Évaluation des connaissances et des pratiques des pédiatres de Bretagne concernant la protection de l’enfance

How Stressful Is Examining Children with Symptoms of Child Abuse?—Measurement of Stress Appraisal (SAM) in German Physicians with Key Expertise in Pediatrics

“…In addition to communication problems with parents, guardians, youth welfare services, and other interdisciplinary professionals, many participants also reported difficulties in recognizing and diagnosing suspicious cases, particularly, if the symptoms were ambiguous. Other studies covering this aspect have reported similar findings to the effect that pediatricians often feel they lack the confidence to decide whether signs that appear suspicious are in fact indications of child abuse [ 21 , 23 , 24 ]. This fear of misdiagnosing child abuse, in combination with the possibly weighty consequences of the diagnosis, were found to trigger stress in many physicians and diffidence in regard to whether or not to act on the suspicion [ 15 , 23 , 24 ].…”

“…The participants were particularly troubled by the circumstance that the youth welfare services were often either difficult to reach or failed to provide feedback on reported cases. The lack of response by child and youth welfare services in cases of child endangerment has also been frequently pinpointed as a problem in international studies [ 21 , 24 , 38 ]. In Germany, the Act to Strengthen Children and Youth, which came into force in 2021, has now made it mandatory for the youth welfare services to respond to child professionals who report reasonable suspicions that a child’s well-being could be at risk [ 4 , 17 ].…”

“…In this context, an Italian study, for example, found that pediatricians and general practitioners had only scant knowledge on how to handle cases of child abuse and highlighted the need for proper training in this regard [ 20 ]. A study from Brittany, published in 2018, also illustrates that suspected cases of child abuse are frequently not reported by pediatricians [ 21 ]. The main reasons cited for this were lack of education on the topic, fear of misdiagnosing the situation, and lack of response from social services [ 21 ].…”

“…A study from Brittany, published in 2018, also illustrates that suspected cases of child abuse are frequently not reported by pediatricians [ 21 ]. The main reasons cited for this were lack of education on the topic, fear of misdiagnosing the situation, and lack of response from social services [ 21 ]. Additionally, in Germany, it is repeatedly pointed out that physicians working in the pediatric field experience a considerable degree of uncertainty in regard to their ability to detect early signs of child abuse, to respond appropriately, and to follow the proper procedure in suspected cases [ 22 ].…”

“…The studies and articles published to date on this theme mainly call attention to the existing uncertainties and problems experienced by pediatricians in child protection situations [ 15 , 21 , 23 , 24 ], or to the long-term emotional toll of treating maltreated or neglected children on these professionals, such as secondary traumatic stress or burnout [ 25 , 26 ]. None of the publications have so far, however, explicitly investigated to what extent such situations may also trigger acute stress in the treating physicians.…”