Possible child abuse underreported because of lack of confidence, information

December 1, 2011

Is lack of confidence keeping you from reporting possible child abuse? A new study suggests that could be the case. What other factors prevented pediatricians and other PCPs from reporting suspected child abuse?

Is your lack of confidence keeping you from reporting possible child abuse?

A new study suggests that could be the case. It pointed out that primary care providers choose not to report 1 in 5 cases of child abuse.

Using injuries drawn from the Child Abuse Reporting and Experience Study, providers completed phone interviews concerning 111 injury visits, which they classified as “no suspicion of abuse,” “suspicious but not reported,” or “suspicious of abuse and reported.” Providers’ evaluations then were validated by 5 experts and by the providers’ retrospective self-assessment 6 weeks and 6 months after the initial injury visit.

Experts and PCPs agreed on suspicion of abuse in 81% of cases of physical injury but differed significantly in the number of cases reported, according to the study. PCPs chose not to report 21% of the suspicious injuries that experts would have reported to child protective services (CPS).

“Child abuse experts and PCPs are in general agreement concerning the assessment of suspected child physical abuse, yet this study demonstrates that primary care providers decide not to report a substantial proportion of child physical abuse cases,” said lead researcher Robert Sege, MD, FAAP, professor of pediatrics at Boston University School of Medicine and director of the Division of Ambulatory Pediatrics at Boston Medical Center.

Pediatricians who fear that a reported family will stop coming to their practice or that they will not learn the results of an investigation can take comfort in the study’s findings. Reported families did not reduce the frequency of their visits to the PCP in the 6 months after the suspicious injury. In 70% of the reported cases, the state child protective agency sent follow-up information to the provider.

Sege attributes underreporting to several factors, including lack of confidence and limited awareness of the role of state agencies. “PCPs need better education about the recognition of injuries that are suspicious for child abuse, particularly bruises and fractures, and the role of state CPS agencies in investigating the child’s circumstances,” he said. The study also recommends training on state laws that mandate reporting of suspected abuse.

Go back to the current issue of the eConsult.