Physical abuse of children has risen significantly over the past two years, according to a consultant paediatrician in one of the State's main children's hospitals.
Dr Peter Keenan, consultant in acute emergency medicine at Temple Street Children's Hospital, Dublin, says the increase is demonstrated by the number of inflicted injuries, usually on toddlers, presenting at the hospital's accident and emergency department.
"The hospital has always seen a fair bit of it, but there has certainly been an upsurge in the past two years," he says. "And it's been a busy summer".
The A & E department was now seeing about two cases a week of young children with inflicted injuries, he said, whereas two years ago there were about two a month.
"The injuries are usually facial, above the neck, head injuries, inflicted fractures, typically fractured ribs or long bones in the arm or leg. I've also seen inflicted scalds where an adult might plunge a child's arm or leg into boiling liquid, or throw it over them."
Dr Keenan displayed X-rays of babies under the age of one with broken collar bones, arms, legs and fractured ribs. "A child could break their collar bone or arms or legs by falling out of bed, so they might have been innocent, but sometimes we see the same child several times with similar injuries."
If a young child presents with fractured ribs, the injury has almost certainly been inflicted.
The suspicion would be that such a fracture would be a squeezing injury or that the child had been hit in the chest.
Photographs are taken of each child's injuries, whether inflicted or not, for each case file. Facial pictures cannot be shown here as they would identify the children, but Dr Keenan showed pictures of toddlers with massive facial bruising, cuts and scalds.
One shows a two-year-old girl with one eye so badly bruised she cannot fully open it. The other is also badly bruised. She has cuts around her eyes and mouth.
Another is of a two-year-old boy sucking a soother. He is asleep and the left half of his face and left ear are bruised and cut. Another child, about one, seems to have cigarette burns on his torso.
In another, a baby girls sits on a nurse's lap. Her right eye is swollen and bruised.
Another shows a baby's bottom which has been beaten until cut and bruised. Another shows a two-year-old boy, his right arm so badly scalded the skin has been burnt away in large patches. He has black eyes, inflammatory bruises on his chin and cuts on his face. The boy was subsequently taken into care.
"Ironically, it's probably the best thing that ever happened to that child," says Dr Keenan. "The child was rescued from the home environment."
Temple Street Hospital is at the heart of Dublin's north inner city. It is one of the most deprived areas in the State, with a higher-than-average concentration of young, single parent families.
While stressing that the vast majority of single parents provide the best-quality care they can, and that physical abuse is not a feature of single parent families only, Dr Keenan is in no doubt that "the physical abuse of children is a pronounced feature of single parenthood in socio-economically deprived areas, and it's getting worse".
Dating the start of the "upsurge" two years ago, Dr Keenan says it may parallel an increase in levels of heroin and substance abuse and of young alcoholism.
He sees an increasing number of parents who are clearly abusing drugs or alcohol and whose children are at risk. He singled out non-paternal boyfriends as a significant feature in situations where a woman's children are being physically abused.
"Young, vulnerable, socially, economically and educationally deprived single mothers are very vulnerable to violent `bowsies'," he says. "They frequently don't have the resources, socially, personally or financially, to protect either themselves or their children.
"There's an awful lot of social and domestic chaos out there," he says. "Young families are often on their own. The old extended family, which helped young mothers cope, taught them how to parent, gave them a break from the kids. That's gone, leaving a crucial gap that isn't being filled."
Asked whether doctors confront parents when he suspects abuse, he says it is usually futile.
"You confront parents who deny it, say the kid fell down the stairs or off their bike, and you're left with your hands up in the air. You end up with a standoff situation. There's no witness, and it's our word against theirs."
The children themselves, or their siblings, are "too terrified to say anything, or too young".
The abuse he sees, he adds, "is only the tip of the iceberg of dreadful neglect these kids suffer.
"By the time it gets to the stage where we are identifying physical abuse, the kids have been in an environment for two, three or four years where they have been so emotionally deprived they are effectively socio-emotionally retarded. We see three-year-olds in here who won't let us examine them, who kick us and tell us to `f*** off'.
"They aren't being loved, not being emotionally stimulated, not being given emotional support. It's just belts, whacks, shouting and chaos.
"In here, you just feel very futile, knowing you're sending kids back to dangerous environments and knowing that in many respects the surveillance the child protection services can give is not adequate."
In cases where doctors suspect abuse, they are obliged to report their concerns to the local health authority, which is then obliged to contact the Garda.
`We are storing up enormous problems", says Dr Keenan, if children continue to be brutalised from such a young age. "These children are being prematurely aged. They are having their childhood stolen from them by violence."