Download PDF by W.MURRAY: 4a - Things We Do


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Remarkably, in the continuous registration network one third of the victims are boys, whereas the CPS reports as many boys as girls. The reasons are unclear as to why there is a significant discrepancy between incidents of child abuse recorded with the registration network and the likely number of victims. It is possible that some cases remain completely out of the GP’s sight. g. bruise) and not the possible cause; after all parents always have the right to see the files of their children. Another possible explanation might be that (early) signs of child abuse are not recognized at all, due to lack of knowledge or failing continuity when patients are seen by other GPs in the evenings or at weekends.

First, past subjective experiences strongly influenced their personal practices. In particular, negative experiences with the CPS reduced the physicians’ confidence in detecting abuse. Second, doctors felt an enormous responsibility to make a correct assessment within the limited time of an office visit. Moreover they reported that their relationships with the families involved both facilitated and hampered their assessment of possible child abuse. On the one hand a close relationship made it more difficult to think of abuse.

Examination A detailed assessment of the injury and full examination of the child will be requested. This requires the child to be fully undressed. It greatly benefits all if the parents are aware that this will happen before the medical assessment. Investigations include clotting screen for children with bruising and skeletal survey for children under two years. Infants may be admitted for a more thorough assessment for non-accidental head injury. Skeletal surveys usually include repeat chest X-ray or full survey as particularly rib fractures may not show up immediately (RCPCH 2008b).

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4a - Things We Do by W.MURRAY

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