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

The U.S. Preventive Services Task Force recently concluded that the evidence was insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment such as abuse or neglect in asymptomatic children.

Meera Viswanathan, PhD, director of the RTI-UNC Evidence-based Practice Center, and colleagues wrote that the conclusion is based on 47 trials containing nearly 16,000 participants that studied links between topics such as reports to child protective services and interventions; initiatives that sought to improve failure to thrive and/or immunize; school attendance; and interventions and outcomes in areas such as child development, school performance, hospitalizations and preventing death.

The task force indicated that the new conclusion mirrors the task force’s 2013 and 2018 draft statement, as well as the AAP’s 2013 guidance, on this same issue. Though the AAP does not have recommendations on preventive interventions, the Academy strongly recommends clinician involvement in preventing child maltreatment and provides guidance and information on risk factors, protective factors, and clinical management, the task force also indicated.

In a related editorial, Desmond K. Runyan, MD, DrPH, executive director of the Kempe Center for the Prevention and Treatment of child Abuse and Neglect at the University of Colorado School of Medicine wrote that the ‘I’ level recommendation does not absolve clinicians of their responsibilities.

“Health care professionals should not interpret the lack of evidence to support primary care programs to prevent child maltreatment as a ‘pass’ on their responsibilities to address maltreatment in the clinical encounter or their roles as advocates for policies that have upstream effects on the occurrence of maltreatment, including access to safe, affordable housing, a livable wage, and quality child care,” Runyan wrote.

“However, a report from 2012 suggested that the United States spends an estimated $124 billion over the lifetime of children who are abused in a single year, whereas the annual expenditure of [NIH] funds of about $30 million per year for child abuse and neglect research amounts to less than $10 per child for the 3.2 million children reported for suspected maltreatment. Physicians and others must advocate for much greater research support to improve the knowledge base for the diagnosis, prevention, and treatment of child maltreatment,” he added.

Alex Kemper, MD, MPH, MS, task force member and chief of ambulatory pediatrics at Nationwide Children’s Hospital, echoed many of Runyan’s sentiments in a previous interview with Healio Family Medicine.

“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, who is a deputy editor at Pediatrics, added. – by Janel Miller

References:

Runyan DK. JAMA. 2018;doi:10.1001/jama.2018.18704.

US Preventive Services Task Force JAMA. 2018;doi:10.1001/jama.2018.17772.

Viswanathan M, et al. JAMA. 2018;doi:10.1001/jama.2018.17647.

Disclosures: Runyan reports serving as an unpaid member of the board of directors of the National Foundation to End Child Abuse and Neglect. Kemper reports no relevant financial disclosures. Please see the studies for all other authors’ relevant financial disclosures.