[just_md]

A 5-year-old girl is brought to the emergency department by her parents because of abdominal pain. Physical examination shows multiple bruises on the abdomen and thorax in different stages of healing. A chest x-ray shows hairline fractures of two ribs. The parents say that they do not know how she developed the bruises or the fractures. Which of the following is the most appropriate next step?
A. Call the police immediately
B. Hospitalize the child for further studies
C. Notify Child Protective Services
D. Obtain a promise from the parents that they will not strike the child again
E. Take the child into protective custody

 

[just_md]

It's easy question. BUT. US specific with child abuse is understandable, in general, but: How it's work in real life? They immediately coming to ER? They located in medical building? How long it takes?
A little more information from people who know this in details.
Thanks!

 

[ashishkabir]

Notify Child protective services... You have to do something to take the child away, but it is not the job of the police to handle these situations. Essentially you keep the child in your care until child protective services can come and take over.

 

[dr pinky]

E !

NEXT STEP : take the child into protective custody

 

[ashishkabir]

Hmm - The answer is C....

If you take the child into protective custody - you're not dealing with the fact that abuse has already occurred. The child is under your care now, so that's fine but the kind of follow up required involves Child protective services who can assess the situation further.

There is a mandatory reporting issue with child abuse and calling child protective services addresses that.

This question is from the Kaplan Qbank... I, for the record, got it wrong when I originally did the qbank, but I'm sure this time

 

[ecgram]

child protective services

 

[just_md]

Yes, correct answer is C.

But mine question is a little other. You reported and ... what? Wait for Child Protective Service, how long to wait?.

ashishkabir, yes it's question from qbank and I answered choice E, which is wrong. I thought that first removed kid from dangerous parents and after this mandatory part of notifying Child Protective Service.

That is why I'm asking older forum members for help in practical part of child abuse.

 

[ashishkabir]

Yup - its certainly a tougher ethics question... I'm glad we're discussing it. Hopefully someone older will offer some insight

 

[doctorF]

although i m not an older....i shall answer

it is written in conrad fischer usmle medical ethics 100 cases book, the very first lines abt child abuse dat,

" physicians are mandatory reporters of child abuse. this means taht the physician has the duty to report child abuse even if they feel uncomfortable. there is no discretion whether or not to report abuse. in addition, even suspected child abuse shall be reported."

hope this helps....

 

[Seetal]

although i m not an older....i shall answer

it is written in conrad fischer usmle medical ethics 100 cases book, the very first lines abt child abuse dat,

" physicians are mandatory reporters of child abuse. this means taht the physician has the duty to report child abuse even if they feel uncomfortable. there is no discretion whether or not to report abuse. in addition, even suspected child abuse shall be reported."

hope this helps....

thanks. now it makes more sense. i did think report it first, then i tot what if im wrong and the child has OGI-brittle bones? so ok report all suspicious cases and then after further hospitalization we'll know whats the ordeal.

 

[just_md]

Thanks to all for replies and personally older doctorF:happy:

But ... I'll try to change a little my question

You family physician and you have such situation in your room. Of course, no X-ray, but bruises visible enough to suspect abuse. Yes, you mandatory notify child protective service. WHAT you do next ?

You are emergency room doctor and you have such situation. Yes, you notify, and WHAT ? Old bruises and hairline fracture of 2 ribs is not reason for hospitalization. Or now it will be mandatory?

May be it's not Step 1 situation, but who knows what to expect in near future.

Thanks.

 

[dr pinky]

Kaplan video!!!!!

Hmm - The answer is C....

If you take the child into protective custody - you're not dealing with the fact that abuse has already occurred. The child is under your care now, so that's fine but the kind of follow up required involves Child protective services who can assess the situation further.

There is a mandatory reporting issue with child abuse and calling child protective services addresses that.

This question is from the Kaplan Qbank... I, for the record, got it wrong when I originally did the qbank, but I'm sure this time

Even in kaplan video Dr Daughtery STRESSES on "taking the child into your custody and then inform Child protection services & counselling the parents followed by proper medical treatment !!!!!!!
I don't get it , what to follow? Plz help :-(

 

[ashishkabir]

See thats what I thought originally too, Dr. Pinky... I took the course with Dr. Daugherty and he said the same thing in class. I wish I had seen this question then - but I'll email him and ask him to clarify, but according to the QBank the explanation is that well you have to deal with the mandatory reporting issue...

HOpefully he'll respond soon!

 

[just_md]

I really confused with this concept. But funny thing is that Kaplan confused more than me.
New addition from Kaplan to the same question
Correct answer E. Taking child to custody first is recommended because to ensure the parents don't leave with the child before the authorities can be notified. First in custody, THEN report to Child Protective Services

Now it's logically

 

[curiousmind]

gud question,
obviously chid has bruises on abdomen and thorax in different stages and
so called parents donno why???
and child has 2 rib fractures......

child should be taken into custody first, everything else like notifying CPServices follows later.

Obviously its the duty of the dr to protect the child from further harm...