Answer to Squier et al.

The author responds to critics formulated by W Squier regarding our paper "The legal challenges to the diagnosis of shaken baby syndrome Or: how to counter 12 common fake news.

Corporal punishment in the home: Is there a legal duty on the medical doctor to report it?

The infliction of corporal punishment on children (in the home) was found to be unconstitutional by the Constitutional Court of South Africa (September 2019). Corporal punishment was historically permitted if exercised within reasonable grounds (moderate or reasonable chastisement). In reaching its judgment, the apex court found that the child's right to human dignity and to be free from all forms of violence was unjustifiably infringed by the exercising of this form of discipline. In addition, the child's best interests was not served. Importantly, there were other non-violent means available to parents to discipline their children. This article examines what this judgment means for medical doctors who reasonably suspect that a child has been the victim of corporal punishment. It is argued that medical doctors have a duty to report such incidents in terms of section 110(1) of the Children's Act 38 of 2005.

Evaluaciones psicológicas forenses de abuso sexual en menores: proceso de revelación y cronicidad del evento en la serranía peruana / Forensic psychological evaluations of child sexual abuse: process of disclosure and its chronicity in the peruvian highlands

Objetivo: Analizar la relación que existe entre las características de la víctima, del agresor y del abuso sexual en niñas, niños y adolescentes con el proceso de revelación; así como con la cronicidad del evento en la División del Instituto de Medicina Legal de la Región Junín-Perú. Materiales y métodos: Diseño transversal analítico. Se analizaron todas las evaluaciones psicológicas forenses desarrolladas de enero a diciembre del año 2017, de las cuales se seleccionaron solo aquellas que cumplían con los criterios de selección, quedando un total de 97 casos. Resultados: El 90% de las víctimas fueron de sexo femenino, el 99% de los agresores fueron de sexo masculino, 66,0% de los casos ocurrieron en un ambiente intrafamiliar y el 5% de las víctimas quedó embarazada. La mayor frecuencia de eventos recurrentes fueron al no tener a la madre viviendo en casa (RPa: 1,44; IC95%: 1,34-1,56; p<0,001), vivir fuera de la ciudad (RPa: 1,27; IC95%: 1,11-1,45; p=0,001), el revelar tardíamente el abuso (RPa: 2,94; IC95%: 1,79-4,84; p<0,001), y entre los que revelaron de manera no intencional (RPa: 1,37; IC95%: 1,06-1,78; p=0,001); en cambio, los agresores extrafamiliares fueron menos frecuentes entre los que tuvieron múltiples eventos (RPa: 0,63; IC95%: 0,44-0,91; p=0,014), ajustados por el sexo y la edad. Conclusiones: Los factores asociados al abuso sexual recurrente fueron: relación de la víctima con la madre, lugar de procedencia de la víctima, latencia de revelación, circunstancia de la revelación y tipo de vínculo de la víctima con el agresor. (AU)

Objective: To analyse the relationship between the characteristics of the victim, the aggressor and sexual abuse in children and adolescents with the disclosure process; as well as with the chronicity of the event in the Division of the Institute of Legal Medicine of the Junín region-Perú. Materials and methods: As a general method of research, the scientific method was applied, carrying out a quantitative study, with a cross-sectional design. All forensic psychological evaluations from January to December of 2017 were analysed, of which only those that fulfilled the selection criteria were selected, leaving a total of 97 cases. Results: Of all the victims, 90% were female, 99% of the aggressors were male, 66.0% of cases occurred in a family environment and 5% of victims became pregnant. The highest frequency of recurrent events was when the mother was not living at home (aPR: 1.44; 95%CI: 1.34-1.56; p <.001), living outside the city (aPR: 1, 27; 95%CI: 1.11-1.45; p=.001), late disclosure of abuse (aPR: 2.94; 95%CI: 1.79-4.84; p <.001), and among those who unintentionally revealed the event (aPR: 1.37; 95%CI: 1.06-1.78; p=.001); in contrast, extra-family offenders were less frequent among those with multiple events (aPR: 0.63, 95%CI: 0.44-0.91, p=.014), adjusted for sex and age. Conclusions: The factors associated with recurrent sexual abuse were the victim's relationship with the mother, place of birth of the victim, disclosure latency, circumstance of the disclosure and type of link between victim and aggressor. (AU)

