The general public has been bewildered by the magnitude of sex abuse cases and the widespread failure by pillars of the community to notify appropriate authorities. The crime of sexually abusing children is punishable in all jurisdictions and this article examines the duty to report suspected cases by individuals in positions of trust over young people, such as in the church or university sports. The Federal Child Abuse Prevention and Treatment Act (CAPTA) defines child maltreatment as an act or failure to act on the part of a parent or caregiver that results in death, serious physical or emotional harm, sexual abuse, or exploitation, and establishes minimum federal standards. Each state has its own definitions of maltreatment and every state identifies persons who are required to report child abuse. As such, state law is highly variable in defining who has a mandatory duty to report, and clergy and other individuals in close supervision of children (e.g., athletic coaches, scout leaders, volunteers in religious programs, and university officials) may necessarily hold such duty.The article outlines why there are strong moral reasons the law should require all adults in close supervision of children to report any individual who they have good reason to believe has abused a child and moreover outlines how to ensure prompt reporting of abuse, while still ensuring that respected individuals are not falsely accused.
[Show abstract][Hide abstract] ABSTRACT: A human rights perspective places the care for children in the obligation sphere. The duty to protect from violence is an outcome of having a declaration confirming inalienable human rights. Nationally, rights may be reflected in constitutions, charters, and criminal codes. Trans-nationally, the United Nation's (UN) Convention on the Rights of the Child (CRC) prioritizes a child's basic human rights, given their dependent status. UN CRC signatory countries commit to implementing minimal standards of care for minors. Laws requiring professionals to report child maltreatment to authorities is one practical strategy to implement minimal child protection and service standards. Mandatory reporting laws officially affirms the wrong of maltreatment, and the right of children. Mandatory reporting can be conceptualized as part of a resilience process, where the law sets the stage for child safety and well-being planning. Although widely enacted law, sizeable research gaps exist in terms of statistics on mandatory reporting compliance in key settings; obstacles and processes in mandatory reporting; the provision of evidence-based training to support the duty to report; and the training-reporting-child outcomes relationship, this latter area being virtually non-existent. The fact that mandatory reporting is not presently evidence-based cannot be separated from this lack of research activity in mandatory reporting. Reporting is an intervention that requires substantial inter-professional investment in research to guide best practices, with methodological expectations of any clinical intervention. Child abuse reporting is consistent with a clinician's other duties to report (i.e., suicidality, homicidality), practice-based skills (e.g., delivering "bad" news, giving assessment feedback), and the pervasive professional principle of "best interests" of the child. Resilience requires the presence of resources and, mandated reporting, is one such resource to the maltreated child. Practice strategies identified in the literature are discussed.
[Show abstract][Hide abstract] ABSTRACT: This 3-month-old male infant, with a history of a short fall, presented with vomiting, enlarging head circumference, and bulging fontanel. He was irritable but otherwise alert and nonlethargic. He had no identified retinal hemorrhages, bruises, or fractures and had bilateral SDH on CT and MRI of different densities. The small facial bruise accompanied by vomiting are significant aspects of the history that suggest recurrent abuse. A prolonged wait for the mother to return home could have been fatal. The father's unemployment suggests a social risk factor for abuse. The finding of isolated SDH in an infant with a history of minimal or no trauma needs careful evaluation for causes other than child abuse. Sentinel injuries may be overlooked and earlier mild symptoms may be ascribed to another cause. Despite the likelihood that the SDHs represent different ages of injury, current research and literature suggests that mixed density subdural fluid may occur in situations without recurrent injury. The possibility of a missed earlier injury and the lack of extracranial findings create a situation where the provider must rely heavily on the history or lack thereof.
The Journal of pediatrics 01/2013; 162(5). DOI:10.1016/j.jpeds.2012.11.072 · 3.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: PURPOSE OF REVIEW: This review summarizes the key articles in the field of child maltreatment, addressing abusive head trauma, physical abuse, sexual abuse, and global issues surrounding maltreatment. This topic is salient for both general pediatricians as well as specialists. RECENT FINDINGS: Many articles this year focus on the importance of making an accurate diagnosis when considering child maltreatment, whether in the form of physical or sexual abuse. There is also a focus on understanding the epidemiology of abuse, as some data show a decrease in numbers, which is felt by many in the field to be a misleading impression. SUMMARY: An appreciation of the scope of Child Abuse Pediatrics requires an understanding of physical abuse, sexual abuse, and neglect. The authors summarize notable advances in our understanding of these key areas in a review of the year's best literature.
Current opinion in pediatrics 02/2013; 25(2). DOI:10.1097/MOP.0b013e32835eb347 · 2.53 Impact Factor
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