11 Steps Pediatricians Can Take to Prevent Child Maltreatment

Pediatricians can play an important role in the prevention of child maltreatment, according to a new report from the American Academy of Pediatrics, which looks at how healthcare professionals can help to strengthen families and promote safe, stable, nurturing relationships with the aim of preventing all types of abuse.

Because of their unique relationship with families, pediatricians “are in an excellent position to help families enhance their ability to protect children and to address factors that put them at increased risk of abuse,” wrote Emalee G. Flaherty, MD, and John Stirling, Jr, MD, in the report, which is published in Pediatrics. Because pediatricians have contact with families during challenging and stressful times, they can become familiar with a family’s stressors and strengths, and provide anticipatory guidance to help prevent abuse.

In the report, Flaherty and Stirling describe some of the triggers and factors that place children at risk for maltreatment, and discuss how pediatricians can identify family strengths, recognize risk factors, provide helpful guidance, and refer families to programs and other resources with the goal of strengthening families, preventing child maltreatment, and enhancing child development.

The authors offer the following guidance for clinicians:

1. Obtain a thorough social history, initially and periodically, throughout a patient’s childhood. The parent-screening tool included in the Bright Futures tool and resource kit can be used to help screen for risk factors and problems; identify and build on family strengths, resilience, and mediating factors; identify and address parents’ concerns; and reinforce effective parenting.
2. Acknowledge the frustration and anger that often accompany parenting. Provide anticipatory guidance about developmental stages that may be stressful or serve as a trigger for child maltreatment. A health visit framework can be helpful or refer to the Connected Kids counseling schedule.
3. Talk with parents about their infant’s crying and how they are coping with it. Learn their perception of their infant’s crying and which strategies they use to cope. The pediatrician should provide parents with insight into the infant’s behavior and teach alternative responses.
4. When caring for children with disabilities, be cognizant of their increased vulnerability and watch for signs of maltreatment. Provide families with information about the child’s condition. Activities may include giving out handouts or having group instructional sessions with parents. Validate the parent’s stresses and provide them with techniques to manage the stress. Provide the family with information about respite care, and identify families at greater risk of abusing their child. Help educate older children about how to protect themselves against abuse and that they should share uncomfortable, abusive, or concerning experiences with a trusted adult.
5. Be alert to signs and symptoms of parental intimate partner violence and postpartum depression. Instruments are available that can be used by clinicians to identify depression in mothers and fathers. Familiarize yourself with appropriate community resources, and know how to respond if a caregiver reports intimate partner violence or depression.
6. Guide parents in providing effective discipline. Encourage parents to use alternatives to corporal punishment, such as time out techniques and positive reinforcement.
7. Talk to parents about normal sexual development and counsel them about how to prevent sexual abuse. The AAP has developed an educational toolkit that helps health care professionals talk to parents and patients about sexual violence topics and provides them with educational materials and other resources.
8. Encourage caregivers to use the pediatric office as a conduit to needed expertise. Become knowledgeable about resources in the community, and, when appropriate, refer families, especially stressed parents, to these resources.
9. Advocate for community programs and resources that will provide effective prevention, intervention, research, and treatment for child maltreatment and for programs that address the underlying problems that contribute to child maltreatment.
10. Advocate for positive behavioral interventions and supports in schools. Encourage schools to implement effective and supportive behavioral expectations and interventions.
11. Recognize signs and symptoms of maltreatment and report suspected maltreatment to the appropriate authorities.

For more:

Child Abuse Linked to Heart Disease

CDC: Child Maltreatment Prevention

Pediatrics: Clinical Report—The Pediatrician’s Role in Child Maltreatment Prevention