Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Senior Consultant Arianne Helene Teeuw, Amsterdam University Medical Center, Netherlands
- Second opponent: Associate Professor Anja Botngård, NTNU: Norwegian University of Science and Technology,
- Third member and chair of the evaluation committee: Professor II Håvard Ove Skjerven, University of Oslo
Chair of the Defence
Associate Professor Lil-Sofie Ording Müller, University of Oslo
Principal Supervisor
Professor II Arne Stray-Pedersen, University of Oslo
Summary
Field: Social and Forensic Pediatrics and child protection, examining clinical management and reporting of child maltreatment (CM) and patterns in abusive head trauma (AHT) in Norway.
Questions/hypotheses: (1) How do healthcare professionals (HCPs) recognize, manage, follow up and report suspected abuse/neglect, and how consistent is the management of these cases? We hypothesized that HCP felt unprepared, and that their approach would be influenced by a combination of, knowledge, experience and personal barriers. (2) What clinical/contextual patterns characterize children reported for suspected AHT, and were there missed chances for earlier intervention?
Methods/data: Mixed-methods. Phase 1: Hospital-based survey of 486 HCPs; six vignettes assessed concern, confidence, management, reporting to child welfare/police, follow-up. Phase 2: retrospective review of 77 suspected AHT cases evaluated at Oslo University Hospital Forensic Medicine (2003-2019) using medico-legal reports, hospital records and police caregiver interviews.
Key findings/conclusions: Although recognition of CM signs was high “on paper,” many HCPs reported never considering abuse in practice. We found inconsistent clinical decision-making, limited adherence to national guidelines, minimal follow-up, and poor willingness to report suspected CM. Reporting was associated with pediatrician role, self-efficacy, knowledge, experience, and confidence.
Among 77 infants and young children with concerns for AHT in our retrospective study, patterns emerged: median age 4 months; the father was most often the sole caregiver at symptom onset—especially in cases deemed inflicted; 78% had no history explaining the injury; and care-seeking was often delayed. Risk factors were common, including caregiver depression, recurrent health concerns (e.g., failure to thrive), unaddressed mental health or caregiving concerns, and prior unexplained injuries, and 32% of cases might have been preventable if warning signs had been recognized earlier.
Additional information
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