Child abuse, domestic violence and elder abuse are all under-recognised. There are about 46,705 children subject to a child protection plan or on a child protection register (NSPCC 2011). Many vulnerable children are unreported. Older children aged 15–18 years are also vulnerable. Be prepared to think the unthinkable.
Abuse can happen in any family, across the social spectrum. This means GPs need to think in a different way to the usual approach to patients and have a high index of suspicion, appreciating that abuse can happen in families that they may know well and like. Objectivity is essential. The carer or parent is often able to deceive the GP as to how injuries occurred. Child abuse most commonly occurs in babies under 1 year or in toddlers who are unable to tell what has happened. In the older child they may be too afraid to give the real account of how they came by their injuries, especially if the perpetrator is sitting by them, is someone they know or another member of the family. This applies equally to domestic violence and elder abuse, both of which are under-diagnosed, with the victims unable, afraid or ashamed to report the abuse. It is essential to:
Recognise abuse
Know what to do – be familiar with local guidelines
Act on it.Child Abuse
The welfare of the child is paramount. The usual concept of confidentially may have to be breached. Communication with other agencies is vital in establishing that abuse has taken place. You may only see part of the jigsaw which, put together with pieces from other agencies, adds up to a clear picture of abuse. One of the advantages of being a GP is easy access to the child’s medical records and probably those of the siblings and carers.
You may suspect abuse from your examination of the child, information from an outside agency or relative, or from the child.
Risk Factors
- Domestic violence
- History of drugs and/or alcohol
- Learning disability or mental health problem
- Registered child sex offender or serious violent offender
- Single parent or teenage mother who is isolated
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