Child abuse: Social and medicolegal issues
- Erin E Endom, MD
Erin E Endom, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Daniel M Lindberg, MD
Daniel M Lindberg, MD
- Section Editor — Pediatric Psychosocial Emergencies
- Associate Professor of Emergency Medicine and Pediatrics
- University of Colorado Kempe Center
- Teresa K Duryea, MD
Teresa K Duryea, MD
- Section Editor — General Pediatrics
- Associate Professor of Pediatrics
- Baylor College of Medicine
Child maltreatment is defined as intentional harm or threat of harm to a child by a person who is acting in the role of caretaker . Healthcare providers who care for children have a professional, and often legal, obligation to identify and protect children who may be victims of abuse and neglect.
This topic will review social considerations for reporting suspected child abuse. Medicolegal aspects of mandated reporting in the United States will also be discussed here. The epidemiology, clinical manifestations, differential diagnosis, evaluation, and management of child abuse are discussed in detail separately. (See "Physical abuse in children: Epidemiology and clinical manifestations" and "Differential diagnosis of suspected child abuse" and "Physical abuse in children: Diagnostic evaluation and management".)
TALKING WITH PARENTS
One of the most difficult tasks in evaluating a child for the possibility of abuse is informing the parents that an investigation is necessary. This discussion may have been foreshadowed when the nature of, and rationale for, additional investigation (eg, skeletal survey, toxicology screening) were explained. Parental reactions to such news may range from appreciation to hysterical denials or violence. The possibility of a violent reaction may be anxiety-provoking, even for a child abuse expert, and more so for a health-care provider with less experience in this delicate area (eg, a general pediatrician, or an emergency medicine physician who is accustomed to caring for adults).
It is critical to explain to the parents, in an empathetic, supportive, and nonaccusatory manner, the reasons why it is necessary to file a report of suspected child abuse or neglect. Whether or not the parents have harmed their child, they deserve to know and must be told that a report is being made, an investigation will be conducted, and the reasons why the investigation is necessary. The physician should emphasize that his or her first concern is for the safety and well-being of the child. Parents usually understand the need for the investigation when they are told that it is necessary for the safety of the child and legally required when an injury is inconsistent with the history. The parents should also receive information regarding what will happen once the report is filed (eg, a visit from a CPS worker, social worker, and/or the police) (figure 1). (See 'Reporting suspected abuse' below.)
REPORTING SUSPECTED ABUSE
All 50 states in the United States (US) and an increasing number of countries around the world (including Argentina, Australia, Canada, Finland, Israel, Japan, the Netherlands, the Republic of Korea, and Spain) have enacted legislation that mandates reporting of suspected child abuse . A reporting system is most effective when combined with a public awareness program, to educate the public about signs of child abuse and methods of contacting professionals qualified to intervene, investigate and assist children and families [3,4].
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