In the case of child abuse, it is important to approach the situation as objectively as possible
Child abuse is not always visible. Yet it happens to 1 in 30 children in the Netherlands. In the Week against Child Abuse, pediatricians draw attention to this topic. ‘Make it a negotiation, however difficult it may be.’
Pediatricians Patrycja Puiman and Marjo Affourtit work together with the ‘Fedtmule team’ from Erasmus MC Sophia to identify all forms of child abuse.
Puiman: ‘Children are referred to us with injuries, but sometimes child abuse is also discovered by accident during a physical examination. For example, unusual bruises or babies ending up at ICK with a brain bleed that later turns out to be due to abuse. We are called to look at the matter as a team of paediatricians, psychologists and medical social workers and to advise. Coroners and the deputy team are often also involved in sexual abuse.’
Suspected child abuse is reported to Erasmus MC Sophia by various authorities such as the GP and Safe Home. Each year, in our region, there are approximately 120 children for sexual abuse and 30 for physical violence in our emergency room, the Goofy outpatient clinic or on the ward. The children range in age from baby to teenager. Erasmus MC is also part of the National Expert Center for Child Abuse and is the Center for Sexual Violence, for children under 16 years of age.
It is important in child abuse to approach the situation as objectively as possible, says Puiman. ‘As a doctor in training, you learn that the parents’ story is the truth. But the situation is different with child abuse, and history is not always reliable. Therefore, you must pay attention and ask yourself if the injury or complaint fits the patient’s history. You should never accept bruises on babies, for example, and an injury without a remedy or children who have waited a long time to seek medical attention can be a signal. To support professionals in identifying them, we have formulated four screening questions which are now used as standard in the emergency department.’
Behind the front door
The biggest problem with child abuse is that it happens behind the front door. “It is by no means always visible, but in the Netherlands one child per class one victim. Mostly from emotional neglect. Most forms of child abuse that we see in our center are physical and sexual abuse. Because children often cannot tell themselves, it is not always recognized and it is difficult for professionals to make the right decision and refer them to our team or Safe Home.’
Puiman believes that accusations should never be based on suspicion of child abuse. ‘When children end up in our emergency room, it often turns out that there are also more concerns, such as financial problems or stress due to relationship problems. I always try to ask open questions; how did your child get this bruise? Can you explain exactly what happened again? How are things going at your house? I always try to imagine it as a movie and understand what happened.’
“However difficult it is, it is important to discuss child abuse. It can also be nice for people themselves if it is revealed that help is needed within the family. Therefore, I think that the Week Against Child Abuse is also important to raise awareness. If you see something different, ask openly if it doesn’t feel right, think about why, consult a professional if in doubt, and always think in terms of the safety and care of the child and family.’
For more information, visit the Week Against Child Abuse website.
What can you do in case of suspicion?
- Don’t look away
- Do it, no matter how difficult it is to negotiate
- Stay away from accusatory atmosphere, but ask open questions and keep asking questions
- Always think from a care point of view and the safety of the child and the family
- For advice and support, please contact the Goofy team, LECK or Safe at Home
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