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The Other Children
A Survey of Child Abuse Physicians on the Medical Evaluation of Children Living With a Physically Abused Child
Kristine A. Campbell, MD, MSc;
Debra L. Bogen, MD;
Rachel P. Berger, MD, MPH
Arch Pediatr Adolesc Med. 2006;160:1241-1246.
Objective To explore the practice and attitudes of child abuse physicians regarding the evaluation of "contact children" identified in the home of a physically abused index child.
Design A self-administered survey.
Setting E-mail and postal mailings from May 10 through September 30, 2005.
Participants Physicians in the United States recognized as experts in child abuse medicine based on membership in the Helfer Society.
Main Outcome Measures Descriptive measures of recommended medical evaluations of contact children in 3 clinical settings, estimates of association between these recommendations, and respondent experiences.
Results There was a 61% (93/153) response rate. Respondents uniformly endorsed medical evaluation for contact children, although there was substantial variability in the extent of evaluation recommended. Recommended diagnostic testing varied by age of contact child and by type of abuse in the index child. Recommendations were influenced by anecdotal recall of abused contact children "missed" during the initial evaluation of another child in the household. Of our 93 respondents, 37 (40%) reported routine disagreement with child protection workers about the need for medical evaluation of contact children.
Conclusions Child abuse physicians perceive that findings of abuse in contact children are sufficiently frequent to warrant medical examination of most contact children, but there is no consensus on the extent of evaluation needed for contact children. A better understanding of risk of abuse in contact children and improved collaboration between physicians and child protection workers are needed to improve evidence-based care of this high-risk population.
Author Affiliations: General Academic Pediatrics (Drs Campbell and Bogen) and Child Advocacy Center (Dr Berger), Children's Hospital of Pittsburgh, Pittsburgh, Pa. Dr Campbell is now with the Division of Safe and Healthy Families, Department of Pediatrics, Primary Children's Medical Center, Salt Lake City, Utah.
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