Managing a Case Of Suspected Child Abuse

You are a resident in the emergency department. An irritated parent comes to you because the social worker has been asking him about striking his child. The child is a  5-year-old boy who has been in the emergency department four times this year with several episodes of trauma that did not seem to relate. Today, the child is brought in complaint of "slipping into a hot bathtub" with a burn wound on his legs. The parent threatens to sue you and says "How dare you think that about me? I love my son!"

What should you do?

a. Giver reassurance to the Parents and treat the patient's injury appropriately,

b. Ask risk management to evaluate the case.

c. Admit the child to remove him from the possibly dangerous environment.

d. Call the police.

e. Ask the father yourself if there has been any abuse.

f. Speak to the wife privately about possible episodes of abuse.

g. Explain to the parents that the next time this happens you will have to call child protective services.

h. Report the family to child protective services.

i. Give the parents a referral to a family therapist they can see with the child the following week.

Answer:
(h) Report the family to child protective services.

Discussion:  Although, in general, it is better to address issues directly with patients and their families,this is not the case when you strongly suspect child abuse Reporting of child abuse is mandatory even based on suspicion alone. Although it is frightening to be confrontational with the family, the caregiver is legally protected even if it turns out to be no abuse as long as the report was made honestly and without malice.

You do not have the authority to remove the child from the custody of the parents. Only child protective services or the courts can do that.

The police would be appropriate for an assault happening at that exact moment, but the police are not appropriate to investigate child abuse

When you have a suspicion of child abuse,it doesn't matter what the parents say. That is why talking directly to the mother or father is incorrect.

When you suspect abuse, even if the family denies it, you must still report.