An optimal caregiving environment during the perinatal period is critical for healthy development. The first 1000 days (from conception until the second birthday) are now widely recognised as a time of extensive neurobiological and psychosocial development that lay down the foundations for children's subsequent trajectories and future life chances (Marmot, 2021). National and international bodies have responded to this evidence by establishing public health and more intensive targeted home visiting programmes for both indigenous and non-indigenous families, which are designed to reduce inequalities and promote optimal development during this period in order to ensure that every child has the best start in life.

Research conducted over the past decade has begun to highlight the impact of abuse and neglect during the first 1000 days, and the mechanisms by which such abuse can compromise the long-term development of children (e.g. McCrory et al., 2011). More recently there has been increasing awareness of the impact of maternal behaviours during pregnancy that may also have a detrimental impact on the unborn baby, including alcohol and substance misuse which are associated with a range of physical, cognitive and mental health problems (e.g. Easey et al., 2019; Mamluk et al., 2020), and domestic abuse, which can have life-changing and indeed fatal consequences for both the mother and the unborn baby (Cleaver et al., 2011).

Despite evidence about the long-term consequences of parenting behaviours on the infant in utero, little attention has been given in policy or practice to safeguarding unborn children. A recent study in England and Wales, for example, found that, although national guidance on assessments of need, risks of harm and reporting requirements now refer to unborn children, there is no national guidance that focuses specifically on safeguarding them from abusive or neglectful parenting behaviours that will affect their long-term development, or supporting parents whose infants are removed at birth (Ward et al., 2022).

Infants under the age of one are disproportionately likely to die or suffer life-changing injuries from abuse or neglect (NSPCC, 2021), and it is clear that some will need to be removed from birth parents in order to ensure their safety. However, increasing numbers are compulsorily removed from their parents at birth or in the immediate post-partum period: Broadhurst and colleagues (2018) found that in England, the number of newborns subject to care proceedings had more than doubled between 2008 and 2017. This is an international issue, with increasingly high numbers of infant removals in both high- and low-income countries (Backhaus et al., 2019). Recent evidence shows that, in England and Wales, vulnerable mothers whose infants are at risk of abuse receive too little support during the pregnancy to help them overcome the difficulties that prevent them from providing nurturing care. Furthermore, at all stages, the process of decision-making and removal is traumatic and often exacerbates the problems for which the mothers were referred (Mason et al., 2022). Broadhurst and colleagues (2018) identified a ‘hidden population’ of mothers who experience the consecutive removal of numerous infants because the problems that inhibit their parenting capacity are never adequately resolved.

This Special Issue draws together a number of papers that shed further light on some of these concerns and explores how they might be addressed. They report on research studies and practice innovations that cover infants' life trajectories, from conception to age 2, using a wide range of methodologies, from quantitative analysis of administrative data to qualitative analysis of interviews with birth parents. They are written by researchers and clinicians in Australia, England, France, the Republic of Ireland, and the USA, demonstrating that child protection in the perinatal period is an international concern.

The first question explored in this Special Issue is how far abuse and neglect in the perinatal period is identified, assessed and acted upon. Kenny and Mathews and Pathirana's paper reviewed laws and statutes in all states and territories in Australia and the USA, and compared mandatory reporting legislation in relation to perinatal substance use. They found numerous variations in reporting requirements; perinatal substance use was included in the legislation in only 20 states in the USA, and mandatory reporting was required in only one in Australia. Although the purpose of mandatory reporting may be to alert child welfare agencies to evidence of significant maltreatment and to provide support to parents, there are ongoing concerns that it may exacerbate parents' fears of being separated from their children or prosecuted, and therefore discourage them from seeking help or attending antenatal care. Although mandatory reporting can provide access to early intervention, it does not always do so. The study found that there is more emphasis on prevention and support in Australia than in the USA, where in some states parents' rights can be terminated if they refuse treatment.

