Social and judicial reports of children suspected of abuse in one pediatric emergency department : description and follow up.
Introduction
Pediatric emergency departments are key actors in child welfare. However, children at risk of abuse may be difficult to detect and may remain unrecognized. One of the barriers to report children at risk of abuse to the child protective services (social report SR) and/or to the prosecutor’s offices (judicial report JR) is the fear to be mistaken.
This study described the reported cases of children suspected of abuse in one pediatric emergency department and their social and judicial feedbacks.
Materials and method
Retrospective analysis of visits of children 0 to 18 years old in one academic pediatric emergency department between January 2015 and December 2016 that were followed by a SR or a JR.
Demographics data, previous visits in an emergency department and the reasons of the SR or the JR were gathered from the electronic medical records. The follow-up and outcomes of the SR or the JR were searched for by contacting the child protective services and the prosecutor’s office.
Results
During the study period in our hospital, 180 children that visited the emergency department had a SR or a JR, that is a prevalence of ,0.17% of visits. The median age was 4.4 years (19 days - 17.3 years), 68 children (38%) were less than 2 years old. A previous visit in an emergency department was found in 84 children (47%) mainly for ""skin lesion, hematoma"" (N = 35, 19%) and ""burn"" (N = 17, 9%). The child abuse was mainly suspected because of the parents' attitude, the features of the lesion and/or the fact that the child or his parents had reported the abuse. Physical abuse was the main diagnosis (N = 73, 40%). There were 122 SR and 58 JR. A follow up was available for 155 children (98 SR and 54 JR). Fifty eight SR (38%) resulted in a socio-educational intervention. All of the JR (N = 54) and 40 SR resulted in an initial judicial process. From these 94 judicial processes, 32 Provisional Placement Orders (34%) were made. Finally, 3 of these 155 children had a differential diagnosis of child abuse and were dismissed by the child protective services and/or the prosecutor’s offices.
Conclusion
Most of the SR and JR performed during the study period resulted in social or judicial measures. Moreover, the differential diagnoses of child abuse in children with a SR or a JR were extremely low. However, the prevalence of SR and JR in our pediatric emergency department was low. These results should encourage physicians that suspect child abuse to report it and endorse researchers and projects that aim to improve child abuse detection, management and follow-up.
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