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Abstract
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As medical professionals it is imperative that we keep child abuse and neglect on our differential diagnosis when assessing children, no matter where we provide care. We must follow our clinical instincts and gather additional history to better understand the mechanism of injury, ask for photo/video documentation to determine plausibility of an injury, and separate the child from the caregiver to obtain a potentially unbiased history when needed. Proficiency in doing a complete anogenital examination, noting normal variants as well as recognizing possible infections or injuries, and referring for additional medical treatment is essential. When young children present with unusual or concerning findings, from marks on the skin to lesions or injuries in the anogenital area, we need to differentiate accidental from inflicted causes as well as rule out medical conditions that mimic abuse as indicated by Dr. Andrea Z. Ali-Panzarella in the article, "A Diagnostic Approach to Conditions that Mimic Sexual Abuse" and by Dr. Vi Ngo in the article "A Closer Look: Medical Conditions that Mimic Physical Abuse."
In the article, "Understanding Abusive Head Trauma: A Primer for the General Pediatrician," Dr. Stephanie A. Deutsch describes how babies and young children who present with lethargy, vomiting, or mental status changes must be considered to be victims of abusive head trauma (or shaken baby syndrome) especially when other medical conditions are ruled out. In the article, "Pulling the Wool Off Our Eyes: Medical Child Abuse," Dr. Amber Hoffman underscores the need to keep a keen eye out for concerns of medical child abuse, especially when the clinical presentation and medical data do not add up. Most importantly, if we, as pediatric clinicians, ever have a "reasonable cause" to suspect abuse, we must adhere to our mandate to make a report to child protective services (CPS) and law enforcement.
Child maltreatment is a devastating public health issue, particularly for child victims. Abuse negatively affects nonoffending caregivers, siblings, communities, and, at times, health care providers. As medical professionals, we can detect, report, and thus stop the abuse from occurring. However, recognizing abuse or neglect can be difficult as we may have to surmount our own biases or belief systems whether they be that "people don't intentionally hurt their children" or "people don't fabricate symptoms to obtain unnecessary medical procedures." Abuse happens in all communities; it is not confined to certain social, racial, or economic groups. We must weigh all of the medical information that we have at our disposal to determine if a report or further evaluation is warranted as we do not want to cause trauma or family disruption. However, if we have any cause to suspect abuse or neglect is occurring it behooves us to make a report to CPS and law enforcement, because stopping abuse outweighs any potential inconvenience to the family. Whereas a medical provider will not be prosecuted for reporting a concern for abuse, a provider who does not report abuse will most likely face charges of a criminal or civil nature...
Language: en |