Research Helps Doctors More Accurately Identify Child AbuseMay 1, 2014
Imagine you’re a pediatrician and you have a child in your office that you suspect is being abused. What kind of questions would you ask to ensure you were correct before you elevated the case to the next level? Turns out that some doctors might be asking the wrong ones. New research from Dr. Kristine Campbell with The Center for Safe and Healthy Families at the University of Utah is examining the types of questions physicians ask and how effective they are in determining if a child is a victim of abuse.
Interviewer: Even for a trained medical professional, diagnosis of child abuse can be challenging. We're going to examine that next on The Scope.
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Interviewer: Dr. Kristine Campbell is with the Center for Safe and Healthy Families. Child abuse is a hard thing to see. It's one of those things where, like, you think if you see it, you would know it, but then if you have to elevate it to the next level, you might start doubting yourself. Some of your research, from what I understand, is trying to maybe take some of that uncertainty out. Tell me a little bit about your research. Why did you do this study?
Dr. Campbell: We did this study because we know that over 150,000 children are reported to Child Protective Services every year around our country for suspected physical abuse, and about 3,500 children are hospitalized with suspected physical abuse every year in our country. We also have increasing awareness of child abuse concerns based on a recent specialization in child abuse pediatrics. Despite this, there's a lot of recommendations for how to do evaluations for child physical abuse, and yet there's very limited evidence for those.
Interviewer: Interesting. So a lot of theories on how you can identify an abused child but nothing, really, to support that that's accurate information?
Dr. Campbell: For the most part, that's true. Yes.
Interviewer: Okay. So is it challenging for physicians to identify child abuse and why?
Dr. Campbell: It's challenging for a couple of reasons. The first is most of us have been taught that the history is really 80 percent of what we do in medicine, and in cases of child abuse, we're stuck in a situation where oftentimes the history that we're being provided is either unknown or actually not true. The second is because of the emotional state of the physician when they're concerned about child abuse, there's just a lot of discomfort. So we find ourselves turning to gut feelings or gut reactions rather than turning to science or evidence.
Interviewer: So what did you discover in your study?
Dr. Campbell: What we did in our study was that we consulted with 29 national experts in child abuse pediatrics to try and identify a very small and limited set of required and highly recommended elements in the history, physical, and physical laboratory evaluation of children where there is a concern for serious child abuse. What we were able to see is that first of all, these physicians are taking tremendous amounts of history. They're taking hundreds and hundreds of little bits of information from families, and yet it's really just a matter of 25 to 30 pieces of information that really required to reach those challenging diagnoses of abusive head trauma or abusive fractures in young children. I think that there are a couple of points, from my perspective, that are important. First of all, the child abuse pediatrician is taking lots and lots of history, but only a little bit of that is actually required for the diagnosis. The second point is what that means is that this additional information, in my mind, is being taken for one of two reasons. The first, which is perhaps more cynical, is that we're looking for potential pieces of information that may be biasing to us, and I hope that's not the case. The second more hopeful interpretation would be that pediatricians who are involved in this kind of work are really also searching for ways to help families who are high-risk and in need of services in their communities.
Interviewer: So it's a checklist, if you will, that a physician can use to determine whether or not it could be child abuse?
Dr. Campbell: I hesitate to say that it's a clear checklist because I think that this is just a starting point, but it gives everyone sort of a firm base to stand on to start the evaluation and then to move forward. I think that sometimes just having a starting point may be a really helpful piece for physicians who are on that very uncomfortable place of trying to first initiate a child abuse evaluation.
Interviewer: So you mentioned that some of these findings is creating discussion among your peers. What exactly is that discussion?
Dr. Campbell: The discussion that's occurring is the question about whether social risk is important in the diagnosis of suspected child physical abuse.
Interviewer: And what does social risk mean?
Dr. Campbell: Social risk means things that certainly are associated with child abuse such as socioeconomic status, marital status, and the presence of domestic violence in the home. These are all really important factors for the wellbeing of children, but I think there's a debate as to whether it should enter into the actual diagnosis of child abuse.
Interviewer: So just because somebody might be abusing their spouse does not necessarily equate to that it's going to turn into child abuse?
Dr. Campbell: It certainly raises the risk, and we know that about a third of families in which this is going on, there's also child abuse. In our state, in fact, it's a mandating report for child abuse. Whether or not that risk factor for an individual patient that is being seen in a pediatric clinic should be used in the diagnosis is still unclear.
Interviewer: Gotcha. Interesting. As a final question, how will a list at the end of the day? How do you hope that your research mattered?
Dr. Campbell: The way that I hope this research matters is that I hope that it gives all of my colleagues who see children where there may be physical abuse a starting point for an evaluation that sets them on a more sort of level emotional floor so that they can move forward. That first step might lead to being able to move forward with a full evaluation of a difficult situation.
Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.