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Educational paper: Detection of child abuse and neglect at the emergency room
Arianne Hélène Teeuw1, Bert H F Derkx, Willeke A Koster
1Department of Social Paediatrics, Emma Children's Hospital, Academic Medical Centre, P.O. Box 22660, 1100, DD, Amsterdam, the Netherlands. a.h.teeuw@amc.nl
Insights
Emergency room staff can identify child abuse and neglect (CAN) in children. A combined screening approach, including checklists and examinations, aids early diagnosis and intervention for child abuse victims.
Area of Science:
- Pediatrics
- Emergency Medicine
- Child Welfare
Background:
- The emergency room (ER) is a critical access point for urgent healthcare needs.
- Child abuse and neglect (CAN) affects an estimated 2% to 10% of children presenting to the ER.
- Early identification of CAN is crucial to prevent recurrent abuse, as up to one-third of victims experience subsequent maltreatment.
Observation:
- ER personnel are often the first healthcare professionals to encounter potential CAN victims.
- Current screening methods for CAN in the ER require an in-depth overview.
- This paper reviews up-to-date screening methods for CAN in the ER setting.
Findings:
- A combined approach offers the most promising strategy for early CAN diagnosis in the ER.
- This approach integrates a risk factor checklist, structured clinical assessment, and 'top-to-toe' inspection.
- Standardized referral protocols for children whose parents present with intoxication or severe psychiatric disorders are essential.
Implications:
- Implementing a comprehensive screening protocol can improve the detection rates of CAN in emergency departments.
- Early intervention facilitated by improved diagnosis can mitigate the long-term consequences of child abuse and neglect.
- Enhanced training for ER staff on CAN recognition and screening is vital for child protection.
Unlabelled:
The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be recognised. Early diagnosis of CAN is important, as without early identification and intervention, about one in three children will suffer subsequent abuse. This educational paper provides the reader with an up-to-date and in-depth overview of the current screening methods for CAN at the ER.
Conclusion:
We believe that a combined approach, using a checklist with risk factors for CAN, a structured clinical assessment and inspection of the undressed patient (called 'top-toe' inspection) and a system of standard referral of all children from parents who attend the ER because of alcohol or drugs intoxication, severe psychiatric disorders or with injuries due to intimate partner violence, is the most promising procedure for the early diagnosis of CAN in the ER setting.
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