Even when reporting is not mandatory, parents may be fearful of accessing routine support or engaging in the process of assessment. The paper by Chamberlain, Gray and Herrman highlights the fact that many parents whose infants may be at risk of harm have been abused and neglected themselves and have gone on to experience traumatic interpersonal experiences and adverse life events, as a result of which they are often suffering from complex post-traumatic stress disorder. By adopting a more positive public health perspective, the authors reframe the purpose of prebirth assessment from identifying risk of harm to the foetus to screening to identify complex PTSD during pregnancy. The objective is then to enable parents to access extra support from perinatal care services. However, historical injustices experienced by the Aboriginal and Torres Islander population mean that they are unwilling to be assessed, or often to access routine antenatal services. The paper describes the elements of a co-designed approach to identifying the key elements necessary to engage Aboriginal parents in prebirth assessment and take-up of services. It would be valuable to explore how such an approach might be replicated in other contexts in which parents are reluctant to trust professionals or engage with services because of previous experience of infant removal (Mason et al., 2022; Ward et al., 2014).

Assessment is of little value unless it leads to action, and there is now a growing initiative to develop intensive treatment programmes, tailored to meet the needs of parents whose infants are at risk of significant harm during the perinatal period. Chamberlain et al.’s paper demonstrates the importance of establishing trusting relationships between professionals and parents who have experienced trauma, a point developed further in Jondec and Barlow's paper. This focuses on an intensive perinatal attachment and mentalisation-based intervention for pregnant women who have previously experienced the removal of a child (the Daisy programme). Fundamental to the intervention is the mentalising relationship between the parent and their key worker, built on the establishment of trust. It is through this relationship that the parent is enabled to understand how their own traumatic experiences have affected their subsequent life choices, develop reflective capacities that may improve their parenting, and repair or develop stronger relationships with formal and informal support networks.

The Daisy programme is offered to pregnant women at 12–16 gestational weeks, who have had at least one child previously removed from their care. Pregnancy can provide a window of opportunity in which mothers may benefit from interventions designed to address issues that compromise their parenting capacity and to increase their ability to nurture a baby; it is also a time when many women may be more receptive to change. However, there is a growing body of evidence to show that, in England and Wales, many local authorities do not accept or act on referrals of unborn children until too late in the pregnancy for interventions to be accessed, or for mothers to demonstrate capacity to change (Lushey et al., 2017; Mason et al., 2022; Ward et al., 2022). Octoman's paper reports on a study that analysed administrative data collected for a cohort of infants in one Australian state, reported as being at risk of harm before their birth, and followed until they were 2. They found that child protection concerns continued for over three-quarters of the cohort after they were born. The most common pathway showed that most children remained with their birth parents, but that there were multiple reports of abuse and neglect, indicating sporadic and ineffective access to services.

Corbett and colleagues' paper on child protection pathways for newborn infants in the Republic of Ireland sheds further light on this issue. They undertook an audit of files in a large maternity hospital and identified a cohort of infants for whom there had been child protection concerns before or immediately after birth. When concerns were identified, mothers were referred to the medical social work team who were able to provide some immediate support and/or refer them to other services. Although two-thirds of the children were discharged to their mothers' care, the data concerning older siblings indicated that the majority would be living outside the parental home by the time the next baby was born. The authors suggest that there is a strong case to be made for developing additional perinatal services, which might most appropriately be based in maternity hospitals.

Findings reported in Corbett and colleagues' paper also demonstrate the extreme vulnerability of infants identified as at risk of harm before birth. The cohort they studied were significantly more likely to be born prematurely and have low birth weight than the national population. Antenatal care had been poor, and three-quarters of them were born with health problems, including neonatal abstinence syndrome. About one in five were born to mothers who tested positive for hepatitis C or HIV. Findings such as these are the rationale for the Pegase Progamme, presented in Toussaint and Rousseau's paper. This initiative is informed by evidence of the extensive physical and mental health needs of abused and neglected children (Turney & Wildeman, 2016). It builds on previous research by one of the authors who found that premature infants who were placed in care in France had disproportionately more positive outcomes (Rousseau et al., 2016). These infants had benefited from the intensive follow-up and enrichment programme offered to all premature infants in France from birth until they are 7. The Pegase programme is modelled on this intervention and is designed to offer similar levels of intensive physical and mental health support to all infants and young children in care up to the age of 5. Progress is monitored at regular intervals, and each child has an individual care package, tailored to meet their needs. As with the initiative discussed in Chamberlain et al.’s paper, a public health approach ensures that all eligible children are included in the assessment and provision of services. The programme is currently being piloted and evaluated in 15 sites in France.