Violência em crianças, estudo de casos hospitalizados e seguidos nos serviços de Urgência de Pediatria e Medicina Legal no Hospital Central de Maputo em 2019 / Violence in children, a study of cases hospitalized and followed up in the pediatrics and forensic medicine emergency services at maputo central hospital in 2019

Introdução: Em Moçambique, anualmente, milhares de crianças são vítimas de violência, incluindo as suas formas mais extremas, como a violência física e sexual, o que compromete a saúde física e psicológica destas crianças. Objectivo: Analisar a violência nas crianças, em relação às características demográficas (da criança e do perpetrador), bem como descrever os aspectos clínicos da violência. Métodos: É um estudo transversal e retrospectivo, baseado em registos hospitalares dos serviços da Urgência de Pediatria e da Medicina Legal do Hospital Central de Maputo. Para a recolha de dados utilizámos o Formulário de Relatório de Casos Notificados. Foi utilizado o programa Excel® e testes de qui-quadrado para a análise dos resultados. Resultados: Identificámos um total de 329 casos de lesões relacionadas com a violência que afectaram crianças no Hospital Central de Maputo em 2019, dos quais 143 (43,5%) foram registados na Urgência de Pediatria e 186 (56,5%) na Medicina Legal. A violência sexual foi a forma de violência mais frequente (58% no total). Em ambos os serviços, as vítimas foram maioritariamente meninas do que meninos. As crianças mais velhas (11-14 anos) foram mais observadas na Medicina Legal (47,3% em comparação com 30,1% da Urgência de Pediatria) e as mais novas (0-5), na Urgência de Pediatria (37,1% em comparação com 28,6% a Medicina Legal). A violência sexual foi mais frequente entre as meninas em ambos os serviços, por outro lado, os meninos sofreram mais violência física. Os homens foram os principais perpetradores (81,8% no total) e a maioria deles eram conhecidos da família ou da vítima. As meninas sofreram lesões mais graves, exigindo cuidados médicos intensivos (12,0% em comparação a e 4,5% dos meninos). Em contrapartida, os meninos tiveram mais consultas médicas com alta imediata. As meninas tiveram de longe mais lesões genitais (66,4%) enquanto que os meninos tiveram mais lesões em todas as outras partes do corpo (cabeça, membros superiores, tórax e abdómen, membros inferiores e anal). Conclusões: A violência sexual foi a forma mais frequente de violência nos dois serviços. As meninas foram as vítimas de violência mais frequentemente descritas, tanto nos dois serviços como para a violência sexual em todas idades. Por outro lado, a violência física foi mais frequente entre os meninos. Os homens foram os principais perpetradores de violência especialmente da violência sexual, sendo estes, frequentemente conhecidos da família da vítima ou da própria vítima, é em vários casos um familiar. A casa da vítima ou do perpetrador é onde ocorreu a maioria dos eventos violentos. As crianças apresentaram várias lesões em consequência da violência sofrida, mas nem todos casos foram considerados graves. As meninas apresentaram lesões mais graves que exigiram cuidados médicos intensivos ou até cirurgia e os rapazes mais consultas médicas com alta imediata.

