Child Abuse

Rationale

Child abuse and trafficking are significant issues around the world that are often poorly recognized. Timely awareness, evaluation, and reporting of suspected child abuse or trafficking is critical, allowing for early intervention to optimize outcomes for children and their families.

Causal Conditions

(list not exhaustive)

The following are components of child abuse and human trafficking:

1. Physical abuse
2. Sexual abuse/exploitation (sex trafficking)
3. Emotional/mental abuse
4. Neglect
5. Child marriage
6. Forced/exploitative labour (human trafficking)
7. Criminal activities (e.g., drug trade, theft)

Key Objectives

The candidate should recognize the signs, symptoms, and situations in which a potential for abuse exists.

Enabling Objectives

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

1. list and interpret critical clinical findings of possible abuse or trafficking, including
   1. suspicious injuries (e.g., fractures, bruises), especially with consideration of the nature of the injury, the caregiver’s explanation for the injury, and whether that explanation is consistent with the characteristics of the injury itself within the context of the child’s developmental status;
   2. suspicious circumstances (e.g., not being registered with a school, being unsure of which country or city they are in, being orphaned or living apart from their family, giving a prepared story that is very similar to stories given by other children);
   3. key manifestations (e.g., sexually transmitted infections, pregnancies, developmental delay, emotional/behavioural issues, failure to thrive);
   4. family dynamics, parental characteristics, or a social situation that may be contributing factors;
   5. other potential signs (e.g., refusal by a parent or guardian to have the child interviewed alone); and
   6. potential mimics of child abuse (e.g., accidental injury, medical conditions);
2. list and interpret critical investigations, including
   1. radiologic studies directed at treating the current injury and investigating evidence of previous trauma; and
   2. other investigations as indicated (e.g., coagulation studies, toxicology, psychological assessment); and
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 protection services;
      2. reporting to police services, when appropriate;
      3. determining whether other children are at risk and should be examined;
      4. admitting the child to hospital until their safety can be definitively established; and
   3. referring the patient for further evaluation and/or treatment (e.g., pediatrician, counsellor, social worker).