AAP offers guidance to pediatricians for preventing child maltreatment

In a clinical report published online July 22 in Pediatrics, recommendations are provided to clarify the pediatrician's role in preventing child maltreatment and mitigating long-term sequelae.

John Stirling, M.D., a retired physician residing in San Diego, and colleagues examined the pediatrician's role in supporting relational health from infancy through adolescence to prevent maltreatment and associated long-term sequelae.

The authors note that initially and periodically throughout a patient's childhood, pediatricians should obtain a thorough social history, including family economic stressors and community conditions. Family resilience and protective factors should be identified and built upon. Maltreatment can be prevented by child and parent strength and resilience, and they can mitigate its long-term health effects. Parents' concerns should be addressed while reinforcing effective parenting. Anticipatory guidance relating to parenting challenges that may be stressful or serve as a trigger for child maltreatment should be provided. Parents should be guided in providing effective, nonphysical discipline; alternatives to corporal punishment should be encouraged. Parents should be helped to address particular problematic behaviors. With respect to children with disabilities or chronic illness, pediatricians need to be cognizant of their increased vulnerability and be aware of signs of maltreatment; in addition, they should be alert to indicators of parental intimate partner violence, unhealthy substance use, and depression. Caregivers should be encouraged to use their own health care providers as a conduit to needed care.

"Trauma-informed, family-centered pediatric care provides the tools to help pediatric health care providers prevent child maltreatment and build resilience, using anticipatory guidance and regular, attentive follow-up," the authors write.

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