Introduction: In Mozambique, yearly, thousands of children are victims of violence, including its most extreme forms, such as physical and sexual violence, which hinders their healthy development. Objective: To analyze violence in children, in relation to demographic characteristics (child and perpetrator) as well as to describe the clinical aspects of violence-related injury. Methods: This study is cross-sectional and retrospective. Based on hospital records from the two services of Maputo Central Hospital, namely Pediatric Emergency and Forensic Medicine. For data collection we used a standardized Case Report Form. Excel® program and chi-square tests were used to analyze the results. Results: We identified a total of 329 cases of violence-related injuries affecting children at Maputo Central Hospital in 2019, of which 143 (43.5%) were registered at Pediatric Emergency and 186 (56.5%) at Forensic Medicine. Sexual violence was most common (58% in total). In both services, the victims were more frequently girls than boys. Also, older children (11-14 years) were more often seen at Forensic Medicine (47.3% compared with 30.1% at Pediatric Emergency) and younger ones (0-5), at Pediatric Emergency (37.1% compared with 28.6% at Forensic Medicine). Sexual violence was by far the most frequent among girls in both services, by contrast, boys suffered more physical violence. Males were the most common perpetrators (81.8%) and most of them were known to the family or the victim in both services. Girls also had more severe injuries, requiring intensive medical care than boys (12.0% and 4.5% respectively). By contrast, boys had more medical consultation with immediate discharge. Girls had by far more genital injuries (66.4%) while boys had more injuries in all other body parts (head, upper limbs, thorax and abdomen, lower limbs and anal). Conclusions: Sexual violence was the most common form of violence afflicting the children, most often girls, presenting at the two services. Sexual violence was most common among girls at all ages and physical violence, among boys. Men were identified as the main perpetrator, especially of sexual violence. The perpetrators were also very frequently known to the family of the victim, in several instances a relative. The victim's or perpetrator's home, is where most of the violent events take place. Multiple injuries were sustained but not all were severe. Girls had more severe injuries requiring intensive medical care and surgery, and boys, more medical consultations with immediate discharge.

Emergency Contraception Administration, Toxicology Kit Use, and Postassault Reporting: A Comparison of Sexual Assault Nurse Examiner (SANE) and Non-SANE Medical Providers.

ABSTRACT: Sexual assault nurse examiners (SANEs) are specially trained to meet the postassault medical forensic needs of sexual assault patients. However, there remains a dearth of literature comparing directly postassault service provision and action in cases treated by SANEs as compared to non-SANE medical providers. In this study, we compare rates of emergency contraception administration, toxicology kit use, reports to police at the time of examination, and mandatory child abuse reports among n = 3,969 sexual assault cases treated by SANEs and non-SANE medical providers. Compared to cases treated by non-SANE medical providers, cases treated by SANEs were significantly more likely to have emergency contraception administered, less likely to have a toxicology kit collected, less likely to have a police report filed at the time of examination, and more likely to have a mandatory child abuse report filed. Observed patterns suggest that non-SANE medical providers may find it difficult to balance the needs of the criminal justice system with those of their patients, whereas SANEs provide a tailored, comprehensive first response. We discuss the importance of consistent, accurate documentation and clearly defined protocols in the medical forensic response to sexual assault patients.

[Legal Aspects of Child Protection]. / Rechtliche Aspekte im Kinderschutz.

Legal Aspects of Child Protection Several legal codes (e. g. family, social and criminal law) are of importance in child protection cases in Germany. The intention of legal codes differs between family law (relations between family members), social law (support for families) and criminal law (penal aspects). Mental health professionals have to know the prevailing legal norms concerning child-welfare. Collaborative work between medicine and youth welfare and child protection services (CPS) requires a weighing of data protection issues and the risk for the child. German child protection law provides a stepped model for health care professionals to inform CPS. This includes a careful weighing of the risk for child abuse and own competences to provide support. Medical personnel should be aware of several further legislative regulations concerning child protection issues.

The potential influence of criminological rationales in considering childhood abuse as mitigating to sentencing.

