Child abuse is a pervasive and complex problem: Few children or abusers report harm themselves, so it’s up to other authorities, such as medical personnel and teachers, or bystanders, such as neighbors, to report suspected abuse. Some 3.5 million children in America were reported as being suspected victims of child abuse in 2018, the most recent year for which data are available; about 680,000 were ultimately determined by authorities to have been abused or neglected.
When suspected abuse has a medical component, like an injury or a bruise, child-abuse pediatricians step in to examine injuries, rule out causes other than abuse, such as a disease, and consider the family’s explanations, reported The Marshall Project. They are trained in what types of fractures generally stem from abuse, and what bleeding patterns in the brain can be caused by shaking. With an abuse expert on staff, the thinking goes, regular pediatricians don’t need to worry about overreacting to an innocent bruise, or missing warning signs because parents are convincing liars. Child-welfare workers also rely on this expertise as they consider removing children from their homes. The American Board of Pediatrics certified the first group of child-abuse pediatricians in 2009; there are now 344 such specialists nationally, stationed in all but three states.
A review of dozens of cases, including thousands of pages of medical records, child-welfare agencies’ records, and testimony, along with court decisions, contracts, and emails from child-abuse pediatricians, shows that these doctors can have near-unilateral power in labeling abuse—even though their conclusions are sometimes at odds with the opinions of specialists like orthopedists and hematologists. Their judgments are echoed, amplified, and often unblinkingly accepted by investigators. Indeed, instances in which medical professionals make reports to child-welfare agencies are 40 percent more likely to be substantiated—meaning the agencies found that abuse occurred—than reports by nonmedical professionals, according to a Marshall Project analysis of the National Data Archive on Child Abuse and Neglect.
But child-abuse pediatricians may have a conflicted perspective. Many are paid in part by child-welfare departments and work directly with state lawyers in cases where the state is removing children from homes, and end up shaping arguments against parents, testifying in court, and working within a system that parents don’t understand is stacked against them. This is particularly problematic because child-removal cases play out in family court, where the state’s burden of proof is low and parents have limited legal rights.
“The first time I started to hear what parents are going through, I was shocked,” Maxine Eichner, a family-law professor at the University of North Carolina School of Law, told me. “There should be a role for child-abuse pediatricians,” she said, but many are “going well beyond their medical expertise and wielding the power of the diagnosis in ways that are really harmful for children and families.”
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