A leading child-abuse doctor says child deaths could be halved by a four-point plan including medical assessments of all infants reported to Child, Youth and Family.
The clinical director of the child-abuse centre at Auckland's Starship hospital, Dr Patrick Kelly, says Child, Youth and Family (CYF) social workers should not be left alone to assess whether young children are at risk.
He told a child-abuse conference in Manukau yesterday that all children under 2 who were notified to CYF should be assessed by a multi-disciplinary team including health professionals.
The proposal could be hugely expensive because CYF received 75,326 notifications of possible abuse or neglect last year. But Dr Kelly said it was a matter of prioritising the money.
A principal adviser to Children's Commissioner Cindy Kiro, Dr Emma Davies, told the conference that the first three years of life were the key to how each person's life unfolded, yet taxpayers' spending on health care for each infant was far less than for an elderly person.
"If we had to choose where to invest, we should put the emphasis on the first few years," she said.
New Zealand's rate of child deaths from maltreatment was the third-worst of 27 developed countries in the last Unicef league table in 2003, better than only Mexico and the United States.
Police statistics reported by former CYF chief social worker Mike Doolan show that 35 children died from maltreatment in the first five years of this decade, an average of seven a year.
Dr Kelly said most children who died were under 3 and 80 per cent were not known to CYF beforehand.
But when he analysed 48 children admitted to his unit with head injuries in the 12 months before the deaths of twins Chris and Cru Kahui in June 2006, including eight children who died, he found that all 48 had seen another health professional such as a midwife, Plunket nurse or family doctor before their admission to Starship.
"We need a paradigm shift. Infant abuse and neglect is not just a matter for the Ministry of Social Development. It's a health issue," he said.
"We are not the ambulance at the bottom of the cliff. Preventive intervention is a health responsibility. We are the fence at the top of the cliff through which these children are falling to their deaths."
He said overseas studies showed that about 30 per cent of infants found to have suffered abusive head trauma had been missed when they first encountered health professionals.
He said that 30 per cent could be saved by training all health professionals to recognise abuse and setting up a national system to alert health professionals to families where abuse had been found.
"We still don't have a national alert for child abuse. I could diagnose child abuse, and that child could be admitted to Gisborne and no one in Gisborne would know the child has been here."
Dr Kelly said the 20 per cent of child casualties who were known to CYF beforehand could also be saved by multidisciplinary assessment of all young children reported to CYF.
"If you put 30 plus 20 together, that's 50 per cent. We could reduce these infant deaths by 50 per cent just by doing what we alreadyknow."
The final point in his four-point plan was a home visiting programme that tackled what he described as the key risk factors for child abuse: domestic violence, substance abuse and maternal depression.
He said overseas studies showed that "strengths-based" home visiting programmes such as the Government's Family Start did not work because they tried to work with a family's "strengths" rather than tackling its problems.
CYF head Ray Smith said he had not had a chance to discuss Dr Kelly's ideas with him, "however we work closely with him and Starship and look forward to exploring how CYF and health professionals can work together more effectively to prevent child abuse".
DR KELLY'S PLAN
* Home visiting programmes which tackle violence, substance abuse and maternal depression.
* Train doctors, nurses and midwives to identify signs of abuse.
* A national system to alert health professionals to families where abuse has occurred.
* Paediatricians to assess all children under 2 referred to Child, Youth and Family.