Domestic Violence-and Hidden Child Abuse?

A 23-year-old undocumented citizen came to a community clinic with her children. She asked to see the social worker. She stated that she was the victim of domestic abuse in her home the night before her visit. She was well known in the clinic and this was not her first experience with domestic violence.

The woman stated that she had always been afraid to leave her husband but now she felt she “had to leave.” She reported that in the past week, her best friend had been murdered by her domestic partner after many years of abuse. All of this had brought her to ask for shelter for herself and her 2 children.

Would you suspect hidden child abuse in this account of domestic violence?

Click here for the discussion . . . .

After consultation with the physician staff, the social worker asked about any child abuse or animal cruelty in the household. The mother reluctantly told of her youngest child being injured in the turmoil the night before and how she had always thought that her children would never be involved in her husband’s anger. There were no animals in the household.

The children consequently were examined and the youngest did have a small laceration on the leg where the father had thrown an empty beer bottle at the mother and the glass had struck the child. The laceration was small and did not require sutures. There was also bruising on the leg that was compatible with an adult hand print. A child protective service referral was made and the family was helped to a women’s shelter.

Domestic violence occurs in all socioeconomic groups, races, and cultures. An estimated 30% of women are the victims of abuse at some point in their life.¹ Domestic violence and child abuse will occur in tandem in about 50% of cases. For a physician to screen for domestic abuse is controversial

When one is busy caring for a child in the office or an emergency department, it’s easy to overlook signs of physical abuse in the child’s mother. It may even seem intrusive to ask about a parent’s condition when caring for the child. Nevertheless, the information will often enlighten you about the underlying reason for the visit. In this case the decision was easy because of the mother’s request for help and the mandate to report all child abuse.

Key Teaching Points

1. Intimate partner abuse is often indicative of child abuse.
2. Identifying child abuse early may prevent more serious injuries.  

Reference:
1. Cahill L, Sherman P. Child abuse and domestic violence. Pediatr Rev. 2006; 27; 339-345.

For more information:

Bays AB, Alexander RC, Block RW, et al. Pediatrics. 1998;101:1091-1092.

Ramsay J, Richardson J, Carter YH, et al. BMJ. 2002: 325: 314-318.