Seeing is Believing: Video Recordings and Child Abuse
ABSTRACT & COMMENTARY
Source: Southall DP, et al. Covert video recordings of life-threatening child abuse: Lessons for child protection. Pediatrics 1997;100:735-760.
Investigators from the united kingdom report on their clinical observations of life-threatening child abuse as diagnosed using covert video surveillance (CVS). Between June 1986 and December 1994, 39 children underwent CVS (36 for acute life-threatening events [ALTE], one for investigation of suspected strangulation, one for fabricated epilepsy, and one for failure to thrive and suspicion of poisoning.) In 29 children, CPR was reported by parents or performed by health care providers. Data from the CVS group were compared with all 46 children (referred to the investigators during the same time period) who also had suffered from recurrent ALTE and received CPR, but for whom the reason for the ALTE was attributed to a natural cause (nine to epilepsy and 37 to respiratory problems).
CVS revealed abuse in 33 of the 39 suspected cases, with documentation of intentional suffocation observed in 30 children. Poisonings, a deliberate fracture, and other emotional and physical abuse were also observed. Bleeding from the nose, mouth, or both was reported in 11 of the CVS cases but in none of the controls. The 39 children undergoing CVS had 41 siblings, 12 of whom had previously died suddenly and unexpectedly. Eleven of the deaths had been classified as SIDS, but, after CVS, four parents admitted to suffocating eight of these siblings. One additional sibling who had died suddenly with a gastroenteritis illness was found upon further investigation to have been intentionally salt poisoned. Further investigation of other siblings via medical, social, and police records found signs of abuse in 15 additional siblings. There were no suspicious deaths in any siblings of the 46 control patients.
COMMENT BY LEONARD FRIEDLAND, MD
I recommend that you read this article. The paper contains transcripts of the selected observations made during CVS and case histories. The information presented is eye-opening and intensely disturbing. An accompanying editorial, "Unbelievable images: Seeing is believing," sums it up. There are several take-home messages. Nose or mouth bleeding observed in a child status-post an ALTE or SIDS event is a red flag for possible abuse. When evaluating a child who has suffered an ALTE or SIDS event, we must investigate if any of the patient’s siblings also had an ALTE or died from SIDS; positive answers are another red flag. Abuse and neglect exist in our society. We must be willing to recognize it in all its forms.
References
1. Krugman RD. Unbelievable images: Seeing is believing. Pediatrics 1997;100:890-891. Editorial.
All of the following statements are true except:
a. Covert video surveillance is one method which can be used to document intentional child abuse.
b. Acute life-threatening events in children are always the result of intentional child abuse.
c. Nose/mouth bleeding observed in a child status-post an ALTE or SIDS event is a red flag for possible abuse.
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