Trauma in children injured by physical violence

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Abstract


Introduction. In recent years, legislation has changed to include the rights of children injured because of physical violence. Trauma departments of St. Petersburg outpatient clinics admit children with injuries of varying severity after physical violence. The actions of medical institutions are always aimed at protecting the child.

Aims. The aim of the present study was to analyze the cases of children in connection with injuries sustained as a result of physical violence in 2014–2015, and to compare the results with those of previous studies (2007–2008).

Material and methods. In 2014–2015, the trauma department of City Children's Outpatient clinic No 62 treated 268 children, who had suffered from physical violence at home, on the street, or in educational institutions, which accounted for 1.6 per 1000 children living in the district, and 1.2% of all children admitted during 2 years.

Results. Compared to 2007–2008, the number of children who suffered from physical violence decreased by almost two times in 2014–2015; in addition, the severity of injuries slightly decreased but the frequency of hospital admission of victims remained high (38%) in 2007–2008. With regard to the circumstances in which the injury occurred, violence from strangers was lower, but violence among peers was higher.

Conclusions. Positive results have been achieved by a complex of measures, including the implementation of the Federal Law “On Basic Guarantees of the Rights of the Child” to improve the care and safety of children, and an investigation of each case of violence is conducted by local authorities for internal affairs.


Introduction

The rights and legitimate interests of children in Russia are ensured by the Constitution of the Russian Federation through the International Convention on the Rights of the Child [1], the Federal Law of July 24, 1998 No. 124-FZ “On the Basic Guarantees of the Rights of the Child in the Russian Federation” [2], and the regulations and executive orders of government and federal executive authorities. These legislative, administrative, social, and educational measures are intended to protect children from all forms of physical and mental violence, insult or verbal abuse, inattention or negligent treatment, harsh treatment, and exploitation.

Children with injuries of varying severity are admitted to the traumatology departments of Saint Petersburg polyclinics. Healthcare facilities must prioritize the protection of children. A child’s claim of experiencing abuse is treated as truthful information. However, children sometimes conceal abuse incidents because they are ashamed or afraid of leading to additional conflicts with their abuser. In such cases, a doctor may suspect physical abuse and abusive treatment, particularly when the nature of a child’s bodily injuries is inconsistent with the reported circumstances.

In Saint Petersburg and the Leningrad regions, since August 21, 1996, the order “On the procedure for informing the bodies of internal affairs of the delivery or applying to medical care facilities of persons with bodily injuries of a criminal nature and recording of such facts in the bodies of internal affairs” has been enforced. This order was signed by the heads of the Internal Affairs Directorate, procurators of Saint Petersburg and the Leningrad Region, Chairman of the Healthcare Service Committee, and Minister of Health of the Leningrad Region. Medical workers are required to record incidents in a special journal to be forwarded to police departments. Recorded information includes the place the injury occurred, details about cases of children admitted with bodily injuries of a criminal nature, and children with injuries due to domestic and inter-child conflicts. In 2007–2008, we studied visits to the traumatology department of the polyclinic No. 62 in the Nevski District of Saint Petersburg by children aged 0–17 years who were injured as a result of abusive treatment from people at home, outdoors, or in school. The obtained data were analyzed and published [3].

Over recent years, the rights of children injured because of unlawful acts were expanded in the legislation. A significant addition was the Federal Law of July 24, 1998 No. 124-FZ “On the Basic Guarantees of the Rights of the Child in the Russian Federation.” This included a prohibition for children to be in public places without accompanying parents at night (22:00 to 6:00) [3]. This also introduced responsibilities of juridical persons, public servants, and citizens with respect to infringing the rights and legitimate interests of children and any wrongdoing [4]. Parents also gained the right to bring lawsuits pertaining to compensation for harm caused to a child’s health and property and for moral harm [5, 6]. In the Russian Federation, the Ministry of Healthcare and Social Development has determined a list of features that prove bodily injury to children, and set time frames and the form of notification on a case [7].

Aim of the study

The present study aimed to analyze the cases of children visiting outpatient care because of injuries resulting from physical abuse in 2014–2015, and compare the identified indicators with previously reported data for 2007–2008 [3].

Materials and methods

The analysis of admissions for children with injuries of the musculoskeletal system in 2014–2015 was performed based on the traumatology department of the children’s polyclinic No. 62 in the Nevski district of Saint Petersburg. We assessed indicators of primary disease incidence, the type and nature of children’s trauma, and the main indicators of the department’s treatment of injured children.

