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Original article
Audit of child maltreatment medical assessments in a culturally diverse, metropolitan setting
  1. Shanti Raman1,
  2. Paul Rex Hotton2
  1. 1 Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
  2. 2 Community Child Health, Sydney Children’s Hospital, Randwick, New South Wales, Australia
  1. Correspondence to Dr Shanti Raman; Shanti.Raman{at}


Objective Child maltreatment (CM) is a major public health problem globally. While there is evidence for the value of medical examination in the assessment of CM, little is known about the quality of clinical assessments for CM. South Western Sydney (SWS) has a large metropolitan population with many vulnerable subgroups. We aimed to describe acute presentations of CM in SWS over a 3-year period—with a focus on the quality of the clinical assessments. We wanted to determine whether the cases assessed fulfilled established minimum standards for clinical assessment of CM and whether the assessments were performed in a child-friendly manner.

Design We gathered data from the acute child protection database on all children <16 years referred for assessment between 2013 and 2015. We performed simple descriptive analysis on the data. We measured the assessment, report writing and follow-up against criteria for minimum standards for CM assessments, and identified whether assessments were child-friendly from available clinical information.

Results There were 304 children referred; 279 seen for acute assessment; most (73%) were for sexual abuse, 75 (27%) were for physical abuse/neglect. Over half the assessments identified other health concerns; joint assessments performed by paediatric and forensic doctors were better at identifying these health concerns than solo assessments. Most assessments were multidisciplinary and used protocols; half were not followed up; a third were performed after-hours and a third had no carer present during assessments.

Conclusions We identified strengths and weaknesses in current CM assessments in our service. Locally relevant standards for CM assessments are achievable in the acute setting, more challenging is addressing appropriate medical and psychosocial follow-up for these children. While we have established baseline domains for measuring a child-friendly approach to CM assessments, more should be done to ensure these vulnerable children are assessed in a timely, child-friendly manner, with appropriate follow-up.

  • child abuse
  • medical assessments
  • child protection
  • child-friendly
  • quality healthcare
  • health services

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  • Contributors SR planned, conceived and designed the study, helped with data analysis and did the writing up. PRH helped with planning, did all the data gathering and analysis, helped with writing up.

  • Competing interests None declared.

  • Ethics approval Human Research Ethics Committee at Liverpool Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.