feature
“If you can prevent a child from being abused,” says Dr. Watson,
“you may prevent a lifetime of problems for them.”
the level requiring a report to CAS versus
giving the parents the benefit of the doubt or
providing general supports.
Start then with a responsibility to learn
about and understand the red flags. The physical signs, which are more obvious, include:
bruises and fractures which are attributed to
usual daily activity or unexplained, particularly in infants, and bruises in unusual areas
(fleshy area of the facial cheeks, buttocks,
abdomen).
Dr. Shouldice said the impact of abuse and
neglect may include developmental, behavioural and mental health symptoms which
may mimic conditions physicians commonly
assess, including aggressive behaviour, anxiety,
depression, impulsivity, and inattention.
“Physicians should consider inquiring
about exposure to violence in the home, as
they would about other psychosocial stressors, when assessing children presenting with
behavioural or mental health symptoms. This
requires speaking with the child separately
from parents and using neutral, open-ended
questions,” she said.
When a doctor does have suspicions, it isn’t
his or her role to confirm them. Remember,
this isn’t about absolute certainty but about
reasonable grounds.
Dr. Shouldice says if doctors do have genuine doubts about involving CAS, it may be
useful to consult child maltreatment experts
(you can find them in all the pediatric training centres), or to consult with CAS (i.e.,
discuss concerns in general, without providing identifying information).
“If you’re consulting, it’s generally because
14
Dialogue Issue 3, 2015
you’re uncertain if you should be concerned,”
says Dr. Shouldice. “If you’ve already reached
the threshold for reasonable grounds to be
concerned, the report should go to CAS.”
Yet other barriers can get in the way of
reporting. Dr. Shouldice says there can be a
tendency to believe a family when they explain
away signs of possible abuse or neglect. She
says the 2011 study in Academic Pediatrics
found that the more familiar doctors were with
families, the less likely they were to report.
Dr. William Watson, a family physician at
St. Michael’s Hospital in Toronto, says there’s
a reluctance to put families under a microscope, and perhaps a fear too that reporting
can make the situation worse. He says doctors
can also worry about what to say to families.
Although that conversation can happen in
a non-judgmental way: “Have you noticed
anything different with your child?” or “I
have a concern and would like to consult with
someone else.”
Child abuse and neglect is complex, but for
doctors who have suspicions the answer is ultimately straightforward: let the experts figure
it out. “If you can prevent a child from being
abused,” says Dr. Watson, “you may prevent a
lifetime of problems for them.”
Sources for Further Reading
• Mandatory and Permissive Reporting,
CPSO policy, www.cpso.on.ca
• “Reporting Child Abuse and Neglect: It’s
Your Duty”, Ministry of Children and
Youth Services, www.children.gov.on.ca