Dr. Mariella Mangion is a consultant paediatrician at Mater Dei Hospital and she is also specialised in non-accidental injuries. Mel McElhatton caught up with Dr. Mangion to help understand Malta’s situation better in relation to child abuse.
1. From a medical point of view, what constitutes as child abuse?
Firstly, I want to give the definition of child abuse as defined by World Health Organisation (WHO) in the Report of the Consultation on Child Abuse Prevention, Geneva, 1999:
Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.
I like this definition because it places equal emphasis on the health and dignity of the child. Therefore, as doctors we seek to identify not only patterns of injuries, but also patterns of behaviours which may indicate child maltreatment. More importantly, we do not look only at the injury or the pattern of behaviour in isolation, but we link it to the story that the child is telling us, we ask the parents/carers for their version of the events, we observe the interaction between the child and carer; we consult with our colleagues; and only after gathering all this information, do we then use our clinical judgement to decide whether child maltreatment is present or otherwise.
The medical signs we look for are patterns of injuries; meaning patterns of bruises or factures or burns which are more specific for non-accidental injury. Therefore for example a bruise could look suspicious because of the combination of the shape of the bruise, the site of the bruise and the age of the child.
Similarly when assessing behaviours we look for change in normal behaviour of the child or a deterioration in the performance of the child or an onset of certain behaviours in the child.
When assessing for neglect we again look at a persistent pattern of neglect - a persistent failure to provide for the child’s physical, emotional or educational needs. So if a mother takes precautions to store medicines safely in a medicine cupboard well out of the child’s reach but on one occasion the child still manages to outwit the mother, this does not constitute neglect but if the mother consistently leaves medicines within very easy reach of children then she is failing to provide for her child’s safety.
2. What would be the most common age of children who are abused?
Children of all ages can present to doctors with symptoms and signs of abuse. However, some types of abuse are more specific to certain ages, and I will give some examples: when a baby is violently shaken, as may happen when a baby is shrieking and crying and the parent loses their temper, then this can cause serious brain injury. Another example is young children presenting with bruises and slap marks or belt marks, where the carer had tried to discipline the child by using corporal punishment. Sexual abuse happens at all age groups from toddlers through to adolescents. In the majority of cases the abuser is either a family member or else someone with whom the child is very familiar.
3. When there is a suspicion or confirmation of child abuse, what is the process undertaken by professionals?
I always advise doctors to tackle cases of child abuse objectively and clinically, and to put aside any emotional feelings which some of these cases may naturally generate. I advise them not to work in isolation but to discuss their findings with senior colleagues before taking action. I advise that the priority is to first treat any medical injuries and ensure child safety, and then to contact the relevant professionals who need to be involved, these usually being social workers and police. To facilitate this process, there are written guidelines for cases of suspected child maltreatment presenting to hospital.
4. The Council of Europe has urged Malta to start using an “independent person” who would speak on the child’s behalf in Court, since seeing their perpetrator could leave children in a vulnerable state. What is your view on this?
The Court process can be very daunting for the child and certainly needs to be modified in order to prevent secondary traumatisation and harm on the child, and there definitely needs to be more training for all the professionals involved throughout the whole process. All children should have access to a child advocate who will ensure that the child’s rights and best interests are maintained at all times throughout the proceedings and in those instances where the child wants to or needs to speak directly in court, then this process must be facilitated and modified to make the child feel as comfortable as possible.
If you suspect that there’s a child being abused or neglected, get in contact with APPOGG or Helpline 179 in order for them to conduct an assessment.
Melissa McElhatton who has recently graduated with a BA (hons) in Social Work started out with Insite as a writer, then as CEO, and following as Social Policy Associate. She is also currently President of Gender Equality Malta (GEM).