Disclaimer: The following article contains some mature themes.
Child Abuse Pediatrics is a relatively new sub-specialty in medicine. It began in 2010 when the American Board of Pediatrics gave board certification in the specialty to 191 pediatricians. Doctors who become child abuse pediatricians evaluate children who may or may not have been abused, determine if the child was abused, work with Child Protective Services (CPS), police officers, and other doctors, and testify in court if needed.
Like other medical sub-specialties, such as oncology or hematology, child abuse pediatrics deserves recognition for helping thousands of children. It also deserves recognition as a complex field. A wrong decision could mean the facilitation of sending a child back to an abusive home, or taking a child away from a loving one.
Unfortunately, there have been some recent news stories about families losing custody of their children due to the verdict of a child abuse pediatrician.
In one 2015 case, a baby who suffered an unexplained brain bleed was diagnosed with shaken baby syndrome by a child abuse pediatrician. As a result, both the baby and his sibling were placed in foster care for five months, and their father was accused of abusing the child. After further investigation, the brain bleed was determined to be the result of excess fluid in the baby’s head, but this was only discovered after a different doctor reviewed the child’s medical records.
Another 2016 case had similar results. A baby had a minor brain bleed, and a child abuse pediatrician believed that it was caused by abuse. Based on her opinion, CPS took custody of the child. Even after three different doctors concluded that the brain bleed was the result of an undiagnosed medical condition, it took seven months for the child to be fully placed back with his family.
These are only two cases, but in both of them, the sole opinion of a child abuse pediatrician facilitated months of court appearances and loss of custody. In the 2016 case, a neurosurgeon who examined the baby before the child abuse pediatrician had concluded that the brain bleed was a result of trauma during birth. However, his medical opinion was overturned by the child abuse pediatrician, suggesting that the opinions of child abuse pediatricians carry more weight than those of specialized doctors. In the two cases described, when a second, or even third or fourth opinion was sought, it became clear that the child abuse pediatrician’s finding was incorrect.
But despite the unfortunate stories where child abuse pediatricians turned out to be wrong, we must remember that the sub-specialization does serve a purpose and that when doctors recognize child abuse, they can help many children out of abusive homes. In a recent 2019 case, a Pittsburgh man called 911 because his baby was choking. At the hospital, doctors found the baby had “three fractured ribs, bruising on the abdomen, brain bleeding, and retinal hemorrhage,” which could not have happened if the injuries were not purposely inflicted on the child. The father is facing two counts of aggravated assault and one count of endangering the welfare of a child.
However, because the sub-specialization is so new to the medical field, regulations and laws must be created to prevent needless custody removal and false allegations of abuse. Fortunately, because of those who went public with their stories, a hearing was held by Texas lawmakers in early November 2019 to hear the testimony of families whose lives were affected by the misdiagnosis of a child abuse pediatrician. The committee chairman, Texas Representative James Frank, “said he intended to call additional hearings in the coming months in order to develop ways to improve the system and protect parents.”
<https://pediatrics.aappublications.org/content/128/1/156/tab-figures-data> – Description of field
<https://www.nbcnews.com/news/us-news/parents-call-reforms-protect-families-mistaken-child-abuse-allegations-n1080926> – 2015 case and image source
<https://thedo.osteopathic.org/2016/05/everyday-heroes-the-horrors-and-rewards-of-child-abuse-pediatrics/> – Cover image