A senior paediatrician who has specialised in child protection for 30 years describes the difficulties faced by professionals
When I started working in child protection in the early Seventies, a seven-year-old girl called Maria Colwell was beaten to death by her stepfather, despite a series of warnings to social services. An inquiry found that there had been a breakdown of communication between the agencies involved and a lack of training for the social workers. Almost 30 years later, Victoria Climbié died under similar circumstances. Now we have seen it again.
Cases like Baby P, Victoria Climbié and Maria Colwell are extremely rare, but when they do happen they often involve staff who have had inadequate training or who are too afraid to raise the issues. People are scared that they will make a mistake, or take a child away from its parents wrongly or perhaps that someone will make an allegation against them. But every person I have met working in child protection has had the right motive: to help children and prevent abuse.
Child abuse is like a jigsaw: you collect all the information - from social workers, teachers, GPs, health visitors and more - and then you try to piece it together and reach a conclusion. Sometimes, in very rare cases, you reach the conclusion too late. Then we hold an emergency case conference and carry out a serious case review.
It is an emotional and stressful job. You have sleepless nights, always questioning whether you have made the right decision. Sometimes you have to face angry defence lawyers in court. The families can become angry and violent. I once had a chair thrown at me because the parents thought I was not accepting what they were saying. People who abuse children can be very manipulative and will do anything to hide the truth.
All these things put people off jobs such as mine. That is why there are approximately 100 vacancies across the countries for paediatricians specialising in child protection. These shortages mean that sometimes people are recruited to jobs with inadequate experience. Then there is the fact that cases such as Baby P are extremely rare - doctors do not see them very often so they become out of touch.
I have come across around a dozen cases in which a child has been killed or left seriously disabled as a result of abuse. In one case a boy was malnourished in a way that you would normally only see in the poorest parts of Africa. The child had marasmus, a form of severe malnutrition that left him looking emaciated. He was grossly underweight, had exposed ribs and swelling of the abdomen and feet. He was six but looked three. The health visitor said there were dog faeces lying around, needles and syringes, the fridge was dirty, there was no food and the house smelt of urine. These cases are rare but when they happen we often find there is unemployment, poverty, drug and alcohol abuse, mental illness and domestic violence.
In another case, a child was seen by a number of doctors who thought he was fine and discharged him. The next day the child was brought to A&E dead. The child had several broken ribs. In any case like that we carry out a serious case review to investigate what happened. We know that the cases of emotional and sexual abuse and neglect are on the increase. If a child is believed to be at great risk, he or she will be taken into care.