Ongoing Pediatric Health Care for the Child Who Has Been Maltreated

Abstract

Pediatricians provide continuous medical care and anticipatory guidance for children who have been reported to state child protection agencies, including tribal child protection agencies, because of suspected child maltreatment. Because families may continue their relationships with their pediatricians after these reports, these primary care providers are in a unique position to recognize and manage the physical, developmental, academic, and emotional consequences of maltreatment and exposure to childhood adversity. Substantial information is available to optimize follow-up medical care of maltreated children. This new clinical report will provide guidance to pediatricians about how they can best oversee and foster the optimal physical health, growth, and development of children who have been maltreated and remain in the care of their biological family or are returned to their care by Child Protective Services agencies. The report describes the pediatrician' s role in helping to strengthen families' and caregivers' capabilities and competencies and in promoting and maximizing high-quality services for their families in their community. Pediatricians should refer to other reports and policies from the American Academy of Pediatrics for more information about the emotional and behavioral consequences of child maltreatment and the treatment of these consequences. Pediatricians provide medical care and anticipatory guidance for children who have been maltreated. Because as many as 25% of the child population has experienced some form of maltreatment, medical encounters in a pediatric practice with maltreated children are not uncommon. 1-3 Although only a small proportion of children who have been maltreated are investigated by Child Protective Services (CPS), each year, state CPS agencies determine that approximately 700 000 children have been victims of child maltreatment. 4 Approximately 75% of these children are neglected, and about 17% are physically abused; many children suffer multiple forms of maltreatment. In the United States, an estimated 1700 children die each year as a result of abuse and neglect. Child maltreatment has many long-term health, developmental, and

Trauma-Informed Care

“…These issues need to be considered even before screening and addressed with standard protocols to respond to identified risks. [76][77][78] Other immediate safety issues may arise when a consequence of trauma is self-harm or intent to injure others. Screening for suicidality, selfinjury, or intent to harm others is included in TIC along with clear protocols for how to address positive endorsement of these issues.…”

Abusive Head Trauma in Infants and Children

“…23,24 Endocrine dysfunction is common in survivors of AHT and may manifest years after injury. 25 Survivors of AHT should be referred at hospital discharge to medical homes where pediatricians can provide ongoing follow-up and prompt referral to pediatric medical subspecialists when indicated. 25…”

Adaptation measures in dental care for children with history of Adverse Childhood Experiences: A practical proposal

“…These individuals have a tendency to consume drugs or alcohol, abuse of substances, and may participate in risky sexual behaviors as a means of coping with stress rather than for social reasons. In the case of females, they are more prone to premature pregnancies, which, when added to the exposure to drugs and alcohol, may cause problems to the fetus 28,29 …”

“…Instead they may seek a sense of community by gang membership, committing violent crime, which may lead to unemployment, poverty, and incarceration. In addition, such individuals are at a greater risk to develop mental health disorders 28,29,31 …”