Intimate Partner Violence: The Role of the Pediatrician

Abstract

The American Academy of Pediatrics and its members recognize the importance of improving the physician's ability to recognize intimate partner violence (IPV) and understand its effects on child health and development and its role in the continuum of family violence. Pediatricians are in a unique position to identify abused caregivers in pediatric settings and to evaluate and treat children raised in homes in which IPV may occur. Children exposed to IPV are at increased risk of being abused and neglected and are more likely to develop adverse health, behavioral, psychological, and social disorders later in life. Identifying IPV, therefore, may be one of the most effective means of preventing child abuse and identifying caregivers and children who may be in need of treatment and/or therapy. Pediatricians should be aware of the profound effects of exposure to IPV on children.

A Literature Review of Strategies for the Prevention of Intimate Partner Violence During the Childbearing Years

“…As Thackeray, Hibbard, and Dowd (2010) note, "Pediatricians need to be aware that most abused caregivers will seek care for their children but not for themselves, which makes the pediatric setting an ideal place to be alert to the presence of IPV" (p.1096). The literature on pediatric care that we reviewed showed that, in pediatric just as in maternal care settings, there are several identified barriers to IPV screening; these include lack of time and resources, lack of knowledge about IPV, insufficient referral sources, and fear of offending or angering the caregiver (Erickson, Hill, & Siegel, 2001;Thackeray et al, 2010). Studies that examined routine IPV screening report a range of findings, from 5% to 18% of participants reporting IPV in one study (Borowsky & Ireland, 2002), and 8.5% in another (Erickson et al, 2001).…”

“…Pediatricians did not uniformly inquire about IPV, and those most likely to conduct routine screenings were those who had previously completed IPV-specific training (Erickson et al, 2001). In response to this ongoing need, education about the dynamics of IPV and the implementation of an office protocol for managing cases of IPV -particularly one developed with input from local community resources and women's shelters -have been recommended (Borowsky & Ireland, 2002;Erickson et al, 2001;Thackeray et al, 2010). There are, however, no identified studies that examine the effectiveness of pediatric screening on reducing IPV.…”

Critical Elements in the Medical Evaluation of Suspected Child Physical Abuse

“…5,22,24,25 27 Almost all elements in the psychosocial history identified as highly recommended relate directly to the presence or absence of violence in the home, a risk factor for abuse as well as a potential injury mechanism. 28,29 Missing from the list of required and recommended As a new subspecialty, CAP providers have a unique opportunity to define appropriate practices that best balance the goals of traditional pediatrics with the emerging expectations of forensic evaluation.…”

Critical Elements in the Medical Evaluation of Suspected Child Physical Abuse

“…27 Almost all elements in the psychosocial history identified as highly recommended relate directly to the presence or absence of violence in the home, a risk factor for abuse as well as a potential injury mechanism. 28,29 Missing from the list of required and recommended elements are descriptions of caregiver mental health, substance abuse, pregnancy planning, and parent perceptions of child temperament or behavior, all of which have been recommended in clinical practice recommendations. 5,6 The importance of these psychosocial elements was a focus of discussion between survey rounds.…”