Study Finds Low Rates of Family Violence Detection by Pediatricians

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A study in the Archives of Pediatrics & Adolescent Medicine concludes that parents report more cases of violence than pediatricians detect, and that pediatricians should ask parents directly about domestic violence. The study examines what parents report about violence vs. what their children's physicians detect. It compares 1) the rates of domestic violence reported by mothers with those identified by physicians, and 2) the rates of harsh discipline practices reported by mothers with the rates of abuse identified by physicians. It also examines the relationship between reported domestic violence and harsh discipline practices. The study involved community-based pediatric practices in the New Haven, CT area, as well as 1,148 parents who participated in the 90-minute in-person interview portion of the study.

Study results include:

• Pediatricians found domestic violence in 0.3% of the cases, but parents reported domestic violence in 4.2%.
• Pediatricians identified physical abuse of children in 0.5% of the cases, while mothers reported hitting their children and leaving a mark in 21.6%. Mothers reporting domestic violence were significantly more likely to report hitting hard enough to leave a mark, compared with those not reporting domestic violence.
• Physicians identifying domestic violence were not significantly more likely to report child abuse than those not identifying domestic violence.

Although parents were not asked specifically about child abuse, if they answered yes to the question of whether they had "hit hard enough to leave a mark," the authors interpreted this as indicative of abusive behavior. While study strengths include a large data set and a high response rate, the authors note that a study limitation may be the difference between the questions asked of the pediatricians and those asked of the mothers. (Mothers were asked specifically about domestic violence, while physicians were asked if they had noted any family or social problems.) Also, the authors conducted the study in the late 1980s and early 1990s, when less attention was being focused on domestic violence.

The article cites other studies indicating that about 3 million cases of child abuse and neglect are reported yearly, and that children of battered women are 6 to 15 times more likely to be abused than children of women who are not battered. The authors state that "our results point to a greatly missed opportunity for identifying family violence in the pediatric primary care setting ... [and] most women favor direct questioning about abuse and are probably less likely to disclose such information without inquiry."

Kerker BD et al. 2000. Identification of violence in the home. Archives of Pediatrics & Adolescent Medicine 154(5):457-462.

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MCH Alert. 2001. Arlington, VA: National Center for Education in Maternal and Child Health. http://www.ncemch.org/alert.