BACKGROUND: U.S. courts currently show no coherent approach with regard to how evidence of childhood abuse is considered in sentencing. Existing state and federal caselaw suggests that courts rarely place significant consideration on evidence of childhood abuse during sentencing, but the reasons why offenders who have been subjected to childhood abuse rarely receive mitigated or alternative sentences remain unknown. Yet literature has suggested it might be because no convincing rationales have been yet developed for the court in contending that penalties of offenders who were subjected to childhood abuse should be mitigated. OBJECTIVE: This research examines if and how criminological theoretical perspectives linking childhood abuse and later offending (Social Control Theory, Social Learning Theory, General Strain Theory) are persuasive in arguing childhood abuse (neglect, witnessing trauma, sexual abuse, physical abuse) as mitigating to criminal sentencing. PARTICIPANTS: A national sample of U.S. adults (N = 521). METHODS: A multi-factorial, vignette-based experiment was conducted, utilizing OLS and mediation analyses. RESULTS: Evidence on childhood abuse, and particularly sexual abuse, reduced support for incapacitation (B = -0.13, p ≤ 0.05) and increased support for rehabilitation (B = 0.16, p ≤ 0.01). Social Control Theory was particularly persuasive in arguing childhood abuse as mitigating to prison time and in relation to support for rehabilitative sentencing (mediated by beliefs regarding what the theory conveys about future dangerousness and reduced responsibility). CONCLUSIONS: Criminological theories appear to be persuasive rationales for arguing childhood abuse as mitigating to sentencing contexts involving incapacitation and rehabilitation. Implications for sentencing guidelines and systems are discussed.

Abusive head trauma in court: a multi-center study on criminal proceedings in Germany.

The shaken baby syndrome (SBS) is a common variant of abusive head trauma (AHT) in infants and toddlers. Data on the legal outcome of such cases are still sparse. By means of a retrospective multi-center analysis, 72 cases of living children diagnosed with SBS/AHT from three German university institutes of legal medicine were identified. Forty-six of these cases with 68 accused individuals were available and could be evaluated with regard to basic data on the course of the criminal proceedings as well as the profile of the defendants (sub-divided into suspects, convicts, and confessed perpetrators). Criminal proceedings predominantly commenced with a complaint by the treating hospital (62%) and were found to be closed (without judgment) in 50% of the cases, mostly due to a "lack of sufficient suspicion." Of the 23 cases with judgment, the court decided on acquittal in 4 cases (17%). Imprisonment was the most frequent sentence (16 out of 19 cases with conviction, 84%), whereby the sentence has been suspended on probation in 63% of the cases. Suspects and perpetrators were mostly male and derived from the close family environment of the injured children. All confessed perpetrators stated an "excessive demand" as the reason for the violent shaking of the child. The results of the present study are in line with data from other studies with other legal systems. As many criminal proceedings were closed and the 4 acquittals occurred because the perpetration could not be ascribed to a specific perpetrator, improving the forensic methods for such an unequivocal assignment would be desirable.

Deviations in criminal filings of child abuse and neglect during COVID-19 from forecasted models: An analysis of the state of Oklahoma, USA.

BACKGROUND: The COVID-19 pandemic has contributed to risk factors for child abuse and neglect and disrupted conventional abuse surveillance. OBJECTIVE: The goal of this study was to assess how counts of criminal charges have been affected by COVID-19 social distancing measures and related policy changes. PARTICIPANTS AND SETTING: This study used publicly available court filings pertaining to child abuse and neglect from Jan 1, 2010 to June 30, 2020. METHODS: Autoregressive integrated moving average (ARIMA) algorithms were constructed with case data from January 2010 to January 2020 to forecast trends in criminal charges for February to June 2020. These forecasted values were then compared to actual charges filed for this time period. RESULTS: Criminal cases filed between February and June 2020, had an overall 25.7 percent lower average than forecasted. All individual months had progressively lower cases than forecasted with the exception of March. June had the largest deviation from forecasted with 60.1 percent fewer cases than predicted. CONCLUSIONS: Although risk factors for child abuse have increased due to COVID-19, these findings demonstrate a declining trend in child abuse charges. Rather than a decreasing incidence of child abuse and neglect, it is more likely that less cases are being reported. The results warrant immediate action and further investigation in order to address the dangers this pandemic poses for children in abusive situations.

