Child abuse

The specific injury management will be dictated by the extent and nature of injuries present.

Treatment recommended for ALL patients in selected patient group

While legislation such as mandatory reporting varies among countries, and also between states in the US and Australia, the overriding principle of 'paramountcy' (i.e., the welfare of the child is paramount) is universal.

Doctors are required to share information with other agencies, and with social work and law enforcement bodies, to ensure that the child's needs are met and he or she is protected from harm.

Doctors may be asked to provide written reports for use in multidisciplinary meetings, police investigations, and civil or criminal courts, and may be required to appear as witnesses (of fact or as experts) in court.

Treatment recommended for ALL patients in selected patient group

If the diagnosis of child abuse is suspected during the investigation, the parents and/or carers should be informed of all relevant investigations and referrals being made, unless doing so places the child or other family members in possible danger.

Child abuse is often an ongoing process. The child's safety is paramount, and it may be necessary to move the child to a place of safety while ongoing investigations are conducted. This is a decision that requires immediate liaison with child welfare/child abuse and neglect social workers and other team members.

When physical abuse is a significant concern, child protection procedures are implemented. These will vary according to the individual circumstances of the case. In some countries, cases are registered on a register of children at risk, and the progress of the family and welfare of the child are monitored at regular intervals by the relevant social and healthcare agencies. When a child is taken into care (e.g., fostering, kinship care, or adoption) access visits for parents may be negotiated and may be supervised when relevant.

It is important to consider potential risks posed to siblings and other children remaining in the home environment during this time. The social services and/or social care team will make a decision regarding the level of risk in any individual situation.

Medical evaluation of all children in a potentially abusive or neglectful home is necessary. Medical evaluation of siblings of an abused or neglected child should include a head-to-toe examination, a skeletal survey if the child is <2 years of age, and other testing deemed necessary by the examining physician.

Treatment recommended for ALL patients in selected patient group

Mental health services should be considered following the immediate management of injuries.

Cognitive behavioural therapy is increasingly used, but must be individualised. Family therapy is also indicated in certain situations, to support other members of the family.[163]Romanelli LH, Landsverk J, Levitt JM, et al; Child Welfare-Mental Health Best Practices Group. Best practices for mental health in child welfare: screening, assessment, and treatment guidelines. Child Welfare. 2009;88(1):163-88. http://www.ncbi.nlm.nih.gov/pubmed/19653458?tool=bestpractice.com For younger children, play therapy may be an option.