Safeguarding in adolescence: under-recognised and poorly addressed
- 1General and Adolescent Paediatrics, UCL Institute of Child Health, London, UK
- 2Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
- Correspondence to Dr Sophie N Khadr, Clinical Lecturer in Adolescent Health, General and Adolescent Paediatrics, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK;
Contributors All authors contributed to the manuscript.
- Accepted 2 June 2011
- Published Online First 19 July 2011
Health professionals have a responsibility to safeguard children and adolescents up to the age of 18 years, that is, to recognise and respond to maltreatment.1 The terms ‘child abuse’ and ‘child maltreatment’ often evoke the image of an infant or young child. Yet up to a third of all children subject to a Child Protection Plan in the UK are adolescents.2 Twenty-seven per cent of serious case reviews conducted between 2009 and 2010 involved young people aged 11–17 years (figure 1).3 Many more vulnerable adolescents (eg, homeless youth or victims of gang violence) are not widely acknowledged by health and social care professionals or the media to be ‘abused’ or ‘maltreated’ in the conventional sense, limiting the application of usual safeguarding mechanisms. Maltreatment in adolescence is likely to grow over the coming decades, as the burden of morbidity and mortality shifts from children to adolescents across the high-, middle- and low-income worlds.4 The rates of violent death in infants and young children in England and Wales have fallen over the last 30 years, whereas rates in adolescents have remained static or risen over the same period.5
In this article, we propose that adolescent maltreatment needs to be viewed through a wider lens and explore reasons for failure of professionals to respond to young people's needs. We suggest a safeguarding approach better suited to adolescent social models: one that recognises that the nature and presentation of maltreatment in adolescents often differ from those seen in younger children.
Forms and patterns of maltreatment
There are two basic patterns of maltreatment in adolescence: continuation of an abusive pattern that began in early childhood and maltreatment beginning in …