Optometrists should keep an eye out for child abuse

ATLANTA – Parents or care givers may bring abused children to a health care professional that will not give them a full body exam, Andrea Gregory, MD, FAAP, said at a presentation here at SECO.

Because of this, she explained, even optometrists should understand what to look for in terms of injury.

"Children are a vulnerable population – they need someone else to care for them," Gregory said. "They require and depend on responsible caring providers – parents and health care providers – to be their voice."

She continued: "It is heartbreaking to hear some of the horrors that people perpetrate on children, but it's important to know about, too. It doesn't help that child if you bury your head in the sand."

Gregory cited current numbers on the rate of child abuse in the U.S. She said that 678,810 children were maltreated in 2012, with 18% of those children experiencing physical abuse.

"Child maltreatment can happen to anyone – all socioeconomic statuses, all races – but we have identified some risk factors in children that make them more likely to be abused and risk factors in care givers that make them more likely to be perpetrators," she explained.

Gregory listed young children as well as children who were born premature, are medically complex or have a disability as those at higher risk of being abused. She said that care givers who abuse alcohol or drugs, are young parents or have a high level of family stress are more likely to abuse children in their care.

Additionally, Gregory explained commonalities in child abuse injuries that can help health care professionals identify cases.

"Kids get bruises," she said. "I consider it a mark of a healthy child if they have bruises on their shins. But we really want to know what's normal and abnormal."

Gregory said that normal spots for bruising include forward-facing areas such as the forehand, elbows and shins; abnormal areas include the upper back, buttocks, groin, nose, mouth and back of the legs.

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"Kids can get accidental bruises in these areas, too," she stated. "You have a toddler who trips and falls on a toy and gets a big bruise, but there should be a plausible explanation and it should be isolated. You shouldn't see multiple spots."

Additionally, patterns of injuries or specific marks such as those inflicted by items such as paddles, hairbrushes, cigarettes and restraints are cause for concern.

Gregory cautioned that, even with concerning marks, optometrists and health care providers should not assume.

"Look for other things," she said. "Is this accidental? Is there a plausible explanation? Is it normal? Could there be an underlying medical condition? A simple question to the parent will often elicit that."

Still, Gregory acknowledged that it is not the job of an optometrist or medical professional to determine abuse.

"That's the job of child protective services and the legal system," she said. "It is your job to refer whenever you are concerned. Health care workers in almost all states are mandatory reporters."

Gregory was adamant that optometrists not be concerned with falsely reporting a parent.

She stated: "I want your fear to be that if you don't report, that child is going to continue to be harmed.

"While they're in your office, ask basic questions," she instructed. "'I see you've got a bruise there – what happened?' Try to avoid any accusations. It may not be the care giver that's with them that is doing the abuse. If it is and you accuse, that child may be more likely to be harmed when they leave your office."

Gregory said optometrists should thoroughly document with notes, diagrams and actual quotes. Optometrists can also elicit the help of a family physician or pediatrician, especially if they are worried about the possibility of an extreme case.

In order to report, optometrists should call the DSS office in the county where the child lives and be as thorough as possible, Gregory said. If they wish to, they can remain anonymous.

Most importantly, Gregory said, is to not second guess your gut instinct.

"Don't talk yourself out of this," she said. "If you have an initial suspicion, make the report." – by Chelsea Frajerman

Disclosure: Gregory reported no relevant financial disclosures.