The papers by Chamberlain and colleagues, Jondec and Barlow, and Corbett and colleagues all highlight high levels of mental health problems and post-traumatic stress in mothers whose infants are at risk of harm. Yet a recent study undertaken in England and Wales found that the process of infant removal is frequently harsh and insensitive and often serves to compound the mother's distress (Mason et al., 2022). Mason, Ward and Broadhurst's paper explores data from interviews with mothers who have experienced infant removal and identifies a number of common themes. These include isolation, shame, acute trauma and overwhelming grief. Many of these mothers have minimal if any support from family, friends or professionals after discharge from hospital and the problems that had led to the removal of their infant become exacerbated. The loss of their maternal identity and the perceived illegitimacy of their grief are powerful contributors to their distress. The paper discusses the Hope box initiative, designed to reduce mothers' trauma by helping them build up and preserve memories and retain a connection with their infant.

Taken together the papers in this Special Issue provide a wide range of information on current issues concerning assessment and practice when child protection concerns are identified in the perinatal period. They also identify further areas for improvement including the collection and analysis of more comprehensive administrative data, and the need to establish training in trauma-informed practice. There are numerous evidence-informed messages for policymakers and practitioners. The papers come from five countries, but they cover common issues; and they have been brought together as part of a programme of work undertaken through the International Research Network on Infants and Child Protection (www.irnicp.org), a group that aims to develop an evidence base, promote knowledge transfer, and accelerate systems change with regard to how child welfare agencies respond to infants during the perinatal period so as to optimise their development and wellbeing.

围产期最佳的照料环境对于健康发育至关重要。前 1000 天（从受孕到两岁生日）现在被广泛认为是神经生物学和社会心理广泛发展的时期，为儿童随后的轨迹和未来的生活机会奠定了基础 (Marmot,  2021 )。国家和国际机构通过为土著和非土著家庭制定公共卫生和更有针对性的家访计划对这一证据作出回应，旨在减少不平等现象并促进这一时期的最佳发展，以确保每个孩子都有人生最好的开始。

过去十年进行的研究已经开始强调最初 1000 天内虐待和忽视的影响，以及此类虐待可能损害儿童长期发展的机制（例如 McCrory 等人，  2011 年）。最近，人们越来越意识到怀孕期间母亲行为的影响，这些行为也可能对未出生的婴儿产生不利影响，包括与一系列身体、认知和心理健康问题相关的酒精和物质滥用（例如 Easey 等al.,  2019；Mamluk et al.,  2020 )，以及家庭虐待，这可能对母亲和未出生的婴儿产生改变生活甚至致命的后果 (Cleaver et al.,  2011 )。

尽管有证据表明养育行为对子宫内婴儿的长期影响，但政策或实践中很少关注保护未出生的婴儿。例如，最近在英格兰和威尔士进行的一项研究发现，尽管关于需求评估、伤害风险和报告要求的国家指南现在指的是未出生的孩子，但没有专门针对保护他们免受虐待或疏忽养育的国家指南会影响他们长期发展的行为，或支持婴儿出生时被带走的父母（Ward 等人，  2022 年）。

一岁以下的婴儿极有可能因虐待或忽视而死亡或遭受改变生命的伤害（NSPCC，  2021 年），很明显，为了确保他们的安全，需要将一些婴儿从亲生父母身边带走。然而，越来越多的人在出生时或产后即刻被强制从父母身边带走：Broadhurst 及其同事（2018 年）发现，在英格兰，接受护理程序的新生儿人数在 2008 年至 2017 年期间增加了一倍多。这是一个国际问题，高收入国家和低收入国家的婴儿迁移数量都在增加（Backhaus 等人，  2019). 最近的证据表明，在英格兰和威尔士，婴儿面临虐待风险的弱势母亲在怀孕期间得不到支持，无法帮助她们克服阻碍她们提供养育照料的困难。此外，在所有阶段，决策和移除的过程都是创伤性的，并且常常会加剧母亲被转介的问题（Mason 等人，  2022 年）。Broadhurst 及其同事（2018 年）确定了一个“隐藏人口”的母亲，她们经历了连续带走大量婴儿的经历，因为抑制她们养育能力的问题从未得到充分解决。