Mujeres Filicidas: Análsis desde una perspectiva psicojurídica / Filicidal women: Analysis from a psycho-legal perspective

Resumen El presente escrito tiene por objetivo, identificar si existe una perspectiva psicojurídica del delito de homicidio de una madre hacia sus hijos (Filicidio) y sus características principales. Se trata de una revisión documental, en la cual se seleccionaron 67 artículos entre los años 2005-2017 en idiomas inglés y español, de bases de datos como; Science Direct, Redalyc, MedLine, PubMed, Scielo. Como resultado de esta revisión no se encontró ningún documento que contenga un enfoque desde la psicología jurídica que aborde este delito. Se propuso clasificar esta conducta punible según dos tipologías en las cuales se tiene en cuenta, la motivación de la agresora y características de la víctima, se consideran varios vacíos en las leyes, lo cual pretende trazar un camino para investigaciones desde esta área, que puedan contribuir a la prevención y mitigación de este tipo de hechos y aportar a futuras políticas publicas

Abstract This paper aims to identify if there is a psycho-juridical perspective of the crime of homicide of a mother towards her children (Filicide) and its main characteristics. It is a documentary review, in which 67 articles were selected between the years 2005-2017 in English and Spanish, databases such as; Science Direct, Redalyc, MedLine, PubMed, Scielo. As a result of this review we did not find any document that contains a legal psychology approach that addresses this crime. It was proposed to classify this punishable conduct according to two typologies in which the motivation of the aggressor and characteristics of the victim are considered, several gaps are considered in the laws, which intends to chart a way for investigations from this area, that can Contribute to the prevention and mitigation of this type of events and contribute to future public politics

Una mirada a la infancia en el marco de la violencia: del niño víctima a la responsabilidad subjetiva / A View of Infancy through the Lens of Violence: From the child as victim to subjective responsibility

La Modernidad dio nacimiento a una nueva forma de comprender la infancia en la que el niño es desprovisto de deberes y solo es considerado sujeto de derechos. Como corolario, en el caso colombiano la ley hace del menor de edad un sujeto inimputable y, en consecuencia, no se le considera responsable por ninguno de sus actos. Esto adquiere mayor relevancia cuando en un país como Colombia algunos menores de edad ejecutan una serie de crímenes tales como asesinatos, robos y secuestros, además de ser codiciados para participar activamente dentro del conflicto armado. En este escenario, ¿hasta que punto podemos hablar de responsabilidad subjetiva en los menores de edad? ¿cuáles pueden ser las consecuencias de que se haga de un menor de edad una excepción ante la ley?

Modernity gave birth to a new way of understanding childhood, one which relinquished the child from duties, but bestowed them with rights. As a corollary, in Colombia the law considers minors to be unimpeachable subjects, thus, they are not held responsible for any of their acts. This has significant relevance in a country like Colombia, where some youth carry out a variety of crimes like murder, robbery, and kidnappings, and are actively recruited to participate in armed conflict. Within this context, to what extent can we talk about youth subjective responsibility? What might be the consequences of making minor an exception before the law?

Infant Homicides Within the Context of Safe Haven Laws - United States, 2008-2017.

Homicide is the 13th leading cause of death among infants (i.e., children aged <1 year) in the United States (1). Infant homicides occurring within the first 24 hours of life (i.e., neonaticide) are primarily perpetrated by the mother, who might be of young age, unmarried, have lower educational attainment, and is most likely associated with concealment of an unintended pregnancy and nonhospital birthing (2). After the first day of life, infant homicides might be associated with other factors (e.g., child abuse and neglect or caregiver frustration) (2). A 2002 study of the age variation in homicide risk in U.S. infants during 1989-1998 found that the overall infant homicide rate was 8.3 per 100,000 person-years, and on the first day of life was 222.2 per 100,000 person-years, a homicide rate at least 10 times greater than that for any other time of life (3). Because of this period of heightened risk, by 2008 all 50 states* and Puerto Rico had enacted Safe Haven Laws. These laws allow a parent† to legally surrender an infant who might otherwise be abandoned or endangered (4). CDC analyzed infant homicides in the United States during 2008-2017 to determine whether rates changed after nationwide implementation of Safe Haven Laws, and to examine the association between infant homicide rates and state-specific Safe Haven age limits. During 2008-2017, the overall infant homicide rate was 7.2 per 100,000 person-years, and on the first day of life was 74.0 per 100,000 person-years, representing a 66.7% decrease from 1989-1998. However, the homicide rate on first day of life was still 5.4 times higher than that for any other time in life. No obvious association was found between infant homicide rates and Safe Haven age limits. States are encouraged to evaluate the effectiveness of their Safe Haven Laws and other prevention strategies to ensure they are achieving the intended benefits of preventing infant homicides. Programs and policies that strengthen economic supports, provide affordable childcare, and enhance and improve skills for young parents might contribute to the prevention of infant homicides.

