Nearly 1 million of these reports are substantiated, but some estimate the actual numbers are three to four times higher. Others counter that half of the reports cover child abuse due to neglect, and neglect in turn is linked to extreme poverty, substance abuse, and the absence of a nurturing parent, which is passed from one generation to the next. Most are under age four and die of head and abdominal injuries as well as from neglect. 2 Forty percent of these children had prior involvement with child protection services. Never before has the focus been as strong on the need for collaboration between medicine and child protection.
Physicians can no longer be comfortable reporting a few of their suspicious cases.
We as primary care providers must be able to make a diagnosis within a reasonable degree of medical certainty or ask for help from a child abuse consultant who can team with child protection and law enforcement investigators to provide a broader history. In most areas of medicine, the clinician is given a true and accurate history. A medical diagnosis is often made on that history alone. In cases of physical abuse, the diagnosis may be made based on either no history at all, or a history intended to deceive. The presenting injury is the prevailing information to make the diagnosis.