If unrecognized a child returned to an abusive environment faces 50% chance of further battering and perhaps as high as a 15% chance of death.
Prompt reporting and removal of the child from abusive environment. 24 hour Child helplines can help in this regard.
I totally agree but the first step in this regard is keeping a very index of suspiician and to really make your self aware of the subtle signs and symptoms of abuse.
In total agreement. A high index of suspicion is important in diagnosing child abuse cases. Child physicians should always be alert in order to identify even the most subtle signs.
physician bodies should work with their Government to set up functional child support systems and relevant laws. This will enhance reporting of child abuse cases and hence child protection
Dear Chinyere and Khaled
Thank you very much by so important opinions
Regards
General physicians should have a very high index of suspicious, often the family ignore the child abuse in order to avoid involving police, and the legal system is too difficult for poor families, courts advocate fees are trouble some , Physical abuse is very common in some of the religious schools and needs to be addressed , we have a N GO as K OPAL in Karachi taking care of all aspects, and often we face financial constrains
I fully agree with all the previous opinions, but apart from the physical abuse, various types of emotional abuse are more and more common, and sometimes very difficult to diagnose. I mean even infants brought by their parents to the doctor for "digestive or neurological symptoms" . Sometimes it is quite difficult to rule-out an organic problem and usually instead of being happy when you tell them that the baby is ok, the parents are disappointed. Although this is another type of abuse this is not commonly reported.
Dear Ioana
Very timely and important guidance.
Thank you very much
Besta regards
I agree a high index of suspicion and afortunatly in this hospital is an integral group the abuse´s clinical group who finish diagnosis
Thankyou, great discussion around such an important topic . I worked in child abuse for over 20 years and as a general paediatrician I teach medical students and residents about child abuse . One important statement I try and pass on is that if you think the problem could be child abuse related, discuss with a colleague or social worker And be aware of the non mobile child with bruises. We all know of so many tragic cases that have slipped through physicians hands. better to over diagnose than under
Dear Kim
Your phrase is very important: if you think the problem could be child abuse related, discuss with a colleague or social worker
Thank you very much
Best regards
Child abuse is a very large topic, as it includes physical abuse, sexual abuse, emotional abuse, neglect, and medical child abuse (previously referred to as Munchausen Syndrome by proxy. In child sexual abuse, the diagnosis is primarily based on the child's disclosure of being sexually abused. In the vast majority of cases, the physical and laboratory evaluation does not reveal any definitive indicators of trauma or sexual contact. The misdiagnosis of child sexual abuse is sometimes a problem, when physical findings are thought to represent recent or healed injury, when in fact the finding is due to another condition or is a variant of normal. It is recommended that if a physician finds something on the physical examination that raises concern for sexual abuse, high quality photographs should be taken and sent to an expert in child sexual abuse medical evaluation for review. Diagnostic errors are more common among physicians and nurses who examine fewer than 5 children monthly for suspected sexual abuse.
See the attached article describing a study of diagnostic accuracy based on review of photographs and case histories.
Dear Joyce
Thank you very much for kindly sending the scientific paper
Best regards
Dear colleagues,
besides the vey important remarks of Dr.Adams concerning CSA I would like to stress the extremely important role of qualified physicians in diagnosing or excluding physical abuse. Only a qualified medical opinion may be able to differentiate abuse from accidents or other differential diagnosis. As our medical opinion may have fargoing consequences as well if false negative or if false positive, our opinion should be based on the best available evidence which findings are abuse related.
So you should be up to date to the pertinent literature. In my opinion besides textbooks like Carole Jenny´s or Rob Reece´s the Quarterly Update literature review (www.quarterlyupdate.org) is probably the only source to stay updated with the literature (which is widespread over many medical disciplines) and as well every physician caring for possibly abused children should be knowledgeable about the sytematic reviews of the Welsh Child Protection Group ("core info"- www.core-info.cardiff.ac.uk).
Best regards
Bernhard Herrmann, MD, Child Protection Center, Kassel, Germany; 20 yrs in child abuse
PS.
Concerning CSA be knowledgeable about Dr. Adams great guidelines on medical evaluation: Adams JA: Medical Evaluation of Suspected Child Sexual Abuse: 2011 Update. J Child Sexual Abuse 2011; 20:588-605
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