Monday, 4 July 2011

SBS: Bruises, burns and broken bones: Are doctors ready to call it child abuse?

ORONO, Maine — Physicians are often the first to examine babies and children who have been injured deliberately at the hands of their parents or other adults. The locations of bruises or burns, specific types of fractures and elevated levels of certain blood enzymes are among the red flags that should alert physicians to the possibility that a young patient may have been abused.
But, according to a national expert speaking Thursday in Orono, some doctors either don’t recognize the signs of abuse and neglect or are reluctant to report their suspicions to law enforcement or child protective authorities.
At a child welfare conference at the University of Maine, board-certified child abuse pediatrician Dr. Vincent Palusci told participants the physician role is crucial to documenting, treating and prosecuting child abuse and to helping rule it out.
“The medical evidence is often weak in legal cases,” Palusci said, speaking to a packed audience of about 250 social workers, lawyers, law enforcement officials and others who work closely with child abuse victims and their families.
Palusci said pediatricians, emergency room doctors and family practice physicians must stay up to date with new clinical developments in diagnosing head trauma, bone fractures, internal injuries and other trauma associated with abuse. He also put in a plug for the relatively new clinical specialty of pediatric child abuse. Only about 120 pediatricians nationwide are certified, including Dr. Lawrence Ricci of Spurwink children’s services program in South Portland, who introduced Palusci at Thursday’s conference.
Doctors and other medical professionals at Eastern Maine Medical Center in Bangor, The Aroostook Medical Center in Presque Isle, Houlton Regional Hospital and Maine Medical Center in Portland tuned in to Palusci’s talk through videoconferencing technology.
Dr. Mark Brown, chief of pediatrics at EMMC, said about 35 pediatricians, emergency room doctors and other professionals participated through the computer link. Brown said doctors sometimes are cautious about reporting suspected child abuse for fear of mistakenly implicating innocent parents or other caregivers.
“You always worry about it,” he said. “You want to be precise and take a team approach so there’s not just one person making the call.”
On the other hand, he said, giving the parents the benefit of the doubt can be a mistake.
“The next time may be more severe,” he said. “Had you acted earlier, you might have had a normal baby in foster care rather than a baby with a permanent disability.”
Brown said much of Palusci’s talk was a review for the EMMC physicians, who stay abreast of child abuse issues.
According to the national Every Child Matters Education Fund, which advocates for the welfare of children in the United States, the rate of child abuse deaths in this country is three times higher than Canada’s and 11 times higher than Italy’s. Maine’s per-capita spending on child abuse prevention ranks among the lowest in the nation, at $31.88. Top-ranked Rhode Island spends $181.34 per person, according to the organization.
In Maine, reported cases of child abuse and neglect decreased from 16,678 in 2001 to 16,191 in 2008, according to statistics from the federal Department of Health and Human Services, while the number of reported child deaths because of abuse and neglect rose from two deaths to four deaths over the same period. The actual incidence of child abuse and fatalities is thought to be much greater than reported.
Accurate diagnosis of abuse-related injuries not only helps remove a child from the abusive environment but also enhances treatment and recovery, Palusci said. In the example of abusive brain injury in an infant, sometimes called “shaken baby syndrome,” early intervention can significantly reduce the likelihood and severity of permanent brain damage and even death, he said.
At the same time, he said, doctors must be careful not to assume a child has been abused, even if the nature of the injuries indicate it. For example, certain medical conditions can leave babies’ bones brittle and easily broken, he said, and inquisitive toddlers sometimes do fall down stairs or climb into scalding water.
“You don’t want to be the person who ran to an abuse diagnosis that got someone [wrongfully] convicted,” he said. “Then they’re going to do a television documentary on you.”
The conference, titled “Hot Topics in Child Welfare,” was the 17th annual child welfare conference in Maine, aimed at increasing collaboration between professionals in the field. Workshops throughout the day on Thursday focused on ethical implications for social workers, successful investigation and prosecution of child abuse cases, and strategies for engaging appropriate family participation in cases where children have been removed from an abusive home.
The daylong event wrapped up with a second presentation by Palusci on how children encounter abuse while in hospitals and other medical settings.
The event was organized and funded by the National Council on Ending Child Abuse Deaths, the Maine Department of Health and Human Services, and the Community Health and Counseling agency in Bangor. Additional support was provided by the Bangor Police Department, Eastern Maine Medical Center, Penobscot Community Health Care and other organizations.

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