Child abuse registration, fetal growth, and preterm birth: a population based study

Objectives: To study the relation of intra-uterine growth and gestational age with child protection registration in a 20 year whole population birth cohort. Setting: West Sussex area of England. Study design: Retrospective whole population birth cohort. Outcomes: Child protection registration; individual categories of registration - sexual abuse, physical abuse, emotional abuse, and neglect. Population and participants: 119 771 infants born in West Sussex between January 1983 and December 2001 with complete data including birth weight, gestational age, maternal age, and postcode. Results: In all categories of registration a linear trend was noted such that the lower the birth weight z score the higher the likelihood of child protection registration. Similar trends were noted for gestational age. All these trends were robust to adjustment for maternal age and socioeconomic status. Conclusions: The results of this study suggest that lower levels of fetal growth and shorter gestational duration are associated with increased likelihood of child protection registration in all categories including sexual abuse independent of maternal age or socioeconomic status. This study does not permit comment on whether poor fetal growth or preterm birth predispose to child abuse and neglect or the association arises because they share a common pathway.