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Physicians do not learn much about child protective services and the legal system during their training, yet in pediatric practice there is an increasing need for understanding of these two areas, especially in the area of child maltreatment. Medical professionals often have questions regarding the process of mandated reporting of child abuse to state agencies, as well as the civil and criminal court actions that may result from those reports, which may require physicians to provide factual and expert testimony.


The Federal Child Abuse Prevention and Treatment Act (CAPTA) (Public Law 93-247), and subsequent amendments, provides definitions to inform national, state, and community efforts to prevent, identify, and treat child abuse and neglect and provides federal assistance to states to support these efforts.1 Federal legislation defines child abuse and neglect as, at a minimum:2

  • “Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation”; or

  • “An act or failure to act which presents an imminent risk of serious harm.”

Each state provides its own definitions of maltreatment within civil and criminal statutes.2 It is important for inpatient pediatricians to be familiar with their state laws and definitions of the various types of maltreatment.

All 50 states allow anyone—but have statues that require certain professionals—to report incidents of suspected child abuse and neglect to the state child protective services (CPS) agency. Common mandated reporters are physicians, nurses, teachers, psychologists, social workers, and law enforcement personnel. Only a reasonable suspicion or belief of abuse is required to make a report to state authorities; a person does not need evidence that abuse or neglect exists to make a report.

All states have immunity provisions for mandated reporters, so that the reporter is protected from any civil or criminal liability if a report is later deemed erroneous or unsubstantiated.3 In contrast, failure of a mandated reporter to report suspected child abuse may result in a fine, malpractice suit, or criminal sanctions. Therefore a report should be filed any time there is “reasonable cause” to believe that abuse or neglect exits.

As an inpatient pediatrician, it is essential to confirm that a report has been made in all cases in which doing so is necessary. If another person or institution has filed a report about the same episode of abuse, no other professionals are required to duplicate that report.3 However, if a new indicator of abuse is observed, a new report must be filed. For example, a report is filed for a nonambulatory child with an unexplained femur fracture. He is subsequently transferred to another hospital for further treatment, where he is found to have suspicious rib fractures as well. The accepting physician must make a supplementary report about ...

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