GPs’ suspicion of child abuse: how does it arise and what is the follow-up?

Abstract

Background: Child abuse is widespread, occurs in all cultures and communities, remains undiscovered in 90% of cases and has serious long-term effects. Physicians generally underidentify and underreport child abuse. To understand this low reporting rate and how the suspicion of child abuse arises, we examined GPs' experiences. Research questions: How does the suspicion of child abuse arise in GPs' diagnostic reasoning? How do they act upon their suspicion and which barriers do they encounter in their management? Methods: Twenty-six GPs participated in four focus groups. We used purposive sampling to include GPs with different levels of experience. We performed a thematic content analysis. Results: Suspicion of child abuse arose from common triggers and a gut feeling that 'something is wrong here'. GPs acted upon their suspicion by gathering more data, through history taking and physical examination. They often found it difficult to decide whether a child was abused, because parents, despite good intentions, may simply lack parenting skills and have different values. Clear signs of sexual abuse and physical violence were institutionally reported by GPs, whereas in less clear-cut cases they followed them up and built a supporting network of professionals around the family. Conclusions: A low child abuse reporting rate by GPs to CACRC does not mean a low detection rate. In trying to improve a child's situation, GPs make use of patients' trust in their doctor by involving other professionals. Awareness of the role of gut feelings in developing a suspicion may increase early detection and preventive actions. KEY POINTS Physicians generally underidentify and underreport child abuse. Suspicion of child abuse arose from common triggers and a gut feeling that 'something is wrong here'. GPs acted upon their suspicion by gathering more data, through history taking and physical examination. GPs found it difficult to decide whether a child was abused, because parents, despite good intentions, may lack parenting skills.

How child health care physicians struggle from gut feelings to managing suspicions of child abuse

“…We used a coding book that had been composed in our comparable study among FPs with almost the same research questions and methods. 17 This procedure enabled us to compare the outcomes of the two studies. During the analysis, the coding book was adapted to account for domain-specific aspects, but the three major themes could be retained.…”

“…The study design we chose was similar to that of a previous study among FPs on the same topic. 17 This approach enabled us to compare the results regarding both professions working in the youth health care chain.…”

“…13,14 The wording CHCPs used to describe their gut feelings was similar to how other physicians expressed it. 29,30 Compared to FPs, 17 the role of CHCPs is less self-evident: they have less authority, see parents only in connection with their small children, and seem to have to put in much greater effort to gain the parents' trust. On the other hand, CHCPs might be better informed than FPs about the children's situation because of their collaboration with nurses and other easily accessible professionals working closely with the family, such as district nurses, schoolteachers and the police.…”

“…15,16 As regards the FPs, we found in a previous study that an early alert that can arouse suspicion of child abuse is the gut feeling that 'there is something wrong here'. 17 This uneasy feeling might induce an FP to observe the child and its parents more closely, to ask more relevant questions and to carefully examine the chid. 17,18 FPs found it difficult to decide whether a child was being abused, because parents, despite good intentions, may simply lack certain parenting skills or may have other values regarding good parenting.…”

“…17 This uneasy feeling might induce an FP to observe the child and its parents more closely, to ask more relevant questions and to carefully examine the chid. 17,18 FPs found it difficult to decide whether a child was being abused, because parents, despite good intentions, may simply lack certain parenting skills or may have other values regarding good parenting. When there were clear signs of sexual abuse or physical violence, FPs did file a report to the CACRC, but in cases of emotional child abuse, they generally limited themselves to following up the child and the family.…”