How Should Clinicians Minimize Bias When Responding to Suspicions About Child Abuse?

Abstract

Clinicians have ethical and legal obligations to report suspected maltreatment of children. A decision to report suspected abuse is one of great ethical, clinical, and legal importance and can weigh heavily on clinicians who have established relationships with a family. Mandated reporting is done inequitably, however, with overreporting of families with low socioeconomic status and minoritized families and underreporting of families with high socioeconomic status and White families. This article canvasses evidence-based approaches to evaluating and reporting suspicion of child maltreatment in ways that minimize bias and promote equity. The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity Case A 9-month-old boy is brought to an emergency department (ED) by his mother. The baby's mother reports that she slipped in an icy parking lot while lifting the baby from the car seat. She reports that, as she fell to the ground, the baby slipped out of her hands, hitting his head on the icy concrete. Physical examination of the baby reveals right-sided scalp swelling and multiple bruises on the torso and extremities. When asked about the bruises, the mother panicked, stating, "I didn't think to check under my baby's clothes. It was too cold. I just drove right here." The ED physician and nurse caring for the baby are distressed by the severity of the baby's injuries. The physician reviews the baby's electronic health record (EHR). Notes from an ED visit 6 months ago include photographic and narrative documentation of 2 bruises on the then-3-month-old baby's right arm. The physician and nurse confer quietly about what they observed, what they know, and how to respond. Commentary