7 Abuse of spouses and intimate partners is a pediatric issue even when children are not being physically assaulted. Pediatricians should be aware of the profound effects family violence has on children who witness it or even overhear it. Witnessing violence in the home can be as traumatic for children as being the victim of physical or sexual abuse. Children whose mothers are abused may experience serious emotional distress and manifest severe behavioral problems as a result. 6,8 Adolescents who observe abusive relationships at home may repeat that dynamic in dating or other relationships.
Abused women are unlikely to seek care for their injuries from pediatricians.
However, mothers of children seen by pediatricians may show signs of injury such as facial bruising. They may have other less obvious signs of abuse such as depression, anxiety, failure to keep medical appointments, reluctance to answer questions about discipline in the home, or frequent office visits for complaints not borne out by the medical evaluation of their child. Women may reveal the abuse to the pediatrician if they are questioned in a sympathetic and sensitive manner, in a confidential setting, away from the abuser, and provided some assurance of safety. A pediatrician who suspects that family violence is occurring or who recognizes signs of possible inflicted injury should try to deal with the issue as soon as possible, preferably while the family is in the office. The pediatrician should gently introduce the topic in a way that assures her that the conversation is confidential, the problem is acknowledged, other resources for help are accessible, and her wishes about further disclosure or referral will be respected.