Risk factors for child abuse: levels of knowledge and difficulties in family medicine. A mixed method study

Océane Regnaut, Marie Jeu-Steenhouwer, Cécile Manaouil, Maxime Gignon, Océane Regnaut, Marie Jeu-Steenhouwer, Cécile Manaouil, Maxime Gignon

Abstract

Background: Family physicians (FPs) have a central role in the detection and management of child abuse. According to the literature, only 2-5% of initial reports of child abuse come from the medical profession.

Methods: The objective of this study was to assess levels of knowledge of risk factors for child abuse by Family Physicians (FPs) and the attention that the physicians pay to these risk factors. We conducted a mixed-method survey based on semi-structured interviews. 50 FPs practicing in the Somme County (northern France) were interviewed with closed and open questions. The FPs' level of knowledge of risk factors for child abuse and obstacles in the detection of child abuse were assessed.

Results: The FPs' level of knowledge of risk factors for child abuse was similar to that reported in the literature. However, FPs knew little about the significant role of prematurity. Likewise, the FP's training did not seem to influence their knowledge of risk factors. Fear of an incorrect diagnosis was the main obstacle to reporting a suspected case. The FPs considered that they were often alone in dealing with a difficult situation and considered that the judicial system and the social services were not sufficiently active.

Conclusions: Few FPs had actually received specific training in the detection and management of child abuse but many stated their need for this type of training. FPs encounter many obstacles in the detection of child abuse, which sometimes make the FP reluctant to report a suspected or potential case. Medical education need to be improved in this field.

Figures

Fig. 1
Fig. 1
The obstacles encountered by the family practitioner when faced with suspected child abuse

References

    1. Gignon M, Manaouil C, Verfaillie F, et al. Suspected child abuse: a perilous situation for practician? Presse Med. 2009;38(3):344–345. doi: 10.1016/j.lpm.2008.12.016.
    1. Bulletin de l’Ordre National des Médecins. Protection de l’enfance: Tous concernés! Le bulletin de l’Ordre des médecins. Paris 2011. . Accessed 21 Aug 2014.
    1. Bulletin de l’Ordre National des Médecins . Le rôle du médecin face aux maltraitances. Paris: Le bulletin de l’Ordre des médecins; 2002.
    1. ODAS/SNATEM. Protection de l’enfance: Mieux comprendre les circuits, mieux connaitre les dangers. Paris1999. . Accessed 21 Aug 2014.
    1. Morris JL, Johnson CF, Clasen M. To report or not to report. Physicians’ attitudes toward discipline and child abuse. Am J Dis Child. 1985;139(2):194–197. doi: 10.1001/archpedi.1985.02140040096037.
    1. Lazenbatt A, Freeman R. Recognizing and reporting child physical abuse: a survey of primary healthcare professionals. J Adv Nurs. 2006;56(3):227–236. doi: 10.1111/j.1365-2648.2006.04030.x.
    1. Flaherty EG, Sege R, Binns HJ, et al. Health care providers’ experience reporting child abuse in the primary care setting. Pediatric Practice Research Group. Arch Pediatr Adolesc Med. 2000;154(5):489–493. doi: 10.1001/archpedi.154.5.489.
    1. Jones R, Flaherty EG, Binns HJ, et al. Clinicians’ description of factors influencing their reporting of suspected child abuse: report of the Child Abuse Reporting Experience Study Research Group. Pediatrics. 2008;122(2):259–266. doi: 10.1542/peds.2007-2312.
    1. Van Haeringen AR, Dadds M, Armstrong KL. The child abuse lottery–will the doctor suspect and report? Physician attitudes towards and reporting of suspected child abuse and neglect. Child Abuse Negl. 1998;22(3):159–169. doi: 10.1016/S0145-2134(97)00172-5.
    1. Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians’ reporting of suspected child maltreatment. Ambul Pediatr. 2005;5(2):96–101. doi: 10.1367/A04-094R.1.
    1. Schweitzer RD, Buckley L, Harnett P, et al. Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia. Aust Health Rev. 2006;30(3):298–304. doi: 10.1071/AH060298.
    1. Flaherty EG, Jones R, Sege R. Group CARESR. Telling their stories: primary care practitioners’ experience evaluating and reporting injuries caused by child abuse. Child Abuse Negl. 2004;28(9):939–945. doi: 10.1016/j.chiabu.2004.03.013.
    1. Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child. 1985;139(4):393–395.
    1. Tursz A. Early childhood abuse: an underestimated phenomenon that doctors must learn to recognize. Rev Prat. 2011;61(5):652.
    1. ODAS. Protection de l’enfance: Une plus grande vulnérabilité des familles, une meilleure coordination des acteurs. Paris 2007. . Accessed 21 Aug 2014.
    1. Tursz A, Gerbouin-Rérolle P. Enfants maltraités. Paris: Les chiffres et leur base juridique en France; 2008.
    1. Diquelou JY. Risk factors for child abuse during the perinatal period. Preventive approach in the obstetric milieu. Role of a child abuse risk index. J Gynecol Obstet Biol Reprod (Paris) 1996;25(8):809–818.
    1. Wu SS, Ma CX, Carter RL, et al. Risk factors for infant maltreatment: a population-based study. Child Abuse Negl. 2004;28(12):1253–1264. doi: 10.1016/j.chiabu.2004.07.005.
    1. Dubowitz H, Kim J, Black MM, et al. Identifying children at high risk for a child maltreatment report. Child Abuse Negl. 2011;35(2):96–104. doi: 10.1016/j.chiabu.2010.09.003.
    1. Flaherty EG, Sege R, Mattson CL, et al. Assessment of suspicion of abuse in the primary care setting. Ambul Pediatr. 2002;2(2):120–126. doi: 10.1367/1539-4409(2002)002<0120:AOSOAI>;2.
    1. Kempe CH. Sexual abuse, another hidden pediatric problem: the 1977 C. Anderson Aldrich lecture. Pediatrics. 1978;62(3):382–389.
    1. Johnson CF. Child maltreatment 2002: recognition, reporting and risk. Pediatr Int. 2002;44(5):554–560. doi: 10.1046/j.1442-200X.2002.01642.x.
    1. Moreira GA, Vasconcelos AA, Marques LDA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr. 2013;31(2):223–230. doi: 10.1590/S0103-05822013000200014.
    1. Gignon M, Manaouil C, Jarde O. A unit dedicated to minor victims of violence. Soins Pediatr Pueric. 2010;255:34–37.
    1. Vulliamy AP, Sullivan R. Reporting child abuse: pediatricians’ experiences with the child protection system. Child Abuse Negl. 2000;24(11):1461–1470. doi: 10.1016/S0145-2134(00)00199-X.

Source: PubMed

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