A Pediatrician’s Perspective on Child Protection

Abstract

When the author started his pediatric residency in 1958, trauma inflicted on children had been described in the medical literature, mostly by radiologists, but its existence was not generally recognized by clinicians. Child maltreatment was initially viewed as a disorder of parenting. This meant that, in addition to investigative responsibilities, the new breed of case workers were charged with providing support. Mandatory reporting laws, along with professional and public awareness, soon swamped the protective services system; the supportive mission was not maintained. In the past decade, there has been a marked diminution in the prevalence of physical and sexual abuse; neglect now constitutes over 75% of the reported cases of maltreatment. The author maintains that children’s protective services have outlived their usefulness. Investigations of assaults should be conducted by law enforcement personnel, and suspected neglect should first be evaluated by public health nurses.