USPSTF: Insufficient evidence to screen children for preventing abuse, neglect

Alex Kemper

The U.S. Preventive Service Task Force issued a draft recommendation today calling for more research into primary care interventions that can prevent abuse and neglect in healthy children younger than 18 years, stating that current evidence is insufficient to base recommendations , according to a press release.

“Child maltreatment — which can include psychological, physical and sexual abuse, as well as failure to provide for a child's basic needs — is a serious problem that affects hundreds of thousands of children each year,” Alex Kemper, MD, MPH, MS, task force member and chief of ambulatory pediatrics at Nationwide Children’s Hospital, told Healio Family Medicine.

These children can suffer from psychological harm, injuries, chronic pain, substance abuse, depression and sometimes death, he said.

“Unfortunately, based on our review, we still do not have enough evidence to make a recommendation about ways that clinicians can help prevent child maltreatment before it occurs. As a result, the task force is calling for more studies on this topic so that we can better understand how to help children get the care they need,” Kemper continued.

Some of these research gaps include what primary care clinicians can do to prevent child maltreatment before it occurs and interventions in more diverse populations and settings, Kemper noted, adding that the measure of the benefits and harms of such interventions also needs to be done more consistently in these studies.

The ‘I’ level draft recommendation does not mean primary care physicians should not address possible maltreatment with their patients, he added.

“Primary care clinicians are in a unique position to help monitor children for signs of abuse and neglect, such as frequent injuries (sometimes with unexplained or inconsistent explanations of injury), signs of poor hygiene and lack of medical care. Other signs that a child may be maltreated include frequent absences from school, being excessively withdrawn or fearful, unexplained changes in behavior, trouble walking or sitting, and displaying knowledge of sexual acts that is inappropriate for his or her age,” Kemper said. “It's important that clinicians are vigilant for these indicators. Children who display signs or are otherwise identified as potentially being mistreated should always be treated and reported to an appropriate authority.”

“Additionally, all clinicians should be aware of local, state, and federal laws that require reporting cases of suspected child abuse or maltreatment to Child Protective Services or other legal bodies. ... [Clinicians] should always use their best medical judgment when deciding how to respond if they think a child might be being abused or neglected,” Kemper said.

In 2016, about 671,000 children were subjected to maltreatment, and more than 1,700 children died as a result, he added.

The task force said this draft recommendation aligns with their 2013 final recommendation and American Academy of Family Physicians’ stance on the issue. AAP does not have any recommendations on these interventions, “but strongly recommends clinician involvement in preventing child maltreatment and provides guidance and information on risk factors, protective factors and clinical management,” the task force said.

Other resources for clinicians on preventing maltreatment in children and adolescents include the CDC website and the Administration for Children and Families.

The USPSTF’s draft statement and evidence review has been posted for public comment on the USPSTF website: www.uspreventiveservicestaskforce.org. Input will be accepted through June 18, 2018, at www.uspreventiveservicestaskforce.org/tfcomment.htm. - by Janel Miller