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MCC Examination Objectives Medical expertViolence, familyChild abuse

Child abuse

Version: March 2023
Legacy ID: 114-1

Rationale

Child abuse is common, yet underrecognized and underreported. Timely recognition and evaluation of suspected child abuse is critical, allowing for early intervention to optimize outcomes for children and their families.

Causal Conditions

(list not exhaustive)

  1. Physical abuse
  2. Sexual abuse
  3. Emotional/mental abuse
  4. Neglect
  5. 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 issues, physical manifestations);
    2. family dynamics, parental characteristics, and a social situation that may be contributing factors;
    3. other potential signs of abuse (e.g., refusal by a parent or guardian to have the child interviewed alone);
    4. potential mimics of child abuse (e.g., accidental injury, medical conditions); and
    5. the need for an appropriate history and physical examination to look for further evidence of abuse (e.g., bruising, scars, failure to thrive);
  2. list 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); 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. determining whether other children are at risk and whether they should be examined; and
      3. admitting the child to hospital until their safety can be definitively established; and
    3. referral to a pediatrician or hospital child protection team for further evaluation/opinion if available.