本期特刊汇集了多篇论文，进一步阐明了其中一些问题，并探讨了如何解决这些问题。他们报告研究和实践创新，涵盖婴儿从受孕到 2 岁的生活轨迹，使用范围广泛的方法，从行政数据的定量分析到与亲生父母访谈的定性分析。它们由澳大利亚、英国、法国、爱尔兰共和国和美国的研究人员和临床医生撰写，表明围产期儿童保护是一个国际关注的问题。

本期特刊探讨的第一个问题是在多大程度上识别、评估和应对围产期虐待和忽视行为。Kenny 和 Mathews 以及 Pathirana 的论文回顾了澳大利亚和美国所有州和地区的法律和法规，并比较了与围产期药物使用相关的强制性报告立法。他们发现报告要求存在许多差异；美国只有 20 个州将围产期物质使用纳入立法，澳大利亚只有一个州要求强制报告。虽然强制报告的目的可能是提醒儿童福利机构注意严重虐待的证据并为父母提供支持，但人们一直担心这可能会加剧父母与孩子分离或被起诉的恐惧，因此阻止她们寻求帮助或参加产前检查。尽管强制报告可以提供早期干预，但并非总是如此。研究发现，澳大利亚比美国更重视预防和支持，在美国的一些州，如果父母拒绝治疗，他们的权利可能会被终止。

即使报告不是强制性的，父母也可能害怕获得日常支持或参与评估过程。Chamberlain、Gray 和 Herrman 的论文强调了一个事实，即许多婴儿可能面临伤害风险的父母自己曾受到虐待和忽视，并继续经历创伤性的人际关系经历和不利的生活事件，因此他们经常患有复杂的创伤后应激障碍。通过采用更积极的公共卫生观点，作者将出生前​​评估的目的从识别对胎儿的伤害风险重新定义为筛查以识别怀孕期间复杂的 PTSD。然后，目标是使父母能够从围产期护理服务中获得额外支持。然而，原住民和托雷斯岛民经历的历史不公正意味着他们不愿接受评估，或不愿经常接受常规产前服务。该文件描述了共同设计方法的要素，以确定让土著父母参与出生前评估和接受服务所必需的关键要素。探索这种方法如何在其他情况下复制是很有价值的，在这些情况下，父母不愿意信任专业人士或因为以前的婴儿搬家经验而不愿参与服务（Mason 等人，该文件描述了共同设计方法的要素，以确定让土著父母参与出生前评估和接受服务所必需的关键要素。探索这种方法如何在其他情况下复制是很有价值的，在这些情况下，父母不愿意信任专业人士或因为以前的婴儿搬家经验而不愿参与服务（Mason 等人，该文件描述了共同设计方法的要素，以确定让土著父母参与出生前评估和接受服务所必需的关键要素。探索这种方法如何在其他情况下复制是很有价值的，在这些情况下，父母不愿意信任专业人士或因为以前的婴儿搬家经验而不愿参与服务（Mason 等人， 2022 年；沃德等人，  2014 年）。

除非它导致采取行动，否则评估几乎没有价值，现在越来越多的倡议制定强化治疗方案，以满足其婴儿在围产期面临重大伤害风险的父母的需求。Chamberlain 等人的论文证明了在专业人士和经历过创伤的父​​母之间建立信任关系的重要性，Jondec 和 Barlow 的论文进一步阐述了这一点。这侧重于对以前经历过带走孩子的孕妇进行密集的围产期依恋和基于心理的干预（雏菊计划）。干预的基础是父母与其关键员工之间建立在信任基础上的心智化关系。

