初级预防策略通常旨在加强家庭功能,包括密集性家庭访视项目辅以父母培训和其他父母教育计划。[45]Barlow J, Simpkiss D, Stewart Brown S. Interventions to prevent or ameliorate child physical abuse and neglect, findings from a systematic review. J Child Services. 2006;1:6-28.[46]Zielinski DS, Eckenrode J, Olds DL. Nurse home visitation and the prevention of child maltreatment: impact on the timing of official reports. Dev Psychopathol. 2009;21:441-453.http://www.ncbi.nlm.nih.gov/pubmed/19338692?tool=bestpractice.com[47]Klevens J, Whitaker DJ. Primary prevention of child physical abuse and neglect: gaps and promising directions. Child Maltreat. 2007;12:364-377.http://www.ncbi.nlm.nih.gov/pubmed/17954942?tool=bestpractice.com[48]Flaherty EG, Stirling J Jr; American Academy of Pediatrics, Committee on Child Abuse and Neglect. Clinical report: the pediatrician’s role in child maltreatment prevention. Pediatrics. 2010;126:833-841.http://pediatrics.aappublications.org/content/126/4/833.longhttp://www.ncbi.nlm.nih.gov/pubmed/20945525?tool=bestpractice.com[49]Oveisi S, Ardabili HE, Dadds MR, et al. Primary prevention of parent-child conflict and abuse in Iranian mothers: a randomized-controlled trial. Child Abuse Negl. 2010;34:206-213.http://www.ncbi.nlm.nih.gov/pubmed/20207004?tool=bestpractice.com[50]Pinquart M, Teubert D. Effects of parenting education with expectant and new parents: a meta-analysis. J Fam Psychol. 2010;24:316-327.http://www.ncbi.nlm.nih.gov/pubmed/20545405?tool=bestpractice.com[51]Segal L, Sara Opie R, Dalziel K. Theory! The missing link in understanding the performance of neonate/infant home-visiting programs to prevent child maltreatment: a systematic review. Milbank Q. 2012;90:47-106.http://www.ncbi.nlm.nih.gov/pubmed/22428693?tool=bestpractice.com 现已表明,在不同的美国人群中,关注加强减少儿童虐待方面的父母教育的初级医疗保健预防模型有效。[52]Dubowitz H, Feigelman S, Lane W, et al. Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model. Pediatrics. 2009;123:858-864.http://www.ncbi.nlm.nih.gov/pubmed/19255014?tool=bestpractice.com[53]Dubowitz H, Lane WG, Semiatin JN, et al. The SEEK model of pediatric primary care: can child maltreatment be prevented in a low-risk population? Acad Pediatr. 2012;12:259-268.http://www.ncbi.nlm.nih.gov/pubmed/22658954?tool=bestpractice.com[54]Barlow A, Mullany B, Neault N, et al. Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. Am J Psychiatry. 2015;172:154-162.http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2014.14030332http://www.ncbi.nlm.nih.gov/pubmed/25321149?tool=bestpractice.com 在美国和日本,针对人为头部损伤预防的家庭特异性项目(包括在新生儿病房和托儿所的教育视频,让父母就不摇晃婴儿达成一致)也有一些获益。[55]Dias MS, Smith K, DeGuehery K, et al. Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. Pediatrics. 2005 Apr;115(4):e470-7.http://pediatrics.aappublications.org/content/115/4/e470.fullhttp://www.ncbi.nlm.nih.gov/pubmed/15805350?tool=bestpractice.com[56]Barr RG, Rivara FP, Barr M, et al. Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trial. Pediatrics. 2009;123:972-980.http://www.ncbi.nlm.nih.gov/pubmed/19255028?tool=bestpractice.com[57]Fujiwara T, Yamada F, Okuyama M, et al. Effectiveness of educational materials designed to change knowledge and behavior about crying and shaken baby syndrome: a replication of a randomized controlled trial in Japan. Child Abuse Negl. 2012;36:613-620.http://www.ncbi.nlm.nih.gov/pubmed/22954642?tool=bestpractice.com 世界卫生组织 (WHO) 确定了一组在减少对儿童的暴力行为方面取得成功的策略。WHO: seven strategies for ending violence against children. 公众和专业人士宣传活动也可能有益。儿童虐待预防:有中等质量证据表明,家庭访视、父母教育、虐待性头部创伤预防及多元化干预有希望预防实际发生的儿童虐待。 家庭访视、父母教育及儿童性虐待预防似乎对减少儿童虐待危险因素有效。[58]Mikton C, Butchart A. Child maltreatment prevention: a systematic review of reviews. Bull World Health Organ. 2009;87:353-361.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862009000500012&lng=en&nrm=iso&tlng=enhttp://www.ncbi.nlm.nih.gov/pubmed/19551253?tool=bestpractice.com受试者<200名的随机对照临床试验(RCT)、受试者>200名且方法学存在缺陷的随机对照临床试验(RCT)、方法学存在缺陷的系统评价或者高质量的观察性(队列)研究。
目前无足够证据支持对儿童虐待进行普遍筛查。[59]Selph SS, Bougatsos C, Blazina I, et al. Behavioral interventions and counseling to prevent child abuse and neglect: a systematic review to update the US Preventive services task force recommendation. Ann Intern Med. 2013;158:179-190.http://annals.org/article.aspx?articleid=1558515http://www.ncbi.nlm.nih.gov/pubmed/23338775?tool=bestpractice.com 但是,越来越多的支持者支持使用家庭暴力筛查作为儿童虐待筛查工具,因为伴儿童身体虐待的家庭暴力发生率为 22%~67% 之间。[9]Jouriles EN, McDonald R, Slep AM, et al. Child abuse in the context of domestic violence: prevalence, explanations, and practice implications. Violence Vict. 2008;23:221-235.http://www.ncbi.nlm.nih.gov/pubmed/18624091?tool=bestpractice.com