DIAGNOSIS AND MANAGEMENT OF VICTIMS OF CH ILD-ABUSE IN THE EMERGENCY ROOM

Child abuse is a nonexceptional problem from which no social class or ethnic group is exempt. The Decentralized Social Action Surveillance S ystem identified 16000 cases in France in 1994. In the emergency room, the diagnosis can be difficult when child abuse is not the reason for seeking medical help. A number of clinical findings that lack specifi city in isolation are suggestive when combined; lesions in unusual sit es, as well as specific patterns over time, also provide valuable clue s to the diagnosis. The risk to the child is difficult to evaluate, pa rticularly as it is not correlated with the severity of observed lesio ns. Interviews with the parents and one-on-one interviews with the chi ld are essential to establish good rapport. Attempts to obtain an admi ssion of child abuse can hinder communication. Each lesion should be d escribed and indicated on a diagram and/or documented by photography. Investigations should be performed as needed (roentgenograms, clotting tests). Child abuse victims should always be hospitalized; reluctant parents should be told that the child's physical condition requires ad mission. A request for admission under compulsion can be made when the re is an immediate threat to the child (refusal of the parents to admi t the child, precipitous departure from the emergency room, physical t hreats). The initial management is difficult. Many subsequent difficul ties can be traced back to mistakes made during the fist admission. An experienced senior physician and a team of health care professionals and social workers should be involved in the care of the child.