Psychological Consequences in Abused and Neglected School Children Exposed to Family Violence.

Although family should be the basis for the development and formation of a child's personality, violence is mostly done in the family, and remains undiscovered for a long time. The real number of abused children is much more than that displayed in the registered cases. The secrecy of the problem is an important feature of this phenomenon. Families in which abuse takes place are mostly isolated. Social isolation does not come about by chance; secrecy is usually encouraged by an abuser to control over famoly members. In most cases, social reaction to violence is late, inadequate and focused on the consequences, but not on the causes. "Abuse implies an act of execution that directly inflicts damage, while neglect implies an act of non-fulfillment of something that is necessary for the well-being of a child". The most common forms of domestic violence are physical, emotional abuse in the presence of violence against the mother, and in a lesser extent sexual abuse. In addition, there is physical, emotional, educational and medical neglect. The presence of violence against the mother and the feeling of impotence leave the same consequences as the endured violence. It is considered that children living in violent families are likely to live under cumulative stress. Traumatic responses include a wide range of conditions from acute stress reactions through post-traumatic stress disorder to complex long-lasting, repeated trauma syndrome. All children will not react to this kind of experience in the same way, with the protective and risk factors in developmental psychopathology having a significant role to play. Because of their developmental vulnerability and dependency, children are at greater risk of violence than adults. Researches point to the need for a multidisciplinary approach to treatment and prevention of child abuse, with greater interaction between health institutions, relevant centers for social work, police, court, government and non-governmental sector, and the existence of adequate family and criminal laws.

Child protection and resilience in the face of COVID-19 in South Africa: A rapid review of C-19 legislation.

BACKGROUND & PURPOSE: In response to the COVID-19 (C-19) pandemic, the South African government instituted strict lockdown and related legislation. Although this response was well intended, many believed it advanced children's vulnerability to abuse and neglect. This article interrogates these concerns. It investigates how C-19 legislation enabled, or constrained, South African children's protection from abuse and neglect and appraises the findings from a social-ecological resilience perspective with the aim of advancing child protection in times of emergency. METHOD: The authors conducted a rapid review of the legislation, directives and regulations pertaining to South Africa's strict lockdown (15 March to 31 May 2020). They searched two databases (SA Government platform and LexisNexus) and identified 140 documents for potential inclusion. Following full-text screening, 17 documents were reviewed. Document analysis was used to extract relevant themes. FINDINGS: The regulations and directives that informed South Africa's strict lockdown offered three protective pathways. They (i) limited C-19 contagion and championed physical health; (ii) ensured uninterrupted protection (legal and statutory) for children at risk of abuse; and (iii) advanced social protection measures available to disadvantaged households. CONCLUSION: C-19 legislation has potential to advance children's protection from abuse and neglect during emergency times. However, this potential will be curtailed if C-19 legislation is inadequately operationalised and/or prioritises physical health to the detriment of children's intellectual, emotional, social and security needs. To overcome such risks, social ecologies must work with legislators to co-design and co-operationalise C-19 legislation that will not only protect children, but advance their resilience.

For Victims of Fatal Child Abuse, Who Has the Right to Consent to Organ Donation?

In rare circumstances, children who have suffered traumatic brain injury from child abuse are declared dead by neurologic criteria and are eligible to donate organs. When the parents are the suspected abusers, there can be confusion about who has the legal right to authorize organ donation. Furthermore, organ donation may interfere with the collection of forensic evidence that is necessary to evaluate the abuse. Under those circumstances, particularly in the context of a child homicide investigation, the goals of organ donation and collection and preservation of critical forensic evidence may seem mutually exclusive. In this Ethics Rounds, we discuss such a case and suggest ways to resolve the apparent conflicts between the desire to procure organs for donation and the need to thoroughly evaluate the evidence of abuse.