31 August 2009

New Pediatric Sub-Specialty Board Approved for Certification of Pediatricians with Expertise in the Management of Victims of Child Maltreatment

It has been well demonstrated that maltreatment in the earliest years of life can lead to life- long behavioral and health problems (Sameroff, 1998). In November of 2009, approximately 200 doctors will sit for a board examination offered for the first time by the American Board of Pediatrics. The Board Exam will be for candidates in the field of child abuse pediatrics- a specialty involving not only caring for child maltreatment victims but also working with law enforcement and caseworkers and testifying in court cases. The acceptance of child abuse pediatrics as a medical concentration is expected to lead to an established system of accreditation for the estimated 25 child maltreatment fellowship programs in the U.S. for which there are presently no nationally agreed upon standards.

Administrators expect the changes to result in more specialists who can teach in medical universities, conduct research and serve as a resource for the general medical community. Additionally, practitioners also hope the increased acceptance of the concentration will generate higher reimbursements from insurance organizations and government health care programs- a benefit for hospitals that usually lose money on their child maltreatment teams because of the time devoted to these complicated cases (Hollingsworth, 2009).

The need for the maltreatment focus area is clear: research has regularly indicated that many medical professionals lack the knowledge to effectively handle these demanding cases. A recent study published in Pediatrics suggests that current standards of child maltreatment instruction are insufficient (Hollingsworth, 2009).

Even medical professionals who are not certified in child abuse pediatrics should focus on preventing child abuse and neglect: it is an integral component of accomplishing their responsibility of ensuring children’s health and welfare. Young children who are abused or chronically neglected have increased risks for social-emotional, behavioral and cognitive delays. Too often, by the time a child is determined to be a maltreatment victim, these problems have already begun to develop (Hawley, 2000). In 2008, children under six were the victims in nearly half of all investigations of abuse or neglect in Shelby County (TN DCS, 2008).

General principles that all who are involved in child care should become aware of include the following (Dubowitz, 2002):

1. Risk factors for abuse and neglect (such as parental substance abuse and maternal depression) need to be recognized and confronted. Caregivers at risk for abuse and/or neglect usually need mental health and social supports, and providers should expedite referrals.

2. Recognition and identification of a parent’s strengths and resources is vital to understanding the circumstances and preparing an appropriate response.

3. Child and family intentions/goals should be defined, clarified and integrated into the overall health care plan. For instance, a mother’s desire for her toddler to respect rather than fear her assists in the introduction of effective discipline approaches.

4. Acceptance of unconventional and informal assistance (i.e., friends, family, faith community) can be supported. For example, doctors can promote a grandmother’s engagement in child rearing by asking her to attend office visits.

For more information on the well-being of children in Memphis and Shelby County, visit The Urban Child Institute at http://www.theurbanchildinstitute.org.

Dubowitz, H. (2002, June). Preventing child neglect and physical abuse: A role for pediatricians.
Pediatrics In Review, 23(6), 191-196.

Hawley, T. (2000). Starting smart: How early experiences affect brain development. Zero To Three/The Ounce of Prevention Fund. Washington, DC.

Hollingsworth, H. (2009, August 18). New specialty spurs hope for helping abused kids. Associated Press: Yahoo News. Retrieved on August 24, 2009 from

Sameroff, A.J. (1998). Environmental risk factors in infancy. Pediatrics, 102, 1287-1292.

Tennessee Department of Children’s Services. CPS/Custody Data. Nashville, TN.

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