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Reporting suspected child abuse is the optometrist’s legal – and ethical – duty

Issue: August 2012

ByMichael D. DePaolis, OD, FAAO

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Given the somewhat insular nature of optometric practice, it is understandable. We see dozens of patients daily, intently focused on helping them see – and occasionally feel – better. So, it is no surprise that we really do not think about it. The “it” I speak of is child abuse.

In the U.S. alone, each year more than 6 million children are victims of abuse. According to the U.S. Department of Health and Human Services’ Child Maltreatment 2009 report, 18% of these children are physically abused, 9% are sexually abused and more than three-fourths suffer from neglect, medical or otherwise. While the short-term impact is devastating – five children die from abuse in the U.S. every day – the ongoing consequences are equally problematic. According to the Child Welfare Information Gateway, abused children are approximately 30% more likely to abuse their own children, commit a serious crime or be arrested as an adult than non-abused children. In short, child abuse often perpetuates a vicious cycle.

Michael D. DePaolis

Unfortunately, child abuse knows no boundaries, as it impacts children of all ethnic, gender and socioeconomic strata. Especially disturbing is the fact that approximately one-third of victims are younger than 4 years, a population unable to defend themselves against or seek refuge from their abuse. So, it comes as no surprise that child protective agencies rely heavily on those outside of the home to report suspected abuse. Indeed, studies confirm that educators (teachers, nurses, counselors, etc.), law enforcement personnel and social workers are most likely to report suspected child abuse. Surprisingly, a Lancet (December 2008) article revealed that physicians accounted for only 6% of suspected child abuse cases reported to protective agencies. The question, of course, is whether we are simply not seeing these cases … or just not thinking about the possibility of child abuse.

Again, given the nature of patients presenting for routine eye care, it is understandable why child abuse is not often on our radar screen. Rather, given the rarity with which we encounter encephalopathy, subdural hemorrhage and retinal hemorrhage – the classic triad of shaken baby syndrome – we often think of child abuse as an emergency department problem. In reality, this is a poor assumption, especially in the case of more subtle forms of child abuse. Could abuse be the cause for a preadolescent with chronic conjunctivitis suggestive of chlamydial infection, a preschooler with an “accidental” curling iron keratitis or an infant with periorbital ecchymosis? Certainly, any of these children could easily end up in our offices.

The reality is that child abuse presents in various ways and can surface anywhere, including our offices. We simply cannot afford to miss or not report clinical findings suggestive of abuse. It is much more than the law. It is our ethical responsibility and duty to protect these children.