29. The Child at Risk: Child Protection and the Anesthetist

Craig Sims¹ and Dana Weber¹

(1)

Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Nedlands, WA, Australia

Craig Sims (Corresponding author)

Email: craig.sims@health.wa.gov.au

Dana Weber

Email: dana.weber@health.wa.gov.au

Keywords

Non accidental injuryDetectionSuspicious fracturesChild abuse injury patterns

Anesthetists may encounter children who have been physically or sexually abused. There are ethical and legal obligations to protect the child in this circumstance. The safety of the child is paramount and overrides all other considerations. Surgeons, nurses and all other health workers have the same legal obligation to report suspected child abuse. They should have training in child protection and be aware of the arrangements for child protection in their own hospitals. Although doctors have obligations to maintain patient confidentiality, the legal obligations to report suspected child abuse over ride confidentiality considerations. Modern societies have specific legislation dealing with these obligations, such as the 2004 Children’s Act in the United Kingdom and state-based legislation in Australia. New Zealand does not yet have legislation for mandatory reporting of suspected child abuse.

29.1 Detection of Abuse

The anesthetist may be the first person to notice the signs of child abuse, either as part of the preoperative assessment or in theater. Alternatively, the anesthetist may be present when the surgeon or nursing staff notice signs, and rarely a child may disclose abuse to the anesthetist. Anesthetists involved in resuscitation or intensive care may also notice signs of abuse (Table 29.1).

Table 29.1

Situations when the anesthetist may encounter possible child abuse

Situations when the anesthetist may be involved with suspected child abuse
Notices signs at preoperative assessment or in theater
Is present when surgeon or nursing staff discover signs
A child needs resuscitation or intensive care management with head injury or other injury without adequate explanation
A child may disclose abuse to anesthetist
Provides anesthesia for forensic examination of a child who is suspected of having been abused