Diagnosing physical child abuse: the way forward
- Department of Child Health, University of Wales College of Medicine, Academic Centre, Llandough Hospital, Penarth, Vale of Glamorgan CF64 2XX, UK
- Professor Sibert
- Received 12 October 1999
- Accepted 22 March 2000
Each year in England and Wales, as many as 40 000 children are the subject of a case conference for suspected physical abuse. Abuse has major physical and psychological consequences for the health and welfare of the affected children. The evidence indicates that a significant proportion of abused children experience serious long term effects and they carry the legacy of their abuse with them into adult life.1 2 The management and diagnosis of abuse in children is therefore of great importance.
The management of child abuse must start with accurate diagnosis. With such an important subject one would expect there to be a considerable number of publications giving quantitative evidence on which to base diagnosis. Unfortunately, this is not the case and there has been little work giving probabilities for diagnosis, risk, and outcome for the abused child.
In this article, we will review the evidence we have on the diagnosis of physical abuse in children. We will also review the differential diagnosis, the process of differentiation of physical abuse from accident, and what basis we have for giving evidence to the child protection process.
Who should assess a child with physical abuse?
The initial recognition of the possibility of abuse is in some ways the most important step in the child protection process. This is done by social workers, health visitors, neighbours, teachers, and many other people involved with children. It is also the responsibility of all doctors who deal with children.
There are, of course, many disincentives for this happening. Some doctors may be unhappy about even recognising the possibility that parents could have harmed a child. Doctors may feel uncertain about the diagnosis and they may accept accidental explanations readily.
Every doctor who may suspect a child is abused should have access to expert advice. One should never walk alone in child protection! Help is …
