resident Population (projected from 2007); Note: Rate is per 100,000; Rate Ratios are unadjusted; Ethnicity is Level 1 Prioritised

 

New Zealand Distribution by Ethnicity and Gender

In New Zealand during 2007–2011, hospital admissions for injuries arising from the assault, neglect or maltreatment of children were significantly higher for males. Admissions were also significantly higher for Māori and Pacific children than for European/Other children (Table 1).

Nature of the Injury Sustained

During 2007–2011, the most common specific injury types sustained as the result of the assault, neglect or maltreatment of children aged 0–4 years were traumatic subdural haemorrhages and superficial head injuries, followed by fractures of the skull and face, and fractures of the femur. For children aged 5–12 years head, upper limb and abdominal/ spinal/pelvic injuries predominated (Table 2).


 

Table 2. Nature of Injuries Arising from Assault, Neglect or Maltreatment in Hospitalised Children 0–12 Years by Age Group, New Zealand 2007–2011

Primary Diagnosis New Zealand
Number: Total 2007−2011 Number: Annual Average % of Total
Assault, Neglect or Maltreatment
Children 0–4 Years
Traumatic Subdural Haemorrhage 101 20.2 25.8
Superficial Head Injury 68 13.6 17.4
Fracture Skull or Facial Bones 16 3.2 4.1
Other Head Injuries 50 10.0 12.8
Injuries to Abdomen, Spine and Pelvis 31 6.2 7.9
Injuries to Thorax (including Rib Fractures) 11 2.2 2.8
Injuries to Upper Limb 27 5.4 6.9
Fracture of Femur 15 3.0 3.8
Other Injuries to Lower Limb 15 3.0 3.8
Maltreatment 36 7.2 9.2
Other Injuries 21 4.2 5.4
Total 391 78.2 100.0
Children 5–12 Years
Superficial Head Injury 34 6.8 17.3
Fracture Skull or Facial Bones 14 2.8 7.1
Concussion 17 3.4 8.6
Other Head Injuries 30 6.0 15.2
Injuries to Abdomen, Spine and Pelvis 25 5.0 12.7
Injuries to Upper Limb 26 5.2 13.2
Injuries to Lower Limb 12 2.4 6.1
Maltreatment 11 2.2 5.6
Other Injuries 28 5.6 14.2
Total 197 39.4 100.0

Source: National Minimum Dataset

 

References

1. Leeb R, Paulozzi L, Melanson C, et al. 2008. Child Maltreatment Surveillance: Uniform Definitions for Public Health and Recommended Data Elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control.

2. National Collaborating Centre for Women’s and Children’s Health. 2009. When to suspect child maltreatment (Clinical Guideline). London: Royal College of Obstetricians and Gynaecologists. Available at: http://guidance.nice.org.uk/CG89/ accessed August 2012.

3. Ministry of Health. 2002. Family Violence Intervention Guidelines Child and Partner Abuse. Wellington: Ministry of Health. http://www.health.govt.nz/publication/family–violence–intervention–guidelines–child–and–partner–abuse

4. Centre for Social Research and Evaluation Te Pokapū Rangahau Arotake Hapori. 2008. Preventing physical and psychological maltreatment of children in families. Review of research for Campaign for Action on Family Violence. Available at: http://www.areyouok.org.nz/research_evaluation_and_statistics.php accessed July 2012.

5. UNICEF. 2003. A league table of child maltreatment deaths in rich nations.  Innocenti Report Card no. 5. Florence: UNICEF Innocenti Research Centre. http://www.unicef–irc.org/publications/pdf/repcard5e.pdf

6. Gilbert R, Fluke J, O'Donnell M, et al. 2012. Child maltreatment: variation in trends and policies in six developed countries. The Lancet 379(9817) 758–72.

7. NZ Child and Youth Mortality Review Committee. 2011. National data overview. https://secure–www.otago.ac.nz/nzmrdg/docs/NZCYMRC%20Data%202006%E2%80%932010%20–%20All%20age%20groups,%20methodology%20and%20extras.pdf

8. NZCYES. 2011. The Children's Social Health Monitor 2011 Update. Dunedin: New Zealand Child and Youth Epidemiology Service. http://www.nzchildren.co.nz/index.php