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

Abstract

Worldwide, many children suffer from abuse, often with numerous serious lifelong consequences. Unfortunately, child abuse remains undiscovered in 90% of cases. 1 In the Netherlands, about 90,000-127,000 children aged 0-17 years (i.e. 3% of all children) are victims of child abuse, with at least 17 child fatalities a year. 2 Prevention and early detection of child abuse have high priority in Dutch government policy.An important tool is the national guideline on child abuse. 3 It presents a five-step guide, from obtaining more information and documentation to consulting the Dutch Child Abuse Counselling and Reporting Centre (CACRC), discussing the matter with the parents or caregivers, consulting with a colleague and reporting it to

Can we trust our gut feeling when we suspect child abuse?

“…3 In this issue of Acta Paediatrica, Dr Stolper et al present a qualitative research paper concerning how Child Health Care (CHC) physicians struggle with gut feelings when managing suspicions of child abuse. 4 In many respects, this work parallels that of an earlier paper concerning how GPs handle suspicion of child abuse. 5 GPs in the Netherlands are family physicians, while CHC physicians follow up children's health and development at well baby clinics from zero to 4 years of age, a system similar to those in the Nordic countries.…”

“…A sense of “reassurance” on the other hand is defined as a secure feeling about further management and course of a patient's problem, even if the physician may not be sure about the diagnosis 3 . In this issue of Acta Paediatrica, Dr Stolper et al present a qualitative research paper concerning how Child Health Care (CHC) physicians struggle with gut feelings when managing suspicions of child abuse 4 . In many respects, this work parallels that of an earlier paper concerning how GPs handle suspicion of child abuse 5 .…”

Overcoming barriers to recognizing and reporting child abuse

“…Rational analysis and evidence-based decision-making must play a significant role in making the diagnosis. [25][26][27] Allowing bias to enter the equation not only results in overreporting in certain populations but prevents the recognition of abuse in others. 24 Questions that clinicians can ask of themselves when considering abuse as a diagnosis include: What is the supporting evidence?…”

“…29 Likewise, ignoring a sign of abuse because a clinician is biased in favor of the family allows that abuse to remain hidden and potentially escalate. 27,30 Jenny and colleagues noted that abusive head trauma is more likely to be missed if the child is from a White, twoparent household. 31 Multidisciplinary approaches to child maltreatment serve several purposes.…”

Collaborative support for child abuse prevention: Perspectives of public health nurses and midwives regarding pregnant and postpartum women of concern

“…Stolper et al [ 15 ] stated that a feeling that “there is something wrong here,” a vague and intuitive sense of alertness, helps child health nurses become alert to situations that may lead to child abuse or maltreatment. Furthermore, a U.S. study by child abuse pediatricians (CAPs) reported that the diagnosis of child abuse is procured by a combination of intuitive responses elicited by family encounters and social information obtained outside those encounters [ 16 ].…”