Violence against children: the medical care and the expertise assessment

Abstract

There are several ways of violence against children and adolescents. Medical care, whether in an emergency room or a clinic, is often the

first opportunity for identification of violence against them. The clinical method is still the best tool for the physician to diagnose child abuse or maltreatment. The actual incidence of abuse is unknown. It is estimated that 10% of the injuries in children under five years of age, who are seen in emergency rooms, were caused by maltreatment, 15% were hospitalized for burns and 50% of children who was admitted with fractures under one year of age were victims of maltreatment. Members of the family are the most frequent offenders. Being themselves victims of child maltreatment, low level of education and alcohol and drug use are considered risk factors for the adult to become an aggressor. In Brazil, maltreatment against children had more attention of the society since the late 1980s, when this topic was contemplated by the Federal Constitution (art. 227, 1988) and when the Statute of Children and Adolescents (ECA, 1990) was created. Notification to the authorities of suspected or confirmed cases of violence against children or adolescents were made compulsory by these legal instruments, providing penalties for physicians, teachers, and directors of health and educational institutions who omitted reporting such cases. The seriousness of the implications of violence for the health of children and adolescents has led many social organizations to implement programs to combat violence. The aim of this paper is to emphasize the physician’s role in the treatment of children and adolescents who may have been victims of violence. We performed a review of publications on the subject in the period 2000-2010. Such data reveal the importance of physicians and other health professionals, not only by their recognition of the signs of violence against children and adolescents, but also by their correct handling of these situations, with notification of the event and referral to the local authority, also requesting further investigation. Not neglecting children or adolescents who are victims of violence is the main role of these professionals.