Child abuse and neglect is a common problem in our society, prevalent in all races, religions, and socioeconomic groups. All states have laws requiring that physicians report suspected child abuse to a government agency in charge of protecting children. This is sometimes a frustrating experience for the physician. These agencies are overworked and have limited resources. All physicians who care for children should know which local agency enforces the child welfare laws in their state.

Child abuse is not a diagnosis; it is a legal determination. A physician who suspects that a child is abused or neglected or is in danger of being abused or neglected has a duty to report that suspicion. Physicians should not try to investigate the potential abuse on their own. This may endanger the child, confuse the legal issues, and subject the physician to prosecution for failing to report the suspected abuse. Many physicians are slow to report suspicions of child abuse because they are concerned that they may be making an unfounded judgment about the parents or the family. Physicians must also guard against parents’ rationalizations about why their behavior should not be considered child abuse. The physician’s obligation is to evaluate the effect of the behavior on the child. The child protection agency will investigate the parents’ explanations before taking any legal action. Physicians must not second-guess the child protection agency or attempt private resolutions of possible abuse.

As with other reporting laws, neither the patient nor the parents nor the physician have the right to stop the reporting or to withhold information from the law enforcement agency. A parent may refuse to answer an investigator’s questions under the Fifth Amendment protections against self-incrimination. This part of the process should not involve the physician. The physician should provide all the known information in as objective a manner as possible.