Medical Council of Canada

Medical expert

Child Abuse - 114-1

Rationale

Child abuse occurs when a caregiver whom a child trusts or depends on, compromises, either by acts of omission or commission, the safety and/or physical, emotional or sexual well-being of a child and may lead to significant morbidity and mortality.

Child abuse is a common, yet under-recognized and under-reported condition. Accurate and timely diagnosis of children who are suspected victims of abuse can ensure appropriate evaluation, investigation, and outcomes for these children and their families.

Causal Conditions

(list not exhaustive)
  1. Physical abuse
  2. Mental abuse
  3. Sexual abuse
  4. Emotional abuse
  5. Neglect
  6. Exposure to domestic violence

Key Objectives

The candidate should be aware of presentations in which a history of abuse should be considered. Given a child in whom a history of abuse is suspected, the candidate will construct an appropriate management plan with particular attention to issues of safety and prevention.

Given a child in whom a history of abuse is disclosed, the candidate will identify the cause, severity, complications, and contributing factors. An appropriate initial management and prevention plan should also be constructed.

Enabling Objectives

Given a child presenting with any injury, the candidate will recognize those injuries suspicious for abuse when considering the nature of the injury, the caregiver's explanation for the injury, and whether that explanation is supported by the characteristics of the injury and the child's developmental status.

Given a child in whom abuse is suspected or disclosed, the candidate will

  1. list and interpret critical clinical findings, including
    1. key manifestations of abuse (e.g., sexually transmitted infections, developmental delay, emotional/behavioural problems;
    2. family dynamics, parental characteristics and social situation that may be contributing factors;
    3. other potential signs of abuse (e.g., refusal by parent to have child interviewed alone);
    4. potential mimics of child abuse (e.g., accidental injury, medical conditions);
    5. the need for an appropriate history and physical examination to look for further evidence of abuse (e.g., bruising, scars);
  2. list critical investigations, including
    1. radiologic studies directed at treating the current injury and investigating evidence of previous trauma;
    2. other investigations, as indicated (e.g., coagulation studies, toxicology);
  3. construct an effective initial management plan, including
    1. diligent documentation;
    2. outlining strategies for ensuring the child's safety, including specifically;
      1. reporting to appropriate child welfare agency;
      2. determining whether other children are at risk and whether they should be examined;
    3. referral to a pediatrician or hospital child protection team for further evaluation/opinion, if available.
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