One of the most heartbreaking decisions a doctor has to make is whether or not to report a suspected case of domestic violence. Often, injuries to the wrist, forearm or elbow, especially if they are recurring, are a tip-off that something is very wrong in the home.
So, what are the signs of domestic abuse, and when will a doctor report suspected abuse?
US government research shows that every ten seconds, a report of child abuse is filed, and that five children die each and every day from abuse. Most are abused by their parents, or by someone who is known to the family, and most children who die from abuse are under the age of 3. Child abuse transcends all races, religions, and economic levels. Sadly, many instances of child abuse go unreported. This is because often the child loves the abuser and is reluctant to report the abuse. The child may even feel that he or she deserves the abuse. That is where the doctor comes in, and has to use his or her diagnostic skills to determine whether abuse has occurred.
Sometimes, identifying abuse is easy, and doesnt even require determining the cause of an injury. It is easier with children than it is with adults. For instance, if a child presents with an injury that appears not to have occurred as a result of normal activity, and the child is also withdrawn, uncommunicative fearful of adults, and offers explanations that do not make sense (“a bad man came into my room”), abuse is easy to identify. Additionally, breaks and sprains do not usually occur in children who have not progressed beyond crawling. Wrist, arm and elbow injuries to infants are almost invariably due to abuse.
With adults (women, usually), it may be a little more difficult. It is generally a given that no one gets a black eye because “I walked into a door,” but in the absence of other evidence, it is hard to prove abuse. Often, even the most skilled, compassionate doctor cannot draw out the true cause of an injury from an abused adult.
Signs of Abuse
The signs of physical abuse can include:
- Black eyes
- Unexplained broken bones
- Bruises that have a certain shape (“grab” marks, welts that appear to have been caused by a belt, etc.)
- Ligature marks
- Burn marks
- Bite marks
Often, strange explanations may also be given for the injuries to the injured child or adult – “He was falling off the swing, so I grabbed his arm,” or “She was having a bad dream and fell out of bed.” Stairs also seem to play a significant role in domestic injuries.
There are counseling and support groups for abusers and victims. There are also government agencies that are mandated to protect children under the age of 18. Systems vary from state to state, but usually involve family court. When children are involved, usually there is every effort made to reunite families. Abused adults also have access to safe environments and counseling. Doctors are required to report broken bones when abuse is suspected.