We distinguished a group of children who visited with polyclinic due to physical abuse. The analysis of patients’ medical charts was performed according to the following indicators: sex, age, persons accompanying the child, the description of the circumstances of the injury according to the child and accompanying persons, X-ray examination data, treatment in the traumatology department, recommendations for subsequent treatment, and hospitalization.

Results

There were 82,200 children in the Nevski district in 2014–2015. The traumatology department of the children’s polyclinic in the Nevski region is open from 9 a.m. to 10 p.m., 7 days per week. The department sees 25,000–26,000 children annually, of which 10,000–12,000 children are first-time visitors. Over the 2 study years (2014–2015), 23,420 children visited the traumatology department for the first-time (11,585 in 2014 and 11,835 in 2015). Injuries commonly occurred in the street (36.8%) and at home (25.7%). Injuries at school (18%), sports (9.1%), during transport (0.4%), and other injury types (10 %) were also recorded. Injuries were common among children aged 8–14 years (52.3%) and 15–17 years (17.6%). As to the nature and location of injuries, surface trauma was most frequent, including: bruises (40%), injury of joint ligaments (15.2%), wounds (9.1%), and skin burns (3%). Head bruises and suspected concussion accounted for approximately 5.7% of injuries. Bone fractures were found on the upper limb (15.5%), lower limb (6.5%), spinal column and trunk bones (2.4%), and facial bones (1%). Other injuries comprised 4.5% of overall injuries. Injured children received acute care, including: examination, bandaging, surgery (8%), plaster application (26%), and further treatment recommendations. Among the surgeries performed, surgical treatment of wounds, local anesthesia, removal of foreign bodies, and repositions were most common. Overall, 7.3% of first-visit children were hospitalized. The most frequent reasons for hospitalization were concussion and suspected skull fracture (46%), fractures of upper (21%) and lower (5%) limbs, vertebral fractures (6%), wounds (8%), bruises (10%), deep burns (1%), and other injuries (3%).

Among children who made first-time visits during 2014–2015 (23,420 patients), there were 268 children who had suffered from physical abuse (1.2%). This constituted 1.6 cases per 1,000 children residing in the Nevski district. There were 186 boys (69.4%) and 82 girls (30.6%). The distribution of ages was: children younger than 6 years (n = 24, 8.9%), children aged 7–14 years (n = 165, 61.6%), and adolescents aged 15–17 years (n = 79, 29.5%). Information on all abuse incidents was conveyed to the relevant authorities based on the child’s place of residence, including: the child’s name, sex, age, address, nature of injury, and place and circumstances of injury.

When describing the circumstances of the injury, children used the following wording: hit with a belt, smashed with a fist, knocked on the head, punched in the face, objects thrown at them, gripped by the throat and strangled, jerked by the hand, given a jolt, struck to the ground, kicked, not let in or out of a room, pressed behind the door, had a dog sit on them, attacked and beaten by a few men, etc.

In 48 cases (18%), children were injured at home by family members. The accompanying persons reported that small children were often injured by stepfathers and step-grandmothers, whereas adolescents complained about parents. Most of these injuries were superficial in the form of bruises and scratches. After evaluation, parents in most cases dismissed offers of hospitalization for the child. In 80 cases (29.8%), bodily blows occurred on the street; in 36 cases, (13.4%) children known to one another were fighting in the yard at home or school; and in 44 cases (16.4%), children received bodily blows by unknown persons (both adult and minors). It should be noted that adolescents, especially girls, tried to not name names of the offenders and often said that they were injured by strangers. Mobile phones were stolen from some children during these fights.

Children’s fights in educational institutions raised the greatest concern for parents. Among 268 cases of abusive treatment, 129 fights with peers were recorded: at preschool (n = 12, 4.5%), in school (n = 109, 42.5%), and at college (n = 8, 3%). Children fought with their hands and legs. Some fights were “multiple children on one,” and both boys and girls participated in fights. Sometimes, the description in the medical charts of injuries caused by peers at preschool or junior school appeared negligible, but the parents insisted that the case be recorded as an act of aggression on the part of peers or negligence of educators, and asked that it be reported to the relevant authorities. Often, physical actions of classmates were combined with mockery, humiliation, threats, and insults. Parents drew attention to the cases of harassment, particularly when they brought their child for examination several times in a year, and named the offending adolescents [8].

