Healthcare staff under report child physical abuse and one in five worry about getting it wrong

Just under three-quarters of doctors, dentists and community nurses said they were aware of some of the mechanisms of reporting child physical abuse, but 79 per cent felt they needed further information.

Over a fifth (21 per cent) said they were worried about getting it wrong. Confronting families, inexperience and fear of litigation were also common barriers to reporting.

“The ability to recognise physical abuse and willingness to report it varied between the groups” says lead researcher Dr Anne Lazenbatt, from the School of Nursing and Midwifery at Queen’s University Belfast, Northern Ireland.

“Our survey of 419 healthcare professionals showed that community nurses were most likely to recognise and report physical abuse.

“It also revealed that fears, anxieties and lack of knowledge stop primary healthcare professionals from reporting abuse and that they need more education, training and support in this area.”

74 per cent were aware of the mechanisms for reporting – with community nurses showing the highest levels of awareness, followed by doctors and dentists. 99 per cent said recognising and reporting child physical abuse should be part of undergraduate and postgraduate training and 79 per cent wanted further in-service training.

Research published by the United Nations in 2002 suggests that 3,500 children under the age of 15 die from child physical abuse every year in the industrialised world.

And seven per cent of children in the UK have been reported as suffering from physical abuse from a parent or carer, according to the National Society for the Prevention of Cruelty to Children.

Lazenbatt’s research, carried out with Professor Ruth Freeman from the University’s School of Dentistry, drew questionnaire responses from 139 Community Nurses, 147 General Medical Practitioners and 133 General Dental Practitioners in Northern Ireland – a response rate of 43 per cent.

The majority were in the 30-49 age group (71 per cent) and 43 per cent were male. They had been in practice for an average of 15 to 16 years.

Four key issues arose during the research:

•Healthcare professional were worried about misidentifying physical abuse and unwilling to confront the family. They wanted to remain anonymous and feared hostility, damage to their relationships with families and repercussions for the child and the family. They were also concerned about possible legal action.

“The barriers for me are an uncertainty about what I am looking for and not wanting to start a problem for the family” said one of the Dentists who took part.

“I would be hesitant to get involved in child protection work for fear that this would trigger a formal complaint, a disciplinary hearing or even litigation” added one of the Doctors.

•Respondents cited lack of clear guidelines and protocols as a barrier to reporting abuse. They were also concerned about their inexperience and poor interview techniques, especially when they were faced with parents who were keen to avoid detection.

“Recognising child abuse is always going to be a difficult and emotive area” said one Community Nurse. “Often parents, as carers, can give a plausible explanation for any injuries, bruising etc. Frequently this is the explanation people want to believe, as it will be less difficult to deal with by everyone concerned. What makes management of suspected cases of child abuse easier is having clear protocols and guidelines.”

“Identifying and reporting is always more difficult when a child is seen infrequently” pointed out one Dentist.

•Other barriers to reporting included workload pressures, red tape and hierarchy, reporting procedures and lack of sensitivity and support from social services and colleagues. Some Dentists felt that child abuse was not relevant to their profession and another burden in an already stressful occupation.

“I understand the child’s welfare is paramount, but living in small communities it is difficult for social services to be seen to be sensitive or impartial” said one Community Nurse.

And a Doctor expressed frustration with colleagues. “In one case of suspected neglect/abuse it was reported several times and nothing was done. I eventually reported it to an on-duty social worker who dealt with it, but there was a time lapse of 12-18 months.”

•The majority of participants wanted multidisciplinary workshops, in-service education and accessible training tools. They also highlighted perceived deficiencies in the education they had already received.

“There is no more time for complacency” said one Doctor. “To do this we need knowledge and input from a wide range of professionals and agencies, all of whom should be communicating, working in partnership and educated at all levels with a multi-professional / agency framework. This should be mandatory and frequent.”

“The findings suggest that recognising child physical abuse is both a complex and difficult task for primary healthcare professionals and illustrates a substantial gap between their ability to recognise maltreatment and knowledge of the pathways for reporting it” concludes Dr Lazenbatt.

“Although the consequences of failing to identify child physical abuse can be catastrophic, it is also essential that professionals are educated to recognise conditions that might inadvertently be mistaken as abuse so that unnecessary distress can be avoided.

“Child abuse is an important global problem and primary healthcare professionals can play an essential role in recognising and reporting abuse, but only if they receive the education and support they need to make informed decisions.

“Developing clear policies and co-ordinated local responses that involve all those concerned with the welfare and protection of children is also essential.”