Domestic violence and child abuse and neglect often coexist

 
If either domestic violence or child protection issues are recognised then the family should be evaluated for the other one, as they often coexist. This is now explicit in Department of Health policy (5).
 
The relationship between domestic violence, child abuse and neglect and children’s well being

A review of 35 studies that reported on the overlap between domestic violence and child abuse concluded that in 30-60% of families where either domestic violence or child maltreatment were occurring the other form of violence was also occurring (8). Children may also be at risk if they intervene to protect their mother from harm. In households where the mother is abused there is also a higher risk that she may also use violence towards her children (9). 
 
Children witnessing domestic violence

Even if children are not themselves injured they frequently witness attacks on their mother. In one survey, 73% of the mothers said their children had witnessed violent incidents and 67% had seen their mothers beaten (10). The most recent British Crime Survey (11) found that a current or former partner had physically assaulted one in four of all women and one in seven of all men. Half of those who had experienced violence in the past year were living with children under 16 years of age, and 29% said the children were aware of what had happened. In the families of women who are repeatedly assaulted this proportion rose to 45%. Another study reported that 90% of children were present in the same or the next room at the time of the assault (12).   
 
The risk to the unborn child
 
Domestic violence may escalate during pregnancy and has been associated with miscarriages, premature birth, low birth weight, fetal injury and death (13). A study of 127 women in refuges in Northern Ireland reported that 66% had been abused in pregnancy, 13% had lost babies as a result and 22% had threatened miscarriages (14).
 
The outcomes of domestic violence for children

Domestic violence may undermine a mother’s parenting ability
In addition to the social deprivation and isolation for the mother caused by domestic violence (whether or not she remains in the abusive relationship), she may suffer specific health problems related to the violence. These may be physical, resulting from injuries, and mental health problems. One study has reported that for abused women the risks of depression are increased three fold, drug abuse nine fold, alcohol abuse fifteen fold, and suicide attempts five fold (15). An abused woman may become passive and paralysed by her situation, which can also affect her ability to protect and parent her children, the so-called “battered wife syndrome” (16). 
 
The effects of domestic violence on children

Domestic violence can make children fearful, withdrawn, anxious, disturb their sleep, create difficulties at school and problems in making friends (10). A study from psychologists in Canada estimated that half the children living in refuges are likely to show signs of PTSD (17). In a US study, 75% of mothers experiencing domestic violence reported negative behaviours in their children (18). The longer-term effects of domestic violence on children include lack of self-confidence and social skills, violent behaviour, depression, difficulties in forming relationships, disrupted education, and youth homelessness (10). The increase in aggression - playground violence, bullying, ADHD and school exclusion, is more likely in boys than girls (19).
 
Children in refuges have other health needs. In a British study of the health of children in refuges there were low levels of immunisations in addition to behavioural and emotional problems (20). They also experience social disadvantage in that they may become socially isolated and lose contact with friends and family.
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