According to (TUSLA- The Child and Family Agency 2015) child abuse can be
ranked under four main categories that include: emotional, neglect, physical, and
sexual abuse. I came to recognize the importance of making a decision regarding
a potential child abuse case especially two weeks ago after meeting with my
early patient contact program (EPCP) patient. Two of my friends and I were
assigned a lovely 5-year-old boy who is diagnosed with down syndrome and hemophilia.
I had the pleasure of meeting him with both of his mother and aunt who are
taking care and cherishing him beyond description. Because of the boy’s health
conditions, he is prone to bruise and bleed easily even with the slightest
touch. The mother whimpered the loathing looks and anger she’d get every time
she goes out to a public place because people simply assumed that the kid was
abused because of all the bruises, and how physicians ask unusual questions
every time she rushes her son to the emergency department thinking that she
might have used the boy’s condition and abused him.
As a future physician, I believe it is rather important to acquire the
skill needed to evaluate the case and to know when to report a case of an abuse
and when not because the slightest misjudgment can put the parents/caregiver in
dire straits or the opposite if a case of abuse went unnoticed putting the
child in a perpetual abuse exposure that can have a long-term effect on their
physical and mental health.
and ethical framework
a legal obligation to report upon rational grounds when suspect abuse and/or
neglect and they are required by legislation to contact the HSE Children and
Family Services without delay to directly disclose all information pertaining
to the child safety concern. Duty to report overrides patient confidentiality;
physician is protected against liability; however, the parents or guardians
should be informed of the GP’s intention to report unless informing the
parents/guardians might jeopardise the child’s safety. In cases in which
uncertainty exists, GPs may be required to discuss their concerns with other
professional personals who have a better experience in the field. Thus, GPs
must be aware of how to reach out to contact relevant people for expert medical
advice (Department of children and youth affairs 2017).
The standard reporting procedure as
specified in the (Department of children and youth affairs 2017) is as follows:
Reporting child abuse or neglect
should be done without any delays to the HSE children and family services in
person, by telephone or in writing.
Before making an official report,
it is advised to discuss all concerns with a specialized professional, or
directly with the HSE children and family services.
By no means a child should be left
in a situation that exposes them to harm or risk awaiting HSE intervention.
The standard report form should be
used when reporting child welfare and safety concerns to the HSE however, the
HSE follows up on all referrals, even if the standard report has not been used.
posed on doctors when reporting
Probably one of the biggest
challenges that physicians encounter when faced with a child abuse case is the
lack of professional training to deal with abuse victims because their presenting
signs and symptoms can be confused with other potential differential diagnoses
as in the case of my EPCP patient. A study performed by (Bannwart and Brino
2011) in Brazil tried to identify the difficulties in reporting cases of abuse
against children and adolescents from the viewpoint of pediatricians in which
it showed that 75% of participants had doubts about whether to report or not
and there was a frequent belief that health care professionals must confirm,
and check based on solid evidence if the abuse indeed occurred fearing from
making a false accusation. Many also reported that they lack the guidelines
that should be followed in case of child abuse reporting and that social
services do not exist 24 hours at the hospital. The study also showed that some
of the participants expressed their concern of being legally involved and the
hassle of having to deal the juvenile court and that it would impact their
relationship with their patients especially in small communities where people
tend to know each other well. Therefore, it is vital to educate health care
professionals about the conceptual distinction between reporting and
denunciation for the sake of preventing the avoidance behavior of health care professionals
as for the most applicable reporting procedure in cases of alleged or
established child abuse.
As a future physician, I will probably be faced with cases of child
abuse. I believe it is rather important to be exposed and prepared to deal with
these scenarios from early on. Primary precautionary measures have to be
developed parallely to health care measures to reduce the incidence of child abuse.
The training of health professionals should aim to invest in promoting
behaviours to shed the light on the rights and needs of both children and
adolescents to increase the capacity of professionals to recognize cases of
abuse and expanding their duty to report abuse, consolidating the linkage
between these reaction at all levels, institutions, and agencies that are
responsible for fulfilling the entitlements of children and adolescents.