Managing Child Abuse: General Principles

Abstract

1. Andrea G. Asnes, MD, MSW* 2. John M. Leventhal, MD† 1. *Associate Medical Director. 2. †Medical Director, Child Abuse Programs, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. After completing this article, readers should be able to: 1. Identify their roles as mandated reporters of child abuse. 2. Discuss the approach to evaluating cases of suspected child maltreatment. 3. Know when to become concerned about possible child maltreatment and when and how to seek help in evaluating cases. 4. Recognize the role of the pediatric practitioner in ongoing care of and advocacy on the behalf of maltreated children. Child abuse is common. In 2007, the year for which the most recent child protective services (CPS) data are available, 3.2 million reports were filed concerning approximately 5.8 million children younger than 18 years of age who were suspected victims of abuse, neglect, or sexual abuse. Also in 2007, 1,760 child deaths were attributed to abuse or neglect. Neglect constituted 59% of all cases of child maltreatment, more than all other forms of substantiated child maltreatment combined. Most maltreatment occurs in children's homes. In 2007, nearly 80% of the perpetrators of child maltreatment were parents. State laws mandate that pediatric practitioners report suspected cases of child abuse or neglect to local CPS. The process that begins when the clinician first feels concern about a child's welfare and ends when he or she makes a report to CPS is one of the most challenging and disturbing that practitioners must undertake. Because child maltreatment is common, it is likely that all pediatric clinicians will care for abused or neglected children and, therefore, will be obliged to report such children to CPS. For this reason, pediatric practitioners should know and employ a careful, systematic, and thoughtful approach to evaluating all suspected cases of child maltreatment to …