Doctors have key role in preventing and detecting child neglect and abuse

Doctors have a key role in detecting the signs of child abuse and neglect, and in ensuring such cases are well documented and reported to the appropriate public agency to protect the children involved. The issues are discussed in a Seminar published in this week's edition of The Lancet.

Professor Howard Dubowitz, Chief of Division of Child Protection, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, USA, and Dr Susan Bennett, University of Ottawa, Canada reviewed data from various medical databases to compile the Seminar. They investigated definitions of maltreatment, its prevalence, risk factors, protective factors, prevention, assessment and diagnosis, outcomes, reporting and treatment.

The authors say: "The abuse and neglect (or maltreatment) of children is a worldwide problem, although its manifestations and extent vary. It is far more prevalent than is generally recognised."

They add: "Measurement of child maltreatment is inherently difficult, since it is rarely seen directly by people outside the immediate family, and is often unreported."

Many risk factors usually interact to place a child more at risk of abuse or neglect examples include a child's disability and a parent's depression. Violence between parents also increases the risk to their child. But there are also protective factors which decrease the risk of abuse such as supportive grandparents or accessible mental health care.

Usually medical responses to child maltreatment occur after the event; but the Seminar advocates prevention where possible. Strong doctor-family relationships, parental education about disorders their children may have, screening for risk factors or even home visits by nurses can all improve family functioning and decrease the risk of maltreatment.

Diagnosis of child abuse frequently involves detecting injuries which cannot be explained through the child's medical history or other circ

Contact: Professor Howard Dubowitz

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