Poverty and lack of support are two factors that must dealt with if New Zealand is to successfully tackle the problem of child abuse, according to Wanganui paediatrician David Montgomery.
Dr Montgomery is the clinical head of the paediatric ward at Wanganui Hospital and is also the clinical leader of the children's emergency department at Auckland's Middlemore Hospital, so he is no stranger to dealing with cases of child abuse.
He said while child abuse and neglect can happen in any sector of society, it's more likely to happen when a family's resources are stretched.
"There are clear linkages between the socio-economic situation that families find themselves in and child abuse,'' Dr Montgomery said.
"When we're talking about child abuse and neglect, what's better than the cure is prevention. A lot of effort needs to go into supporting families and helping them cope.''
Dr Montgomery said strategies to prevent abuse are needed to help families who are struggling, whether that's economically, with relationships, or mental health and addiction issues.
"It's very stressful being a parent, and even a parent who's well-resourced gets stressed, so a parent who is under-resourced really struggles and suffers a great deal.
"If they could be supported by their community, and their children be prevented from suffering abuse and neglect, that would be the best thing, rather than coming to [the hospital]. We're just the ambulance at the bottom of the cliff,'' he said.
Although there are no statistics kept on the number of children suffering abuse and neglect who come through Wanganui Hospital's doors, Dr Montgomery said it was likely of the 5000 children who come into the emergency department every year, around 10 per cent of them have some abuse or neglect issues.
Dr Montgomery said every member of staff at the Whanganui District Health Board receives mandatory training to recognise family violence, from the clerical staff to managers to doctors and nurses. There's also clear guidelines for dealing with a child that staff suspect may have been abused.
"We have a child and parents and an injury, and obviously our first priority is treating the injury and looking after the health care needs of the child.
"If there's some doubt as to how the injury happened, one of the first things we'll do is tell the parents we're concerned about how the injury could have happened.
"Just because there's an injury, and it doesn't seem to be consistent with the history we've been given, that doesn't mean the parent is a child abuser - it just means it's important that we ask some questions and look into thing a little bit further, and we explain that to parents.
Dr Montgomery said ensuring that the child is safe when they return home is another major concern, and that's when agencies such as Child, Youth and Family and possibly the police can get involved.
"We're not in the business of pointing fingers, but we are in the business of making sure a child is in a safe environment.
"The worst thing that can happen is that we treat a child for a minor injury, only to have them come back at a later date with a much more severe injury.
"But we are very open with parents, we don't sneak around making referrals behind their backs. We involve them as much as possible in the problem-solving,'' he said.
The child abuse cases that stick most in Dr Montgomery's mind are those in which a child has been murdered.
"I've had to treat children, answer police questions and give evidence in court for a number of serious cases where a child has been murdered. Those things are quite prominent in my mind.''
Dr Montgomery said he can remember every child protection case he's been involved with in his more than two decades' experience in paediatrics.
"They always bring a huge emotional burden with them, for families and for all of us involved. It's a very difficult time for everybody.''
But while they're traumatic to deal with, Dr Montgomery said, such cases help build his knowledge to assist other children in the future.
"It helps me with my judgment in making decisions, and it means that I'm more likely to recognise child abuse issues when I come across them,'' he said.