Kindermishandeling vaak niet herkend op de huisartsenpost

Objective

To determine whether child abuse as established by the appropriate Dutch Child Abuse Reporting Authority (AMK), had been noticed by general practitioners (GPs) in the out-of-hours primary care centre concerned.

Design

Retrospective.

Method

We performed a retrospective analysis in 368 children from the catchment area of an out-of-hours GP care centre. The AMK confirmed that these children had been abused during the period January 2005-August 2007.

Results

Out of the 368 children, 193 had visited the centre one or more times from July 2002 to September 2007. The total number of consultations was 709. According to an expert panel, 24 of these visits constituted cases that were strongly suspected of concerning child abuse. In another 82 visits, based on the history taken, child abuse could not be ruled out. Consultations falling into the categories of trauma or intoxication were widely represented. Child abuse was only recognised if patients or guardians mentioned it as such on their own initiative. Following confirmation, effective guidance for child abuse was only implemented in one case.

Conclusion

General practitioners on call at out-of-hours care centres did not sufficiently recognise signs of child abuse. Moreover, when taking the medical history, not enough questions to rule out child abuse were asked. After child abuse had been confirmed, further treatment policy was often inadequate.