![]() One problem lies in the definition of suspected. Still, the safety of the child should take precedence over the physician’s fear of lawsuits. This is also the case in many other jurisdictions, but because laws can vary, it is important for physicians to be familiar with the laws that pertain to their practice. In the United States, physicians are protected against liability for reporting a reasonable suspicion of child abuse and neglect if the report is made in good faith. Physicians should not let these concerns act as barriers to protecting a child. 34 Some physicians might overestimate their ability to manage the situation within their practice. Some pediatricians have experienced negative interactions with child protection agencies, which could make them distrustful of an agency’s response and its effect on the family. 33 Pediatricians worry about the intrusion of agencies into family life, the risk of the child being separated from the parents, or the possibility that the family will leave the practice if reported to a child protection agency. Studies have shown that some pediatricians are hesitant to involve outside agencies, even if they strongly suspect abuse has occurred. It is important to remember that in every state, and in all provinces and territories in Canada, it is mandated that professionals report suspected child abuse and neglect to the appropriate government agency (child protective services or police agencies, including tribal agencies). If the child is not at imminent risk, the pediatrician should decide whether child protective services should be contacted about the allegation. ![]() ![]() ![]() Reporting to child protection authorities. Is the child safe to go home? Is the child at imminent risk of additional harm if sent back to an environment where a possible perpetrator has access to the child? Is the child likely to be harmed or punished for disclosing abuse? Is there concern that the child might be coerced or intimidated to recant the disclosure? If any of these questions are answered “yes” or “maybe,” this is a child protection emergency, and the appropriate authorities (child protective services or law enforcement) should be contacted immediately. The AAP offers a variety of educational materials on child abuse to physicians, including a comprehensive CD-ROM, 30 textbooks on child abuse, 31, 32 and educational offerings at the National Conference and Exhibition. If pediatricians find that their regions do not offer specialized abuse-related services (eg, child advocacy centers or hospital-based child protection programs), it is important for them to educate themselves about childhood genital and anal examinations and about how to interview children to get enough information to make appropriate decisions about reporting to child protective service agencies, referring to counseling facilities, or referring to pediatric clinics specializing in abuse evaluations. In areas without these resources, the general pediatrician is often the most knowledgeable professional in the community regarding the evaluation and interviewing of children. Many communities and regions have specialized clinics or child advocacy centers where children can be referred when concerns of sexual abuse arise. The general pediatrician’s response depends on what resources are available in the community. Less commonly, a child presents to the pediatrician with an abnormal genital or anal examination, pregnancy, an STI, or sexual abuse witnessed by a third party or by discovery of sexually graphic images or videos in the possession of a potential perpetrator. Often, a child will present to the pediatrician after direct disclosure to another person regarding sexual abuse.
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