Daisy 计划面向妊娠 12 至 16 周的孕妇，这些孕妇之前至少生过一个孩子。怀孕可以提供一个机会之窗，母亲可以在这个机会之窗中受益于旨在解决影响其养育能力的问题并提高其养育婴儿能力的干预措施；这也是许多女性可能更容易接受改变的时期。然而，越来越多的证据表明，在英格兰和威尔士，许多地方当局不接受未出生婴儿的转诊或对其采取行动，直到怀孕太晚而无法进行干预，或者母亲无法证明有能力变化（Lushey 等人，  2017 年；Mason 等人，  2022 年；Ward 等人，  2022 年). Octoman 的论文报告了一项研究，该研究分析了为澳大利亚一个州的一组婴儿收集的行政数据，据报告他们在出生前有受到伤害的风险，并一直跟踪到他们 2 岁。他们发现儿童保护问题持续了超过三年 -他们出生后四分之一的队列。最常见的途径表明，大多数儿童仍与亲生父母在一起，但有多项关于虐待和忽视的报告，表明获得服务的机会零星且无效。

Corbett 及其同事关于爱尔兰共和国新生儿儿童保护途径的论文进一步阐明了这个问题。他们对一家大型妇产医院的档案进行了审查，并确定了一组在出生前或刚出生后就存在儿童保护问题的婴儿。当发现问题时，母亲们被转介给医疗社会工作团队，他们能够提供一些即时支持和/或将她们转介给其他服务。虽然三分之二的孩子出院由母亲照顾，但有关哥哥姐姐的数据表明，到下一个孩子出生时，大多数孩子将住在父母家以外的地方。作者建议有充分的理由发展额外的围产期服务，

Corbett 及其同事的论文中报告的调查结果还表明，被确定为在出生前有受到伤害风险的婴儿极度脆弱。他们研究的队列比全国人口更有可能早产和低出生体重。产前保健很差，其中四分之三生来就有健康问题，包括新生儿戒断综合症。大约五分之一的母亲的丙型肝炎或 HIV 检测呈阳性。这些发现是 Pegase Progamme 的基本原理，在 Toussaint 和 Rousseau 的论文中提出。该倡议的依据是受虐待和被忽视的儿童对身心健康的广泛需求（Turney & Wildeman，  2016 年）). 它建立在其中一位作者之前的研究基础上，该作者发现在法国接受护理的早产儿具有不成比例的更积极的结果（Rousseau 等人，  2016 年）). 这些婴儿受益于为法国所有早产儿提供的从出生到 7 岁的密集随访和丰富计划。Pegase 计划以这种干预为蓝本，旨在为他们提供类似水平的强化身心健康支持所有接受护理的 5 岁以下婴幼儿。定期监测进度，每个孩子都有一个单独的护理包，以满足他们的需求。与 Chamberlain 等人的论文中讨论的倡议一样，公共卫生方法可确保所有符合条件的儿童都包含在评估和提供服务中。该计划目前正在法国的 15 个地点进行试点和评估。

Chamberlain 及其同事、Jondec 和 Barlow 以及 Corbett 及其同事的论文都强调了婴儿面临伤害风险的母亲的严重心理健康问题和创伤后压力。然而，最近在英格兰和威尔士进行的一项研究发现，将婴儿带走的过程往往是苛刻和麻木不仁的，而且往往会加剧母亲的痛苦（Mason 等人，  2022 年）). 梅森、沃德和布罗德赫斯特的论文探讨了对经历过婴儿被带走的母亲的采访数据，并确定了一些共同的主题。这些包括孤立、羞耻、严重创伤和压倒性的悲伤。这些母亲中的许多人在出院后从家人、朋友或专业人士那里得到的支持微乎其微，导致婴儿被带走的问题变得更加严重。她们母亲身份的丧失和她们悲伤的不正当性被认为是她们痛苦的重要原因。该论文讨论了 Hope box 倡议，旨在通过帮助母亲建立和保存记忆并与婴儿保持联系来减少母亲的创伤。

综上所述，本期特刊中的论文提供了有关在围产期确定儿童保护问题时评估和实践的当前问题的广泛信息。他们还确定了进一步改进的领域，包括收集和分析更全面的行政数据，以及建立创伤知情实践培训的必要性。政策制定者和从业者有许多循证信息。这些论文来自五个国家，但涵盖了共同的问题；它们已作为通过国际婴儿和儿童保护研究网络 (www.irnicp.org) 开展的工作计划的一部分汇集在一起​​，该网络旨在开发证据基础、促进知识转移、