Child Abuse

I've been putting off this serious but important post on child abuse. We had a lecture on "non-accidental injury" last week by one of the experts on the subject. I was quite taken by the topic. Child neglect and abuse (physical, emotional, and sexual) play an unfortunately prominent role in child morbidity and mortality. It's really shocking to me. As such, it is the responsibility of all physicians (not just pediatricians) to assess patients for these injuries. What really struck me is how difficult it is to identify child abuse. While certain pathologies (types of bruising, various fractures) highly suggest abuse as an etiology, this is confounded by diseases like hemophilia and osteogenesis imperfecta. For every suspected case of abuse, there can be a biologic explanation. On the other hand, injuries that may be explainable could end up being abuse. This puts physicians in a tough position since child abuse is something that we really need 100% sensitivity and specificity for identifying. No one wants to miss a case, and the consequences of a false case could be potentially devastating. This whole issue is an interdisciplinary one, involving social workers and child protective services and the police. I found the talk poignant and educational.