Reporting Child Abuse - Pediatricians

Pediatricians, typically the first professionals to come into contact with a maltreated child, may hesitate to report suspected abuse because they fear offending the parents who pay the bills and who may spread rumors about their competence, potentially damaging their practice. Some fear the time lost in reporting abuse, the possibility of being sued by an outraged parent, or having to testify in court.

Physicians in the United States and in other countries fear repercussions from reporting child abuse. In Great Britain publicity surrounding the investigations of pediatricians connected with child protection work in the mid-1990s through 2003 resulted in increasing complaints from the public. In March 2004 the Royal College of Paediatrics and Child Health (RCPCH; London, England) released a survey of the country's pediatricians regarding these complaints. Nearly 80% of the 6,072 pediatricians responded to the survey. The survey showed that one of seven (14%) RCPCH members who had participated in child abuse investigations had been the subjects of complaints. Complaints against pediatricians working in child protection rose from less than twenty in 1995 to more than one hundred in 2003. Some pediatricians received hate mail, as well as threats to themselves and their families. Nearly one-third (29%) indicated an unwillingness to take part in child protection work in the future.

Reporting Psychological Maltreatment of Children

According to the American Academy of Pediatrics (AAP), pediatricians play a major role in preventing, recognizing, and reporting psychological, or emotional, maltreatment (Steven W. Kairys, Charles F. Johnson, and the Committee on Child Abuse and Neglect, "The Psychological Maltreatment of Children—Technical Report," Pediatrics, vol. 109, no. 4, April 2002). Generally, pediatricians are the only professionals young children see before they attend school. Pediatricians are in a position to observe any abusive interaction between the child and the parent/caregiver. They should be able to identify parental characteristics, such as substance abuse and poor parenting skills, that may predispose parents to abuse their children. Pediatricians should also be able to identify at-risk children, including those who are disabled or whose parents are undergoing a hostile divorce. The consequences of psychological maltreatment may take years to surface; hence, pediatricians are encouraged to report their suspicions so that the child and the caregivers can get help right away.

Pediatricians Intervene in Domestic Abuse to Prevent Child Maltreatment

Researchers Richard A. Wahl, Doris J. Sisk, and Thomas M. Ball reported that an estimated ten million children in the United States are exposed to domestic violence (intimate partner violence) each year ("Clinic-Based Screening for Domestic Violence: Use of a Child Safety Questionnaire," BMC Medicine, vol. 2, May 2004). Noting the American Academy of Pediatrics' policy statement about the role of pediatricians in recognizing families experiencing child abuse, the researchers conducted the first study of its kind. The study involved mothers accompanying their children (sixteen thousand patient visits annually) to their pediatricians. Since research has shown that children of battered women are more likely to be abused, Wahl and his associates sought to screen for domestic abuse among their patients' mothers.

The authors found that active screening (having the mothers fill out a questionnaire asking their exposure to domestic violence) increased the odds of identifying families experiencing domestic violence. Prior to the screening, pediatricians identified four cases of domestic violence per one thousand children during a three-month period. Active screening identified fifteen cases per one thousand children during the subsequent three months. The study was conducted for two years, and overall the pediatricians identified nineteen cases of domestic violence per one thousand children the first year and twenty cases per one thousand children the following year. Wahl et al. noted that the numbers of children living with battered women are probably higher. Up to one-third of questionnaires were not returned.