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Since the 1960s, the amount of research and clinical knowledge in the field of child abuse has grown considerably . As a result, a need arose for physicians to both continue the advancement of research in the field and provide quality clinical care to suspected victims of abuse. Eventually it became clear that as the medical knowledge grew and clinical skill demands increased, new physicians entering the field would require more training and experience than that obtained during pediatric residency. In 2006, the American Board of Pediatrics established child abuse pediatrics as a subspecialty of pediatrics. This was an acknowledgment of the skills, education, and training required to provide appropriate care to child victims of abuse. Subsequently , the Accreditation Council for Graduate Medical Education (ACGME) standardized the fellowship training requirements for physicians entering this field. As justification for the need of consistent fellowship training in child abuse pediatrics, the organization stated that “the purpose of establishing and recognizing additional training and separate certification in child abuse pediatrics is to ensure that abused and neglected children will receive expert and appropriate care” (Accreditation Council for Graduate Medical Education [ACGME], 2012). Most pediatricians, immediately after residency training , have very limited experience working with victims of abuse. In addition, they are usually not exposed to the multiple areas of medicine with which a familiarity is required to be a competent child abuse pediatrician (ACGME, 2012). As a result, many practicing physicians are uncomfortable with evaluating children when abuse is suspected. Part of this problem is the lack of uniform education among pediatric residents in the field of child maltreatment. When pediatric chief residents were surveyed about how well the graduating pediatric residents were prepared to address child abuse, 34% thought that their graduates were less than well trained in child abuse (Narayan, Scoloar, & St GENERAL CONSIDERATIONS Whenever there is concern about any form of child maltreatment , the child would benefit from an appropriate medical evaluation. Over the past few years, a new subspecialty has emerged of physicians who are experienced and knowledgeable about the complex aspects within the field of child abuse pediatrics. Their expertise allows them to provide appropriate medical evaluations for child victims of sexual abuse, physical abuse, emotional abuse, and neglect . The subspecialty of child abuse pediatrics and its recognition by the medical, legal, and child protective services communities has led to improved evaluations and care for child victims of abuse. A familiarity with this new group of pediatricians will provide other professionals with a unique resource in the evaluation, diagnosis, and treatment of child abuse and neglect. CHILD ABUSE PEDIATRICS AS A SUBSPECIALTY Over the past six decades, child abuse has been recognized as a medical issue. Medical interest in child abuse began in 1946, when John Caffey described six infants who presented to medical care with subdural hemorrhages and long bone fractures. While the causal relationship between these injuries was not clearly stated in his article, Caffey did indicate that the two were somehow related and most likely due to trauma. Then in the early 1960s, C. Henry Kempe described “the battered child syndrome,” which acknowledged that children developed injuries from physical abuse and that it is important for the physician to be aware of the possibility of battered child syndrome and to look for inconsistencies between the physical examination and the history provided (Kempe et al., 1965). This article gave rise to increased medical interest in and research into child abuse. Child Abuse Pediatricians Treating Child Victims of Maltreatment BRETT SLINGSBY, M.D. CHRISTINE BARRON, M.D. 30 Child Abuse Pediatricians 297 know when to call, whom to call, or how to communicate and document their concerns. When state agencies are contacted , families typically have many questions and concerns that many physicians do not have the experience to answer. As a mandated reporter, the provider still has a medical, ethical, and legal obligation to contact these agencies when abuse or neglect is suspected, but calling the CAP first can augment the primary care physician’s plan. In addition, pediatricians are often uncomfortable dealing with child maltreatment due to their fear of involvement in court procedures (Flaherty & Sege, 2005; Flaherty, Sege, Griffith, et al., 2008; Flaherty, Sege, Price, et al., 2006; Jones et al., 2008; Lane & Dubowitz, 2009). After the initial evaluation of suspected child maltreatment, occasionally the treating physician is asked to provide court testimony. Testifying is very inconvenient for the physician, who may need to alter a full schedule of patients with frequently changing court dates. Training programs for...

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