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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