March 20, 2017
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AAP report provides guidance on managing child abuse

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The American Academy of Pediatrics and other pediatric behavioral health organizations released a report that outlines guidance and recommendations for clinicians treating children with past maltreatment.

“Abuse or neglect during early childhood (ages birth to 6 years) can endanger a child’s normal development and increase the risk for long-term physical and mental health problems,” Robert D. Sege, MD, PhD, FAAP, of Health Resources in Action in Boston, and colleagues wrote. “Recent population surveys of adults and adolescents report that more than a quarter of U.S. children have experienced abuse or neglect. Comparison of this estimate with published incidence data drawn from child welfare systems suggests that most child maltreatment is undetected or unreported.”

In conjunction with the American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect, Council on Foster Care, Adoption and Kinship Care; American Academy of Child and Adolescent Psychiatry Committee on Child Maltreatment and Violence; and National Center for Child Traumatic Stress, researchers established a clinical report to guide clinicians in recognizing and managing behavioral and mental health symptoms of child maltreatment. The report is an update to the 2008 clinical report from the AAP, American Academy of Child and Adolescent Psychiatry and National Center for Child Traumatic Stress.

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The report includes brief summaries of the effects of maltreatment, a discussion of how to clinically approach behavioral presentations and available treatment options.

Recommended clinical considerations include the following:

  • inquiries of past traumatic experiences in patients’ social and family histories, as awareness of a child’s trauma history improves evaluation;
  • treatment of severe or persistent behavioral consequences of child maltreatment, preferably from a mental health clinician’
  • service as a resource for parents and teachers of maltreated children and help them better understand behavioral consequences of maltreatment; and
  • application of similar considerations when advising foster families and child welfare agencies.

“Using their therapeutic relationship with the child and family, pediatricians can work to educate caregivers and help them to understand that their child’s behavioral responses may differ from those of other children in the same situation,” the researchers wrote. “Many patients with a significant history of trauma will need to be followed by mental health professionals, and the pediatrician plays an important role in referral and co-management. By providing a medical home, the pediatrician can work longitudinally with caregivers and continue to treat symptoms that are obstructing therapy. Pediatricians can facilitate access to community resources, work closely with the child’s school to address behavioral challenges to learning, and help coordinate care among specialists in other disciplines.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.