Child Abuse: Overview and Evaluation | Pediatric Collection
When Child Abuse Enters the Medical Home
When child abuse or neglect concerns present to the provider and “enters the medical home,” the initial responses might very well be a complex combination of fear, denial, and decision paralysis. Even the most experienced pediatrician might feel, “Never. Not this parent”; or maybe judge, “Of course, this family…”; or question, “What do I do now?”. This small and important collection of American Academy of Pediatrics (AAP) publications and reports provides guidance and support to the medical home providers.
Be Aware. The scope of the problem of child maltreatment has essentially remained unchanged for the past decade. The National Child Abuse and Neglect Data System, a voluntary data collection system that gathers information from all 50 states, the District of Columbia, and Puerto Rico about reports of child abuse and neglect and examines trends in child abuse and neglect across the country. While sexual abuse reports have declined, reports for other forms of maltreatment have not consistently declined across our country. Our attention to child maltreatment is now framed in a broader view with a solid evidence base on identification and growing knowledge as pediatricians on the effects of child abuse on health and development. adverse childhood experiences, toxic stress in all forms, but especially interpersonal violence, can alter brain structure, physiology, and over-functioning of the child or teen victim. Awareness that the problem exists and how to address the concern is now more than ever a call to action for the pediatrician. Keeping the diagnosis of child maltreatment on the differential for both physical examination findings and for behavioral changes is the starting point for correct identification and action.
Be Prepared. Our role in identification, evaluation, and treatment for children with a diagnosis of suspected or confirmed child maltreatment can be guided—as with any diagnosis or condition—by evidenced-based guidelines. Listed here are important AAP references that are practical and essential guides when evaluating and treating sentinel injuries, physical abuse, and sexual abuse. The more complex the clinical scenario or patient, the greater the risk for the child is balanced with the need to be thorough in approach, hence the additional resources listed under high-risk populations. Practical things take an impractical amount of time and effort when child maltreatment is a concern. Consultation with other subspecialties, including child abuse pediatricians who can be found by region via the AAP Council on Child Abuse & Neglect website, should be considered depending on the physical or behavior presentations.
Stay Connected. Once a report is made to child protective services, the inherent reaction or next step may be to let the system do its job and to disconnect from the process. A key part of the ongoing evaluation of and then help for the child and family is the connected partnership of the pediatrician and child welfare system. Beyond the mandated report, we play a role in educating caseworkers about everything pediatric so they are best informed about injury, behavior, disease or condition, and of course, child development. Advocating for the parent to establish a safer and more effective parenting style is in our medical home toolbox. Establishing trusted relationships with community partners in child welfare, behavioral health, and home visitation programs is crucial in the ongoing care of these children and families.
Finally, just as we are champions for safety in injury prevention (car seats, helmets, and socket plugs), infection control (immunizations and handwashing), and child development (preschool for all kids, in-office screenings, child find services), we are all inherent child maltreatment prevention champions. As we promote positive parenting in all our early childhood interactions, we have safe and healthy children as our north star. With that in mind and heart, we can be prepared to respond when child abuse enters the medical home and a child needs our advocacy and help.
Andrew Sirotnak, MD, FAAP
Cochair, AAP Council on Child Abuse & Neglect
Editorial Board, Pediatrics in Review
Director, Child Protection Team | Children's Hospital Colorado and The Kempe Center
A print version of this collection will be available on shopAAP in February.