Physicians don't always report child abuse, study shows

Stratford, N.J., pediatrician Martin Finkel, DO, and his colleagues have seen an increase in child abuse among patients during the past year. He attributes the uptick, in large part, to the nation's economic troubles.

"When there is a recession, people are out of work, and they're under much more stress. Who are they going to take their stress out on? The most vulnerable people they can have control over," said Dr. Finkel, founder and medical director of the Child Abuse Research Education and Service Institute at UMDNJ School of Osteopathic Medicine in Stratford.

Physicians need to know how to identify child abuse and take the proper steps when they suspect it, experts say. But some health professionals do not always report cases of abuse to the proper state agency, says a study of 110 primary health care professionals in the November-December issue of Academic Pediatrics.

Most of those in the study were physicians, and they were participants in the Child Abuse Recognition and Evaluation Study.

Researchers surveyed each health professional on one physical injury case he or she recently saw. Participants were asked to rate on a scale of one to five the likelihood that a patient's injury was caused by abuse. Researchers compared how health professionals answered with responses of child abuse experts.

In 81% of the cases, health professionals and experts agreed on the likelihood that a child's injury was due to maltreatment. But health professionals failed to report to child protective services 21% of cases in which the patient's injury was indicative of abuse. In fact, the study showed that some did not report injuries they considered to be "very likely" caused by maltreatment.

"Doctors are not so bad at recognizing child abuse," said Robert Sege, MD, PhD, lead study author and professor of pediatrics at Boston University School of Medicine. "But once they recognize it, it's a difficult decision to report."

The challenges in reporting suspicions of child abuse include physicians' concerns that they are wrong and that reporting will cause unnecessary problems for the family, Dr. Sege said. Some doctors worry that reporting their suspicions will prevent families from bringing their child in the next time he or she needs care.

Laws on reporting child abuse vary by state, but they all require physicians to notify child protective services if there is reasonable suspicion that a youth was abused or neglected, the study authors said.

In 2009, about 3.3 million child abuse reports and allegations were made in the U.S. involving an estimated 6 million children, according to the latest data from Childhelp, a Scottsdale, Ariz.-based nonprofit that helps victims of child abuse and neglect. About five children die every day as a result of abuse, Childhelp says. About 80% of those deaths occur in children younger than 4.

Reporting child abuse

Philadelphia pediatrician Cindy Christian, MD, recommends that physicians who suspect abuse report it to state authorities. She encourages doctors to be open with the family and say, "I see this, and I'm concerned that somebody might be harming your child. Are you concerned?"

Asking parents about their concerns is a way to avoid blaming them for the injury, said Dr. Christian, chair of the American Academy of Pediatrics' Committee on Child Abuse and Neglect.

If doctors decide to report an injury, she recommends that they be honest with the family. She often tells parents, "I'm concerned about what I'm looking at. I think we need to have this investigated further. I have to call child welfare. I want to see you back in a week to see how the injury is healing and how you're doing."

Dr. Christian urges primary care physicians to understand that child abuse and neglect are common public health problems that can have devastating effects on children.

"In primary care practices, whether doctors recognize it or not, there are children in their practice who are victims of abuse," she said. "The first step to helping protect children is to be aware of this."