Among the injuries received due to violence, 138 (51.5%) were superficial injuries: bruises, ligament injuries, and scratches. In 7.1% of cases, fractures were found in the limbs, in 3.7% of cases there were fractures or suspected fractures of nose bones, and eye traumas were found in 2.6% of cases. There were isolated cases of the chest, abdominal wall, and perineum injuries and dog bites.

After care was provided, 149 (55%) of children were sent home, and 7% were sent for consultations with ophthalmologists or ENT-specialists. In most cases, bruises and scratches after fights were localized on the head and face, and doctors could not fully rule out concussion in those children during outpatient examination. Overall, 102 (38%) children were hospitalized with closed craniocerebral injury and suspected concussion, which was a significantly higher rate than the hospitalizations among all first-time visiting children (7.2%).

The information sent to the relevant authorities served as the basis for investigation of unlawful acts causing harm to a child’s health. The children’s officers of the territorial departments of the Ministry of Internal Affairs described the sequence of the investigative activities for each physical abuse case: detailing the circumstances of the trauma, interviews with the heads and members of educational institutions, and interviews with the parents and family members of the injured children. Based on investigation results, recommendations were made on measures to be taken. Recommendations concerning locating the child’s abusers and improving child’s safety were made to the Commission on Juvenile Affairs, relevant educational institutions, and if necessary, files were arranged for the prosecutor’s office.

Dynamics of indicators

When comparing indicators for 2014–2015 and 2007–2008, we found that the number of children injured due to violent actions at home, in the street, at preschool, and school significantly declined (in terms of absolute numbers), with 268 cases in 2014–2015 compared with 469 cases in 2007–2008. The percentage of first-time visits to the traumatology department also declined in 2014–2015 (1.2% vs. 2.7%), as did the number of cases per 1,000 children in the Nevski district (1.6 vs. 2.7 cases). By comparing the groups of injured children across the analyzed years we noted the number of boys as compared with girls and of children aged 7–14 years prevailed equally by 1.5 fold (62%). In children injured by abusive treatment in 2014–2015, 51.5% were diagnosed as superficial traumas, whereas in 2007–2008, 41.2% of cases were superficial traumas. The percentage of hospitalized patients also decreased (38% in 2014–2015 vs. 50.3% in 2007–2008); at the same time, the general condition of all hospitalized children was reported as satisfactory.

The ratio of injured children changed by the circumstance of the trauma. In comparison with previous studies, the number of injuries from strangers decreased by more than by two-fold, which may be explained by increased legal requirements and recommendations of educational institutions on the presence of unaccompanied children in public places at night. Nearly all children who underwent examination after being beaten at home received outpatient treatment, indicating that physical abuse at home was less severe in 2014–2015 than in previous years. However, admissions on account of fights with peers increased significantly.

Conclusion

We postulate that the decrease in reported injuries was achieved by implementation of measures such as requirements of Federal Law No. 124-FZ “On the Basic Guarantees of the Rights of the Child in the Russian Federation,” with amendments that stipulated improved child care and safety. The population of Saint Petersburg is also informed of investigation of each case of inflicted violence by the relevant authorities, including necessary enforcement and punitive measures. Over the last few years, we have also witnessed frequent condemnation of all forms of violence in mass media.

The physical abuse of children makes it necessary to conduct more focused educational work with children in families and in educational institutions. The territorial bodies of the Ministry of Internal Affairs should direct attention to families with problems. Child psychologists and psychotherapists claim that traumatological care alone is not enough for injured children. Fear and other emotional consequences of physical abuse require attention at school and in the family environment, and necessitate the psychological rehabilitation of abused children [8].

The work of healthcare facilities on delivery of care to children who have suffered abusive treatment, and continuing to convey information on the circumstances of such trauma to the relevant authorities remains important and of social significance.

Karina S Solovyova

The Turner Scientific and Research Institute for Children’s Orthopedics

Author for correspondence.
Email: omoturner@mail.ru
MD, PhD, senior research associate of the scientific-organizational department. The Turner Scientific and Research Institute for Children’s Orthopedics.

Marina V Martynova

City Children’s Outpatient clinic No 62

Email: omoturner@mail.ru
Md, Phd, head of the trauma Department of the City Children’s Outpatient clinic No 62 of Saint Petersburg.

