Child abuse, neglect, and exploitation of young people

The BMJ Pub Date : 2024-11-11 DOI:10.1136/bmj.q2364
Andrea G Asnes, Gunjan Tiyyagura
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Abstract

Standardising practice can improve identification and reduce bias Even for the most experienced healthcare providers, recognising and evaluating suspected child maltreatment or exploitation is challenging. The pressure to make the correct diagnosis is extremely high. Failing to recognise maltreatment can result in the child experiencing severe harm or even death. Conversely, incorrect diagnoses of accidental injuries as abusive or misinterpretations of poverty as neglect may burden care givers and lead to subsequent mistrust in healthcare providers.1 Unwarranted investigations and subsequent referral to child welfare (social) services affect marginalised populations disproportionately, including children of black, Hispanic, and Aboriginal ethnicity, and visible minorities.23 Two education articles in The BMJ offer healthcare providers guidance to better identify child abuse and neglect and recognise young people experiencing criminal and sexual exploitation.45 They summarise the growing evidence base that should inform consistent, effective practice. Schwartz et al discuss screening using clinical decision rules such as the TEN-4-FACESp, which identifies region, age, and patterns of bruising that are more likely to be caused by abuse than accidental injury.46 Such tools have advanced the ability of busy frontline clinicians to identify injuries suggestive of child maltreatment, but they rely on providers’ ability to remember which bruises, and at what ages, are “high risk.” Also, a positive screening result does not mean that a child is certainly …
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虐待儿童、忽视和剥削青少年
标准化实践可提高识别能力并减少偏见 即使是经验最丰富的医疗服务提供者,识别和评估疑似虐待或剥削儿童行为也是一项挑战。做出正确诊断的压力非常大。未能识别虐待行为可能导致儿童遭受严重伤害甚至死亡。反之,将意外伤害错误地诊断为虐待或将贫困误解为忽视,可能会加重护理人员的负担,并导致他们随后对医疗服务提供者产生不信任。英国医学杂志》(The BMJ)上的两篇教育文章为医疗服务提供者提供了指导,以更好地识别虐待和忽视儿童行为,并识别遭受犯罪剥削和性剥削的青少年。Schwartz 等人讨论了使用 TEN-4-FACESp 等临床决策规则进行筛查的问题,该规则可识别出更有可能由虐待而非意外伤害造成的瘀伤的区域、年龄和形态。46 这些工具提高了繁忙的一线临床医生识别暗示虐待儿童的伤害的能力,但它们依赖于医疗服务提供者记住哪些瘀伤以及哪些年龄段的瘀伤属于 "高风险 "的能力。此外,筛查结果呈阳性并不意味着儿童肯定受到了虐待。
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