An ethical approach to resolving value conflicts in child protection

Update on child maltreatment: toward refining the evidence base

PURPOSE OF REVIEW

This review is designed to aid general pediatricians as they assess cases of possible child maltreatment. The authors have selected salient articles that inform the daily practice of any professional involved in assessing child abuse.

RECENT FINDINGS

The incidence of child abuse continues to decline in the United States, although a large number of children still suffer from abuse and neglect, and many are subject to more than one type of maltreatment. Clinicians are encouraged to be vigilant about the subtle indicators of physical abuse, with many authors adding to our understanding about how children present after inflicted abdominal or skeletal trauma. Clinicians are also cautioned to watch for signs of Munchausen syndrome by proxy, which may be elusive and difficult to discern.

SUMMARY

The field of child abuse pediatrics is still young, with the first board certification in 2009. The volume of research in the field is exploding and there is a greater level of awareness and data collection occurring throughout the world. Pediatric clinicians are encouraged to play a role in preventing abuse and neglect, as well as addressing intimate partner violence, and to maintain vigilance about child maltreatment and its subtle clinical presentations.

Ethics in child and adolescent psychiatric care: An international perspective

In the treatment of children with psychiatric disorders as a vulnerable population, ethical issues arise that seldom come into play with adults. The UN Conventions on the Rights of the Child and the Rights of Persons with Disabilities set out rights to be respected in child and adolescent psychiatric treatment. Rights of participation and inclusion (minimizing of barriers to the involvement of disabled people) can create complex problems in cases of restraint or deprivation of liberty. This paper analyses the consequences of these conventions and other ethics guidelines on child and adolescent psychiatric treatment and research. Beneficence, justice and autonomy are core principles that are mirrored in the problems of inclusion and protection, confidentiality, and the safety of psychopharmacological interventions. Factors of inclusion are involved in the areas of availability of care, participation in best evidence-based treatment, and research. The right of the child to protection, the right of inclusion, and parents' rights and duties to safeguard their child's wellbeing form a triangle. National laws to regulate the treatment of psychiatrically ill children should be created and implemented and these should be non-discriminatory but at the same time safeguard the developing human being.