Aims NICE guidance on DV recommends routine enquiry (RE) and specific training for professionals in healthcare settings where children are seen.1 DV features in 2/3 of serious case reviews for serious harm due to abuse or neglect.2 RCPCH Child Protection Companion states differential diagnosis of fractures includes abuse; abuse is more likely the younger the child and DV is a risk factor for abuse.4 A previous study in one ED found low levels of enquiry for risk factors in fractures <3 years.3 We assessed the level of targeted enquiry about DV in 3 Paediatric ED.
Methods This multi-site study audited 3 Paediatric EDs for documentation of DV enquiry in children < 3 years with fractures (August 2013–August 2014).
Conclusion This study indicates consistently low rates of DV enquiry by health professionals despite NICE guidelines stating best practice in settings seeing children. This finding raises the concern that medical professionals do not consider DV a risk factor for abuse, or are unable to ask easily about DV. Health professional associated barriers to asking about DV are well evidenced in the literature.5 There is an urgent need for more training in both assessment of risk factors for child abuse and the effects of domestic violence on children. There is need for further consideration of routine enquiry about DV in the paediatric ED setting.
Recommendation 6 Ensure trained staff ask people about domestic violence and abuse, NICE guideline PH50 Feb14
Brandon et al: DFE-RR226. New learning from Serious Case Reviews: a two year report for 2009–2011
Fractures in children under three years presenting to A&E Presented to BAACH Annual Scientific Meeting, 2014 E. Payne, H. Murch, C. Woolley
Child Protection Companion 2013 2nd Edition
Kevin Hamberger, Mary Phelan: Domestic Violence Screening in Medical and Mental Health Care settings: Overcoming Barriers to Screening, Identifying, and Helping Partner Violence Victims’, 2006
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