Child abuse

Supervisor

Anne Smith

Department

Gatehouse, Royal Children's Hospital

Email

anne.smith@rch.org.au

Objectives

Using the resources, look for answers to the following questions and be able to discuss them with your supervisor:

• In discussions of cases of child abuse, identify key concerns on history and examination
• In considering child abuse in the differential diagnosis, be able to plan investigations
• How opinion is formed re: accidental vs non-accidental trauma
• How opinion is phrased
• How best to intervene to protect the child/siblings
• How best to minimise risk of further harm

Resources and learning opportunities

1. Watch a paediatrician conduct a medical evaluation for suspected child abuse. Obtain a copy of the Department of Human Services booklet on Mandatory Reporting
2. Watch the video "Caught Out" about appearing in court as a witness
3. Attend one monthly peer review meeting
4. If available, attend Victorian Institute of Forensic Pathology, protective services and/or a court hearing with Gatehouse consultant
5. Write in your log book the contact numbers for:
   • Your local Protective services agency
   • Police agency that reponds to abused children
   • Phone numbers of doctors you might contact for advice re: child abuse issues
6. Choose one of the following for your special study:
   1. Physical abuse
      • Read chapter 12 "Physical Abuse: Accidental versus Intentional Trauma in Children" Charles F. Johnson, in The APSAC Handbook on Child Maltreatment. p206-226
      • Browse through the atlas "Physical Signs of Child Abuse: A colour atlas" Christopher J. Hobbs and Jane M Wynne
      • Complete the CD-ROM course "The Visual Diagnosis of Child Physical Abuse" American Academy of Pediatrics 2nd Ed. 1998
      • In your log book comment on case scenario 1 (physical abuse example)
   2. Neglect
      • Read chapter 6 "Neglect" in Child Abuse and Neglect: A Clinicians Handbook, Christopher J. Hobbs, Helga G. I. Hanks, Jane M. Wynne p123-148
      • Read Chapter 13 "Prevention and Ongoing Medical Management of Child Neglect", Howard Dubowitz in Treatment of Child Abuse, Robert M Reece p183-191
      • In your log book comment on case scenario 2 (neglect example)
   3. Clinical evaluation
      • Read Chapter 9 "clinical aspects of sexual abuse" in Child Abuse and Neglect: A Clinicians Handbook, Christopher J. Hobbs, Helga G. I. Hanks, Jane M. Wynne
      • Browse the photographic atlas section of "Evaluation of the Sexually Abused Child: A medical textbook and photographic atlas" Astrid Heger, S. Jean Emans and David Muram, 2nd Ed.
      • Complete the CD-ROM: The Medical Evaluation of Suspected Child Abuse CME Course 1. Univ of Calif. San Diego. Adams and Kellog. Jan 2001
      • In your log book list all the reasons you can think of that explain why children who have been sexually abused have genitalia that appear to be entirely normal
   4. Prevalence and long term effects
      • Use the internet to view "Prevalence of Childhood sexual abuse in a community sample of Australian women" Jillian M. Fleming MJA 1997: 166: 65-68
      • Use the internet to view Long term effects of Child Sexual Abuse: Paul E. Mullen and Jillian Fleming, Issues in Child Protection Number 9, Autumn 1998, National Child Protection Clearinghouse
      • In your log book, compare and contrast the incidence and prevalence of the various types of child abuse in Australia
      • In your log book list the possible long term effects of child abuse
   5. Emotional abuse
      • Use the internet to view and read Emotional Abuse: the hidden form of maltreatment: Adam M Tomison and Joe Tucci. Issues in Child Abuse Prevention Number 8. National Child Protection Clearinghouse
      • In your log book complete answers to case scenario 3 (emotional abuse)