Doctors must do more to identify child abuse, Dutch association saysBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1679 (Published 15 September 2008) Cite this as: BMJ 2008;337:a1679
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By definition ‘child abuse’ is when an adult harms a child or a young
person under the age of 18 years. The abuse can be physical, emotional,
sexual, and child neglect. These can result in long term damage to the
child. Domestic violence and bullying are forms of child abuse.
Child abuse in any form is always wrong and is never the fault of the
young person involved. The following list of observations provided by the
National Society for the Prevention of Cruelty to Children (NSPCC) could
point towards the possible child abuse. These include
• Inadequately dressed and dirty or hungry
• left in unsafe situations or without any medical attention
• humiliated, sworn at or constantly “put down”
• Child afraid of parents and or carers.
• Injured and or severely bruised
• Displaying sexual behavior which doesn't seem appropriate for their age
• Children growing up in homes where there is domestic violence, and or
serious drug or alcohol abuse (NSPCC, 2007).
The magnitude of this problem is no different from the Dutch. The
facts available from NSPCC indicate that one child is killed at the hands
of their parents per every ten days in England and Wales. In 52% of all
the cases of children killed at the hands of another person the parent is
the principal suspect. 32% of all the rapes recorded by the police are
committed against the children under the age of 16 years old (NSPCC,
2007a). A recent UNICEF (United Nations International Children's
Emergency Fund) report on child well-being ranked the United Kingdom and
the United States among the lowest ‘first world’ nations with respect to
the well being of their children. It is also reported that child neglect
and child abuse are more common in single-parent families than in families
where both parents are present (Wikipedia, 2007).
All the professionals involved in dealing with children must remain
alert to the possibility of serious, life threatening abuse (Jones P H D
& Lynch A M, 1998).
The General Medical Council (GMC) recognizes that the doctors play an
important role in protecting children from neglect and abuse. Early
identification of child abuse can help the children and young people get
the care and support they needed to be healthy, safe and happy, and to
achieve their potential.
Doctors working with children or young people should have sufficient
knowledge and skills to identify the abuse and they are advised to be
aware of the use of frameworks for assessing children and young people’s
needs like the work of Child protection Committees, Local Safeguarding
Childrens’ Boards policies and procedures and organisations that work to
protect children and promote their welfare.
It is possible for parents and children and young people to think
that by disclosing information about themselves, they will be denied help,
blamed or made to feel ashamed. Doctors must help the children, young
people and parents involved to understand the importance and benefits of
sharing information with an appropriate person or authority. They must not
delay in sharing such information with an appropriate person or authority
if delay would increase harm to the child or young person or to the other
children or young people.
Should there be any doubt about whether to share information, doctors
should seek advice from an experienced colleague, a named or designated
doctor for child protection or from a professional body such as GMC or the
defense organisation. One is justified raising concern, even if it turns
out to be groundless when done honestly, promptly, on the basis of
reasonable belief, and through the appropriate channels. Confidentiality
is important at all times and the information sharing should be
proportionate to the risk of harm. Doctors must inform an appropriate
person or authority promptly of any reasonable concern that children or
young people are at risk of abuse or neglect, when that is in a child’s
best interests or necessary to protect other children or young people.
Should any one decide not to share such concerns or information, they
should record all the reasons and circumstances leading up to such a
Doctors are advised to participate fully in child protection
procedures, attend meetings whenever practical and co-operate with
requests for information about child abuse and neglect. When the purpose
of the review is to protect the other children or young people, one should
be prepared to share relevant information even if the child or young
person or parents do not consent or it is not possible to ask for consent.
Decisions not to share such information must be justified.
The GMC also advises all the doctors to have a good understanding of
the roles, policies and practices of other agencies and professionals
which includes understanding the circumstances in which they consider
disclosure to be justified. These agencies and professionals such as
teachers, social workers, police, youth offending teams and others all
have different relationships with children and young people. They also
have different policies, cultures, and guidance on sharing such
information. Doctors are advised to understand and respect these
differences but at the same time keep in mind the responsibilities and
importance of the trust factor between the doctor and patient relationship
General Medical Council (2007) 0-18 years: guidance for all doctors.
[Internet] General Medical Council Publication. Available from<
http://www.gmc-uk.org/guidance/archive/GMC_0-18.pdf> [Accessed on 16th
of September 2008] Page :24-26.
Jones P H D & Lynch A M. (1998) Diagnosing and responding to
serious child abuse. BMJ, 998;317:484-485.
National Society for the Prevention of Cruelty to Children (2007) What is
child abuse? [Internet] London. Available from<
[Accessed on 16th of September 2008]
National Society for the Prevention of Cruelty to Children (2007a)
Key facts and figures -About child abuse and the NSPCC. [Internet] London.
[Accessed on 16th of September 2008]
Wikipedia. (2007) Child abuse. [Internet] Wikimedia Foundation Inc
publication. San Francisco. Available from<
http://en.wikipedia.org/wiki/Child_abuse> [Accessed on 16th of
Competing interests: No competing interests