Medical ethics and child abuse.

The practice of good medical ethics is of particular importance in cases of juvenile maltreatment. In a number of court cases concerning battered children doctors' statements have been presented to the effect that maltreatment has not taken place. In twelve cases reported during the period 1971-75 the doctors' statement was misleading. In each of twelve cases it should have been the doctor's duty to record in his statement that this was a case of child abuse and/or neglect. It appears that as far as the individual doctor was concerned, he often state "these things should be dealt with by the child welfare authorities", who in their turn mereley referred to the doctor's statement. It is unlikely that this is maltreatment", the child welfare officer will reiterate. In six cases this statement was used in court before any evaluation had been made on the basis of the sequence of events. In all twelve cases the doctor had failed to make an adequate examination of the symptoms. It seems as if the doctor was not sufficiently interested in providing evidence of assault. In some cases, even, pathognomonic findings must have been kept secret. Psychological or emotional maltreatment need to be evaluated by a child psychologist who is a practical diagnostician. Injuries arising from physical abuse are most successfully diagnosed on surgical and casualty wards. Pediatricians must be cautious about dismissing diagnoses of maltreatment that have been established by other specialists, especially child psychologists.