S-1984-01-1995_OVE

L’ASSOCIATION MEDICALE MONDIALE, INC ASOCIACION MEDICA MUNDIAL. INC
.Telephone: 504075 75
Fax: 50405937
THE WORLD MEDICAL ASSOCIATION, INC.
B. P. 63 • 01212 FERNEY·VOLTAIRE Cedex, France
28, avenue des Alpes ~ 01210 FERNEY·VOLTAIRE, France
Cable Address:
WOMEDAS, Fernev·Voltaire
September 1995
WORLD MEDICAL ASSOCIATION STATEMENT
. ON
CHILD ABUSE AND NEGLECT
Adopted by the 36th World Medical Assembly
Singapore, October 1984
and amended by the
41 st World Medical Assembly
Hong Kong, September 1989
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Hong Kong, September 1989
42nd World Medical Assembly
Rancho Mirage, CA., USA, October 1990
42nd World Medical Assembly
Marbella, Spain, September 1992
and the
47th General Assembly
Bali, Indonesia, September 1995
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Original: English ·
One of the most destructive manifestations of family violence and upheaval is child
abuse and neglect. Prevention, early identification and comprehensive treatment of
child abuse victims remain a challenge for the world medical community.
Definitions of child abuse vary from culture to culture. Unfortunately. cultural
···rationalizations’for’harmful’behav;or’toward ‘Children’may be accepted, all too readily,
as proof that the treatment accorded children is neither abusive nor harmful. For
instance, the work contribution of children in the every-day life of families and in
society should be recognized and encouraged as long as it also contributes to the
child’s own development. In contrast to this, an exploitation of children in the labour
market may deprive them of their childhood, of educational opportunities and even
endanger their present and future health. The WMA considers such exploitation of
children a serious form of child abuse and neglect.
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For purposes of this statement, various forms of child abuse include physical, sexual
and emotional abuse. Child neglect represents a failure of a parent or other person
legally responsible for a child’s welfare to provide for the child’s basic needs and an
adequate level of care.
The World Medical Association recognizes that child maltreatment is a world health
problem and recommends that national medical associations adopt the following
guidelines for physicians:
1. Physicians have both a unique and special role in identifying and helping
abused children and their troubled families.
2. Physicians should obtain specialized training in identifying child abuse. Such
training is available from many continuing education programs in the field.
3. Unkage to an experienced multidisciplinary team is strongly recommended for
the physician. A team is likely to include such professionals as physicians,
social workers, child and adult psychiatrists, developmental specialists,
psychologists and attorneys. When participation on a team is not possible or
available, the individual physician must consult with other medical, social, law .-
enforcement and mental health personnel. . ..
4. Primary care physicians (family practitioners, internists, pediatricians)
emergency medicine specialists, surgeons, psychiatrists and other specialists
who treat children must acquire knowledge and skills in the physical
assessment of child abuse and neglect; the assessment of child development
and parenting skills; the utilization of community resources; and the physician’s
legal responsibilities. .
5. The medical evaluation of children who have been physically abused should
consist of: (1) obtaining a history of injury; (2) a physical examination of the
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consist of: (1) obtaining a history of injury; (2) a physical examination of the
patient; (3) a trauma x-ray survey; (4) a bleeding disorders screen; (5) color
photographs; (6) physical examination of siblings; (7) an official written medical
report; (8) a behavioral screening; (9) a developmental screening of infant and
preschool age children.
– .6. The medical assessment and management of sexually abused children
consists of: (1) the treatment of physical and psychological trauma; (2) the
collection and processing of evidence; and (3) the treatment and/or prevention _
of pregnancy and venereal disease. …
,. .
7. It is necessary for physicians to determine the nature and level of family
functioning as it relates to child protection. It is essential for the physician to
understand and be sensitive to how the quality of marital relationships,
disciplinary styles, economic stresses, emotional problems and abuse of
alcohol, drugs and other substances, and other forms of stress relate to child
abuse.
. … 8.~···-lt is·eritteal-for-·the··physictan-ro-be-knowledgeable·about abuse and neglect.
Often, the physical evidence is not obvious, and only through careful interview
with the child and parents may the inconsistencies between historical and
objective data be revealed.
9. In detecting a child with suspected abuse, the immediate actions to be taken by
the physicians include: (1) reporting all suspected cases to child protective
services; (2) hospitaliZing any abused child needing protection during the initial
evaluation period; and (3) informing the parents of the diagnosis and report of
the child’s injuries to protective services.
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10. The child is the physician’s patient and therefore the physician’s primary
concern. Thus, it is the physician’s responsibility to do all he or she can to
protect the child from further harm. Contacting the appropriate agency that
handles child protection matters, is usually mandated by laws. In some cases,
admitting the child to a hospital is also necessary.
11. If hospitalization is required, a prompt evaluation of the child’s physical.
emotional and developmental problems is necessary. If the physician who
originally recognized the child abuse problem is not able to conduct the
evaluation, he or she should seek consultations with the hospital
mUltidisciplinary team or other physicians who have specialized training in child
abuse. .
12. If child abuse is suspected, the physician should discuss with the parents the
fact that child maltreatment is in the differential diagnosis of their child’s
problem. During such a session, it is essential that the physician maintain
objectivity and avoid accusatory or judgmental statements in interactions with
the parents.
13 It is essential that the physician record the findings in the medical chart during
the evaluation process. The medical record often provides critical evidence in
court proceedings.
14. Physicians should participate at all levels of prevention by providing prenatal
and postnatal family counselling; identifying problems in child rearing and
parenting, and advising about family planning and birth control.
15. Personal and public health measures such as home visits by nurses,
anticipatory guidance by parents, well-infant and well-child examinations
should be encouraged by physicians. Programs that improve the child’s general
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should be encouraged by physicians. Programs that improve the child’s general
health also tend to prevent child abuse and should be supported by physicians.
16. Physicians should recognize that child abuse and neglect is a complex problem
and more than one type of treatment or service may be needed to help abused
children and their families. The development of appropriate treatment requires
contributions from many professions, including medicine, law, nursing.
education, psychology and social work. • ~__ …. _e. •~ – — C-.
17. Physicians should promote the development of innovative programs that will
advance medical knOWledge and competence in the field of child abuse and
neglect.
18. Patient confidentiality must be abrogated in cases of child abuse. The first duty
of a doctor is to protect his or her patient if victimization is suspected. No matter
what type of abuse (physical, mental, sexual) an official report must be made to
the appropriate authorities.
19. Physicians should support the enactment of legislation in their respective
—–..–countries;-1hat”wiU-effectively-identify and .protect abused children. Such
legislation should also protect physicians and other health professionals for
their part in identifying. caring for, and treating abused children.
20. Physicians should support legal procedures that allow the abused child to bring
legal action against the alleged child abuser for a reasonable period of time
after the child reaches the age of legal majority. Physicians should also support
falr and objective legal procedures that seek to reasonably prevent
unsupported allegations of child abuse and that require objective evidence to
initiate any type of legal action against an alleged child abuser.
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