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Pediatricians with more knowledge of and confidence in identifying and managing child abuse are more likely to identify abuse

Pediatricians are legally required to report injuries they suspect are due to child abuse to the State's Child Protective Services (CPS). Given how common childhood injuries are, identifying child abuse as the cause of injuries is not easy. The correct diagnosis can save a child from further harm, while a wrong diagnosis can destroy a family. A random national sample of pediatricians were surveyed about their knowledge, attitudes, and experience related to child abuse, and asked their interpretation of the cause of a girl's injury in a purposely vague vignette.

Overall, nearly two-thirds of pediatricians expressed confidence in their ability to identify (61 percent) and manage (62 percent) patients injured by child abuse, especially those pediatricians who received some child abuse continuing medical education. Those with positive attitudes about child abuse screening and confidence in identifying and managing child abuse were more likely to identify the vignette case as probably due to child abuse. Experience with CPS was predictive of whether they would report the case to CPS.

Most pediatricians who had reported child abuse to CPS felt it was a positive move. Nearly two-thirds (62 percent) said that patients were protected from further abuse, 52 percent said the families received intervention and parenting improved, 44 percent indicated that children had been placed outside of the home and thrived, and 24 percent said a patient or family appreciated that they had intervened.

Of the pediatricians who reported negative consequences of reporting the abuse, 40 percent indicated they had lost the reported family as patients, and 21 percent said a child was subjected to further abuse because CPS did not respond adequately to the report. Two percent of pediatricians stated that they were sued for malpractice because they reported abuse. The study was supported in part by the Agency for Healthcare Research and Quality (HS10746).

More details are in "Pediatrician characteristics associated with child abuse identification and reporting: Results from a national survey of pediatricians," by Emalee G. Flaherty, M.D., Robert Sege, M.D., Ph.D., Lori Lyn Price, M.S., and others, in the November 2006 Child Maltreatment 11(4), pp. 361-369.

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