Child abuse more likely suspected in patients with low socioeconomic status

February 2, 2012

Socioeconomic status but not race may influence a physician?s willingness to consider abuse as a cause of an unwitnessed fracture in a child and to report the incident to child protection services. Do the physicians in your practice make decisions based on stereotypes?

A survey conducted by researchers from Indiana University showed that socioeconomic status (SES) but not race may influence a physician’s willingness to consider abuse as a cause of an unwitnessed fracture in a child and to report the incident to child protection services.

Among a national sample of 2,109 general pediatricians who were presented with scenarios that could possibly but not obviously indicate child abuse, most were likely to suspect maltreatment for white children with families with low SES than for black children from families with low SES or for either black or white children of high SES.

As part of the survey, pediatricians were presented with a color photo of a child along with a fictitious medical history and a description of the chief complaint (an unwitnessed event in an 18-month-old child that resulted in an oblique femur fracture).

The physicians were randomly assigned to 1 of 4 scenarios (white child, high SES; black child, high SES; white child, low SES; black child, low SES). A social history was also included. In the high SES version, the parents were an accountant and a bank manager. In the low SES version, the parents were a grocery clerk and a factory worker.

An equal proportion of physicians suspected abuse when the child was white or black, but 48% assigned abuse as the cause of the injury when the child had a low SES compared with 43% when the child had a high SES.

Ninety-six percent of the study sample said that they would report a patient to child protection services when they diagnosed injuries consistent with abuse.

These findings contradict previous studies that linked differentiated diagnosis to race, reporting increased likelihood to consider abuse in black patients.

“Although earlier work has shown that low SES can be a risk factor for abuse, it is imperative that clinicians remain aware that risk factors are not causative factors, particularly as they relate to child abuse,” the survey researchers write.

Go back to the current issue of the eConsult.