Only 5% of reports of child abuse come from doctors. The Haute Autorité de santé publishes recommendations to help them detect it.
Rape, incest, shaken baby syndrome. The signs of parental abuse of their children are numerous but sometimes difficult to detect. Doctors are responsible for reporting them, even in case of doubt, directly to the public prosecutor. A delicate task, which currently represents only 5% of declarations made in France. To compensate for this largely insufficient figure, the High Authority of Health formulates its recommendations in order to guide the doctor in his steps. To do this, it publishes a memo sheet on its website that explains how to spot signs of violence in the family home and how to report them to the courts.
Spot the signs
The HAS recommendations are addressed to the entire medical profession: pediatricians, psychologists, general practitioners, midwives, etc. There are different signs that should alert caregivers: physical signs (burns, bruises, fractures) and signs of heavy neglect (diet, hygiene, lack of sleep). Finally, the doctor must inquire about the psychological situation of the child as well as his family environment. The HAS specifies, however, that the lack of identification of one of these factors must not lead to the elimination of the diagnosis of mistreatment and that the doctor must think about it at each consultation, even if he is not confronted. to specific signs. These locations are carried out during the interview with the child and his entourage during the consultation and the various clinical examinations carried out.
Report cases of mistreatment
If he detects the slightest indication of domestic violence, the doctor must protect the child and report his suspicions to justice. To do this, the doctor must send a written report in the form of a form to the public prosecutor. The form specifies, among other things, the time, date, information about the child and a written note of the words heard during the consultations. If the child is in vital danger, the doctor must call the SAMU directly. But the task turns out to be complicated. Indeed, it is not always easy to dissociate a sign of violence from a physical or psychological fragility of the child, just as a behavioral disorder does not automatically mean that the child is the victim of domestic violence. House.
In addition, previous cases of doctors attacked by parents for false statements prompt them to be extra careful. This was for example the case in 1998 for the child psychiatrist Catherine Bonnet, sentenced to nine years of prohibition to practice for having drawn up certificates and reports. She suspected sexual abuse of children whose parents were separated. The alleged perpetrator disputed the facts and requested sanctions against the doctor. Dr Bonnet had to close his practice, make replacements and even leave to practice abroad.
Do not mention names
It is in this context that the HAS reminds doctors that they can report a case even if they are not certain and that it is not necessary to provide evidence. It also recalls that no prosecution or sanction is possible if the report is made according to the rules. This consists in describing the physical signs without interpreting their origin, in relating the words of the various people questioned in quotes, while favoring the use of the conditional mode. Finally, the doctor must not in any case cite a name, nor issue any form of denunciation.
According to the HAS, “more than 80% of ill-treatment is inflicted within the family, in all social classes. Abuse is characterized by its early onset and chronicity ”.
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