Original Article

Diagnosis of Child Maltreatment: A Family Medicine Physician’s Dilemma

Authors: Kehinde Eniola, MD, MPH, Lori Evarts, MPH

Abstract

Objectives: Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians’ confidence in diagnosing CM.

Methods: We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training.

Results: Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%).

Conclusions: The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians’ confidence and competence levels in diagnosing CM.

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References

1. United Nations, Human Rights, Office of the High Commissioner. Convention on the rights of the child. http://www.ohchr.org/en/professionalinterest/pages/crc.aspx. Published November 20, 1989. Accessed November 11, 2015.
 
2. World Health Organization. Environmental risks. http://www.who.int/ceh/risks/en. Accessed November 11, 2015.
 
3. Leeb RT, Paulozzi L, Melanson C, et al. Child maltreatment surveillance: uniform definitions for public health and recommended data elements, version 1.0. https://www.cdc.gov/violenceprevention/pdf/cm_surveillance-a.pdf. Published January 2008. Accessed February 8, 2017.
 
4. Fingarson AK, Flaherty EG, Sege RD. Improving physician identification and report of child maltreatment. J Clin Outcomes Manag 2011;18:185-190.
 
5. Ravichandiran N, Schuh S, Bejuk M, et al. Delayed identification of pediatric abuse-related fractures. Pediatrics 2010;125:60-66.
 
6. Starling SP, Heisler KW, Paulson JF, et al. Child abuse training and knowledge: a national survey of emergency medicine, family medicine, and pediatric residents and program directors. Pediatrics 2009;123:e595-e602.
 
7. Regnaut O, Jeu-Steenhouwer M, Manaouil C, et al. Risk factors for child abuse: levels of knowledge and difficulties in family medicine. A mixed method study. BMC Res Notes 2015;8:620.
 
8. Jackson AM, Deye KP, Halley T, et al. Curiosity and critical thinking: identifying child abuse before it is too late. Clin Pediatr (Phila) 2015;54:54-61.
 
9. Thorpe EL, Zuckerbraun NS, Wolford JE, et al. Missed opportunities to diagnose child physical abuse. Pediatr Emerg Care 2014;30:771-776.
 
10. Menoch M, Zimmerman S, Garcia-Filion P, et al. Child abuse education: an objective evaluation of resident and attending physician knowledge. Pediatr Emerg Care 2011;27:937-940.
 
11. Lane WG, Dubowitz H. Primary care pediatricians’ experience, comfort, and competence in the evaluation and management of child maltreatment: do we need child abuse experts? Child Abuse Negl 2009;33:76-83.
 
12. Crichton KG, Cooper JN, Minneci PC, et al. A national survey on the use of screening tools to detect physical child abuse. Pediatr Surg Int 2016;32:815-818.
 
13. Wells BM, Crouch JL, Schubert R, et al. Revisiting the issue of the Child Abuse Potential Inventory’ internal consistency in adolescent samples. J Adolesc Health 2011;48:351-357.
 
14. Hymel KP, Herman BE, Narang SK, et al. Potential impact of a validated screening tool for pediatric abusive head trauma. J Pediatr 2015;167:1375-1381.e1.