The Role of the Doctor in Managing an Abused Child

There are different forms of abuse perpetuated against children. The most common forms of abuse are sexual, psychological, physical and child neglect. There are several signs that the doctor should look out for when faced with a child that is possibly being abused. When interviewing the parents/guardians, the history may be inconsistent; the parents/guardians may be reluctant to let the child be interviewed alone even when a chaperone is with the child, the child showing apprehension when certain gestures are made to some parts of the body could indicate past sexual abuse. If the child is old enough to talk and is interviewed alone, the history the child gives is different from that of the parents/guardians. Answers to simple questions posed to the child, like when was the last time s/he marked or celebrated his/her birthday, what presents did s/he receive on his/her birthday or what special treatment was given to the child on his/her birthday may reveal psychological abuse. Physical marks, bruises or fractures on the body that are disproportionate to the history given may be physical abuse. In babies, child abuse can be indicated by the low weight gain after all other causes have been ruled out. Investigations through blood, X-ray and working with a team of experts may be necessary in managing an abused child. If proper history is not taken, the doctor may make a diagnosis of abuse when there is none. Therefore, when the interviewing doctor is uncertain, a senior colleague or another doctor with experience on child abuse should be called to see the patient. Once the diagnosis is made, treatment is often long-term and involves collaboration with several departments including social services and sometimes, the police department.