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The pediatrician, a key element against abuse

The pediatrician, a key element against abuse

Pediatricians are a key element in the network that protects children against Abuse and that fights for the eradication of the problem. However, in many cases they face the difficulty in issuing the diagnosis due to insufficient evidence or excuses from family members. The Series on Child Maltreatment review, published in The Lancet, guides the doctor in any doubts that may arise and proposes ways to end abuse from areas such as advertising or through government measures.

“The mistreatment that is revealed is a minimum amount of the total that exists.” It is said that the mistreatment detected is equivalent to the protruding tip of an iceberg of all the abuse, in which there are 9 or 10 times more than those that reach diagnose yourself, “explained Ángel Nogales Espert MD, Head of the Department of Pediatrics at Hospital 12 de Octubre in Madrid.Child abuse includes physical, psychological, sexual abuse and neglect of the child’s daily care. At present it would have to be a smaller problem in the developed countries; however, it manifests itself in all types of sociocultural level.
To deal with this problem the work of the doctor, and in particular of the pediatrician, is very important because they are the most qualified subjects to reveal possible abuse.In most cases the abuses are not clear. There are children who come to the hospital with their parents or relatives and have different types of injuries that are suggestive of abuse. “In these situations the doctor can not be inhibited because, assuming he suffers abuse of some kind, the child is in a very important risk situation,” explains Nogales.

In these cases, the pediatrician notifies the judge of the possibility of abuse and the social assistance services and judicial services intervene. From there, all the machinery that protects the child is put in place, which ranges from establishing an observation in the home to separating it from the parents’ own home or from people who have parental authority. Sometimes children enter protection programs.

“Something very important that is done from the hospital in these cases is to admit the minor, it is a way of protecting it until the situation is clarified,” explains Nogales. Discretion is present when dealing with family members. “They can not be accused of a fact that perhaps does not exist.” Many times, when they are notified of the suspicion of abuse, they react violently because they believe that we are directly accusing them and then it has been proven that the abuses were carried out by nannies or people close to them. family”.

Difficult diagnosis

To facilitate the work of pediatricians, Dorothy Scott, director of the Child Protection Center of Australia, and Carole Jenny, a pediatrician at Brown University in the United States, have prepared the series on Child Maltreatment review published in the last issue of The Lancet.

In this one the main problems that doctors can find appear. First of all, they emphasize that in order for a change to occur, the existence of a collective responsibility with children by society is necessary, which sometimes does not recognize the obligation to protect them and does not want to believe that there are situations in which the family neglect or mistreat

“Retaining the arguments of parents is an added difficulty,” Jenny explains. “Affirmations of the type: he eats constantly, I do not understand why he is so thin they make the diagnosis wrong because the symptoms and explanations that are given are wrong and impose barriers to identify the problem”.

The physicians say that it is very difficult to have evidence that there is abuse, but they add that there are fractures that suggest that they are not injuries produced spontaneously by a child when playing, but that there is something underlying. In these situations pediatricians should not avoid suspicion or diagnosis, since there are situations that go unnoticed. In Spain, only about ten percent of abuse is diagnosed.

“A child with four or five fractures, or with behavior that is abnormal with the parents and the pediatrician, are indicators that put the doctor on alert for possible abuse,” Nogales explains. “The doctor always acts on the basis of alleged abuse, hence the difficulty, and no diagnosis is made with absolute certainty.”


The authors of Series on Child Maltreatment conclude by explaining that if the mistreatment continues until adolescence it is a risk factor for children to become violent and criminal. In addition, they are more likely than their peers to be arrested for prostitution, and it is more common for them to fall into alcohol and drugs. Also, one in five abused children have suicidal behavior.

“At present the programs are effective, there is more and more awareness and less abuse will be overlooked,” says Nogales. There are indirect signs that lead the pediatrician to act on any suspicion of abuse. “If it happens that there are no abuses, it is explained to the parents, who usually understand it, the doctor can not ignore it because it leaves the child exposed to more abuse”.

Alternatives to end the mistreatment

The Series on Child Maltreatment review offers solutions to facilitate the work of the pediatrician. It mainly advocates relying on the tests the doctor gives in the diagnosis, as well as the implementation of experts in the courts that support the findings of the pediatricians, and that limit their opinions to the area they handle. In the United Kingdom, a radiologist testified in a trial on the evidence he had found in the bones ignoring the skin wounds, which complicated the sentence.

In addition, social inequalities are a very important factor among the causes of child abuse. To improve children’s opportunities, other ways should be explored, such as advertising campaigns and measures that come from the government to reduce alcohol consumption by parents, such as prohibiting advertisements for alcoholic beverages or increasing taxes on high-alcohol drinks. alcohol content

In order for there to be a change, the responsibility of the society, the involvement of the pediatrician and the support to the medical group that fights against the abuse are very important.

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The pediatrician, a key element against abuse


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