Pediatricians have a role in reporting domestic violence

by Crystal Phend

One of the most effective ways to prevent child abuse may be for pediatricians to identify domestic violence against a child’s caregiver, according to a report from the American Academy of Pediatrics.

Intimate partner violence in the home has a profound effect on kids, Jonathan D. Thackeray, MD, of Columbus Children’s Hospital in Columbus, Ohio, and colleagues wrote in the May issue of Pediatrics.

They pointed to elevated risk of abuse, neglect, and development of adverse health, behavioral, psychological, and social disorders later in life.

Children are not only collateral victims in these attacks, but are at risk as intimate partner violence is considered the leading precursor of child maltreatment, according to the clinical guidance report.

Studies have shown that child abuse and intimate partner violence happen together in 30% to 60% of families in which one occurs.

While most often approached as a women’s health problem, “it is clear that intimate partner violence is a pediatric issue,” Thackeray’s group wrote.

The pediatric setting is ideal for identification since most abused caregivers will seek care for their children but not for themselves, Thackeray’s group wrote.

The signs are usually subtle — such as depression, anxiety, failure to keep medical appointments, reluctance to answer questions about discipline in the home — but are often absent altogether, they said.

Because of this, universal screening is advocated by some. But as the U.S. Preventive Services Task Force has concluded, there’s not enough evidence to support this approach over a “case finding” method.

Until better evidence accrues, “it seems reasonable to incorporate early and repeated questioning regarding intimate partner violence as part of anticipatory guidance while remaining mindful of clinical presentations that suggest risk,” according to the AAP report.

Broaching the subject can be uncomfortable for both pediatricians and caregivers, so a self-administered assessment whether written or computerized may be preferred, it noted.

Some nonjudgmental introductory statements suggested were:

* “We all have disagreements at home. What happens when you and your partner disagree?”
* “Is there shouting, pushing, or shoving? Does anyone get hurt?”
* “Has your partner ever threatened to hurt you or your children?”
* “Do you ever feel afraid of your partner?”
* “Has anyone forced you to have sex in the last few years?”

Pediatricians also need to plan ahead for what to do when someone screens positive for such abuse.

Once a woman or man discloses partner abuse, their risk of injury and death at the hands of the abuser rises and, unlike situations involving children, no state agencies are required to step in to protect adults.

“Thus, the process of disclosure is naturally very frightening and may not occur unless the caregiver feels that he or she is not in significant jeopardy,” Thackeray’s group wrote in Pediatrics.

The AAP recommended that pediatricians be familiar with local laws on reporting and partner with obstetricians, prenatal clinic and hospital nurses and social workers, public health administrators, and early childhood education programs to coordinate a community response.

Efforts to intervene should be carried out in a “sensitive and skillful” manner, attempting to maximize the safety of caretakers and their children.

The AAP report suggested discretion when putting a disclosure of abuse in medical records that may be accessible by the abuser or providing printed information, which could put the abused partner at risk if discovered at home.

Crystal Phend is a MedPage Today Senior Staff Writer.

Originally published in MedPage Today. Visit MedPageToday.com for more pediatrics news.

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