Thinking fast and slow in the evaluation of injury plausibility in child protection

Abstract

In evaluating injury in children, child protection paediatricians are tasked with determining whether the history given by parents or caregivers is valid with respect to explaining injury causation. This paper summarises metacognition and in particular the dual processing theory of ‘fast and slow thinking’ to explain how complex information in contexts of uncertainty is processed to produce decisions and responses, applied to a child protection context. An example is used that resembles abusive head trauma which focuses on understanding the difference between likelihood and plausibility in forensic interpretations of injury causation.

Interesting case of vasculitis or suspected child abuse: A fast evolving story

“…Among those with involvement of the genitalia, nine patients, 9% of all hospitalised male patients, referred with penile skin involvement. 3 The bias created by discordance in reporting coupled with the unusual history of the possible mechanisms and timing of the injury, 4 the large gap in parental ages followed by the information given by the family doctor regarding the family heightened the suspicion of child abuse. The resolution of purpuric rash within 1 day with substantial improvement confirmed this was clinically vasculitic rash.…”

On being reflective, not just reflexive

“…1), for thinking slow rather than fast, 1,2 for doing some research or even better for consulting with one or more thoughtful, reflective colleagues. This is particularly important when a complex decision requires wider ethical deliberation 2,3 …”

“…This is particularly important when a complex decision requires wider ethical deliberation. 2,3 Sometimes the answer to whatever is being requested should be 'no', a word that many of us have trouble enunciating. It may be unwise or even impossible to accede to a request that is unethical or one that may be onerous or burdensome.…”