Professional education in child abuse and neglect

Physicians have reported feeling that they were not adequately trained to identify and report child abuse. This article reviews the current state of medical education and residency training and the needs of physicians in practice and proposes changes and additions that can be made to improve the ability and confidence of physicians who are faced with the responsibility of keeping children safe.     

Partial recovery from severe child neglect and abuse

A 3-year-old boy and his 9-month old sister received developmental assessments 2 weeks after removal from a neglectful and abusive family. The children were evaluated for a second time 5 months after removal, after spending the interval together in a foster care setting. They received no specialized services geared toward stimulating their development. Significant impairments in growth, cognition, adaptive skills, and language noted during the initial assessment were not as evident at followup. The developmental profiles, however, were not normal. The largest gains were in adaptive skills. Expressive language skills remained relatively impaired. It appears that significant developmental gains can occur in developmentally impaired children who are removed from an abusive and neglectful home and placed in foster care for several months.     

Oral and dental aspects of child abuse and neglect

In all 50 states, physicians and dentists are required to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may cause suspicion for child abuse or neglect. Physicians receive minimal training in oral health and dental injury and disease and, thus, may not detect dental aspects of abuse or neglect as readily as they do child abuse and neglect involving other areas of the body. Therefore, physicians and dentists are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions.     

Current pediatric roles in child abuse and neglect.

Many pediatricians are being called on to undertake expanded roles in the field of child abuse and neglect, whether as a practicing pediatrician, a hospital-based child abuse consultant, or as a child protection team pediatrician. The practicing pediatrician must consider the diagnosis of child abuse and neglect, confirm the diagnosis, report all suspected cases to child protective services, hospitalize any abused child who needs protection, and provide preventive services. The hospital-based child abuse consultant should provide consultation to primary physicians, report seriously injured cases for the primary physician or surgeon, provide expert medical testimony on difficult to prove cases, teach house staff and medical students about child abuse and neglect, and improve treatment services for abused children who are hospitalized. The child protection team pediatrician will usually become involved in the broader problem of improving team decision making and the interagency system that deals with child abuse and neglect.     

The cutaneous manifestations of child abuse and neglect.

The most easily recognizable physical manifestations of child abuse and neglect are seen in the skin. The findings may be the result of intentional trauma, neglect to provide adequate child care, alterations in family dynamics, or the emotional problems secondary to the maltreatment.     

Demographic and clinical features of child abuse and neglect cases

The aim of this study was to present child abuse and neglect (CAN) cases of the Child and Adolescent Psychiatry Department of Hacettepe University Faculty of Medicine. The charts of all the patients seen at the Child and Adolescent Psychiatry Clinic between 2000 and 2004 were screened regarding the presence of CAN. The mean age of the children was 10.9 years. The offender was generally an extra-familial acquaintance (40.7%). The most common type of abuse was sexual (77.8%) and the most common associated types of abuse were physical and sexual (7.4%). Attention deficit hyperactivity disorder (ADHD) was observed as the most common psychiatric diagnosis (22.2%). Abuse types in relation to age and gender of abused child, risk factors and associated psychopathologies are discussed. Issues related to legislative process and ecology of the abuse experience are mentioned as restrictions for the prevention and treatment of CAN.     

Core content for residency training in child abuse and neglect

Since the identification of child abuse as a medical diagnosis, physicians have become resources to children, families, and communities to assist in diagnosing abuse, consulting with community agencies, testifying in courts of law, administering abuse prevention programs, and participating on teams to investigate and manage child abuse. Because the distribution of pediatric specialists in child abuse is limited, primary care physicians often are asked to perform these functions. Even in the face of this increasing demand, the education of physicians in the field of child abuse is very limited. Primary care residency programs can provide a good initial base to prepare physicians for forensic evaluations. This document outlines the basic elements of residency education in child abuse and neglect.     

儿童虐待问题不可忽视

世界卫生组织 (WHO)把虐待儿童视为当前一个严重的公共卫生问题。儿童虐待 (childabuse)是指父母、监护人或其他年长者对儿童施以躯体暴力和性暴力 ,造成儿童躯体与情感的伤害 ,甚至导致死亡 ,或对儿童的日常照顾、情感需求、生活监护、医疗和教育的忽视 (neglect)现象[1] 。儿童虐待的类型是特定的社会文化环境下对儿童虐待方式的概括 ,亦是一个古老话题。 19世纪欧洲一些国家育婴堂内养育的私生子约 80 %夭折。作为控制人口的一种方法 ,许多国家甚至接受或默认遗弃先天性残疾儿童。很难估计特定文化因素导致的对儿童的摧残究竟有多广泛…     

Burns as a manifestation of child abuse and neglect.

A multidisciplinary child abuse team investigated children with burns admitted to a general hospital in Tulsa, Okla. Of the 26 burn cases investigated, 14 were found to be accidental, seven accidental with extreme degrees of neglect, and five nonaccidental burns. There are correlations between physical findings and social characteristics, which may aid in the identification and disposition of children with burns. A multiplicity of injuries suggests that nonaccidental burns are not spontaneous abuse, but a planned form of aggression. The high mortality of the abused group indicates the seriousness and severity of nonaccidental injuries. This experience has also shown that nonaccidental burns in children demand a thorough investigation of medical, social, and emotional factors.     

Future role of the pediatrician in child abuse and neglect

This article reviews the recent history of responses to child abuse and the present roles of pediatricians. It outlines actions that are needed to protect children, recognizes the difficulties in effecting intervention, and concludes that pediatricians cannot afford to stand by while children continue to suffer harm.     

Should child abuse and neglect be considered when a child dies unexpectedly?

Deaths during two years at a pediatric teaching hospital were studied to develop guidelines for clinicians who must decide when to explore the possibility of child abuse or neglect when a child dies unexpectedly. Unexpected deaths were defined as deaths occurring before arrival at the hospital or within ten days of hospitalization in children past the first month of life and unrelated to any previously known congenital anomaly or medical condition. There were 43 such deaths during two years. The majority (27) were due to natural causes. However, nine deaths were related to suspected child abuse or neglect (SCAN) and in three of those cases evidence of injury was found only at autopsy. The SCAN cases were more often mistaken for medical illness than for uninflicted injury, indicating that autopsy and postmortem skeletal survey are warranted whenever a child dies unexpectedly. The two factors "dead on arrival" and "1 year of age or less" had a positive predictive value for SCAN of 89% and a negative predictive value of 94%. The two factors identify a high-risk group requiring at least hospital-based investigation into the possibility of abuse or neglect. Reporting for SCAN is warranted when unsuspected trauma is found post mortem, there is direct physical or social evidence of child abuse or neglect, or the child is in the high-risk group and hospital-based investigation falls to eliminate the possibility that maltreatment contributed to the child's death.