Anna V Zaletina

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: omoturner@mail.ru
MD, PhD, head of the scientific-organizational department. The Turner Scientific and Research Institute for Children’s Orthopedics

Olga A Kuptsova

The Turner Scientific and Research Institute for Children’s Orthopedics

Email: omoturner@mail.ru
MD, research associate of the scientific-organizational department. The Turner Scientific and Research Institute for Children’s Orthopedics

  1. Конвенция о правах ребенка и законодательство Российской Федерации: Справочник. - М.: Государственный НИИ семьи и воспитания, 2004. - 336 с. [Konventsiya o pravakh rebenka i zakonodatel’stvo Rossiiskoi Federatsii: Spravochnik. Moscow: Gosudarstvennyi NII sem’i i vospitaniy; 2004. 336 p. (In Russ).]
  2. Федеральный закон от 24 июля 1998 года № 124-ФЗ, включая список изменяющих документов (в редакции Федеральных законов от 28.04.2009 № 71-ФЗ, от 05.04.2013 № 58-ФЗ, от 02.07.2013 № 185-ФЗ) «Об основных гарантиях прав ребенка в Российской Федерации». [Federal’nyi zakon ot 24.07.1998 No 124-FZ, vklyuchaya spisok izmenyayushchikh dokumentov (v redaktsii Federal’nykh zakonov ot 28.04.2009 No 71-FZ, ot 05.04.2013 No 58-FZ, ot 02.07.2013 No185-FZ) “Ob osnovnykh garantiyakh prav rebenka v Rossiiskoi Federatsii”. (In Russ).]
  3. Соловьева К.С., Битюков К.А., Мартынова М.В. Повреждения опорно-двигательного аппарата у детей вследствие насильственных действий // Травматология и ортопедия России. - 2009. - № 2. - С. 157-159. [Solov’eva KS, Bityukov KA, Martynova MV. Povrezhdeniya oporno-dvigatel’nogo apparata u detei vsledstvie nasil’stvennykh deistvii. Travmatologiya i ortopediya Rossii. 2009;2:157-159. (In Russ).]
  4. Федеральный закон от 28.04.2009 № 71-ФЗ «О внесении изменений в ФЗ «Об основных гарантиях прав ребенка в Российской Федерации». [Federal’nyi zakon ot 28.04.2009 No 71-FZ “O vnesenii izmenenii v FZ “Ob osnovnykh garantiyakh prav rebenka v Rossiiskoi Federatsii”. (In Russ).]
  5. Федеральный закон от 05.04.2013 № 58-ФЗ «О внесении изменений в ФЗ «Об основных гарантиях прав ребенка в Российской Федерации». [Federal’nyi zakon ot 05.04.2013 No 58-FZ “O vnesenii izmenenii v FZ “Ob osnovnykh garantiyakh prav rebenka v Rossiiskoi Federatsii”. (In Russ).]
  6. Федеральный закон от 02.07.2013 № 185-ФЗ «О внесении изменений в ФЗ «Об основных гарантиях прав ребенка в Российской Федерации». [Federal’nyi zakon ot 02.07.2013 No 185-FZ “O vnesenii izmenenii v FZ “Ob osnovnykh garantiyakh prav rebenka v Rossiiskoi Federatsii”. (In Russ).]
  7. Приказ Минздравсоцразвития России от 17 мая 2012 г. № 565н «Об утверждении Порядка информирования медицинскими организациями органов внутренних дел о поступлении пациентов, в отношении которых имеются достаточные обоснования полагать, что вред их здоровью причинен в результате противоправных действий». Зарегистрирован в Минюсте РФ 25.07.2012. Рег. № 25004. [Prikaz Minzdravsotsrazvitiya Rossii ot 17.05.2012 No 565n “Ob utverzhdenii Poryadka informirovaniya meditsinskimi organizatsiyami organov vnutrennikh del o postuplenii patsientov, v otnoshenii kotorykh imeyutsya dostatochnye obosnovaniya polagat’, chto vred ikh zdorov’yu prichinen v rezul’tate protivopravnykh deistvii”. Zaregistrirovan v Minyuste RF 25.07.2012. Reg. No 25004. (In Russ).]
  8. Лукьянова И.В. Если ребенка травят в школе [интернет]. «Журнальный клуб Интелрос» Фома», № 9 (113), 2012. Доступно по ссылке http://www.intelros.ru/readroom/foma/f9-2012/15900-esli-rebenka-travyat-v-shkole/html. [Luk’yanova IV. Esli rebenka travyat v shkole [internet]. “Zhurnal’nyi klub Intelros” Foma”, No 9 (113); 2012. http://www.intelros.ru/readroom/foma/f9-2012/15900-esli-rebenka-travyat-v-shkole/html. (In Russ).]

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Copyright (c) 2016 Solovyova K.S., Martynova M.V., Zaletina A.V., Kuptsova O.A.

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