Caring For Kids And Their Parents

Child Abuse

Scenario Analysis

In Scene 1, a 10-year-old boy, Michael, is brought in by his mother to see the doctor for an injury that occurred three days prior. Michael gives a vague answer as to how he hurt his ankle, indicating that it was related to skateboarding but not providing specifics about exactly how the injury occurred. During the examination, the doctor correctly identifies other bruises and asks about them. Again, the responses are vague, with Mrs. Thomas stating simply that Michael is “clumsy.” The physician does not attempt to speak with Michael alone to get his explanation of the injuries, and allows the intimidating behavior of Michael’s mother to redirect his focus to the ankle injury. In Scene 2, the doctor is neither angered nor intimidated by the mother’s behavior. The doctor calmly and tactfully explains that further studies will need to be done.

Important clues to the possibility of non-accidental trauma that the doctors in these scenarios should have noted are: the delay in seeking care for the injury; the vagueness of the responses from both Michael and his mother when questioned about how the injury occurred; the suspicious location of the other injuries in areas not commonly associated with falls in children; the progressive agitation of Michael’s mother with continued questioning; and Michael’s withdrawn behavior in response to the entire interaction.

When there are suspicions of physical or sexual abuse or neglect, the physician is mandated by law to inform the appropriate authorities. As demonstrated in Scene 2, you should clearly state your concerns to the child’s caregiver and indicate that you will be reporting these concerns to the appropriate authorities. This should be done in a nonjudgmental way that indicates your primary concern is for the child’s safety.

Once the report has been made, Child Protective Services (CPS) will investigate the circumstances of the injury and interview the caregiver and child, as well as any other parties involved in the child’s care. If you believe the child to be in imminent danger, you may need to admit him/her to the hospital to ensure safety while the investigation is ongoing. If the investigation determines that there is no concern for abuse, as a physician who made the report, you cannot be subjected to any negative consequences, either civil or criminal.

Your institution’s social workers can assist you in this process and answer specific questions about your state’s requirements. You can also obtain information by searching the Internet for the Child Protective Services (CPS) agency in your state.

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