Because a parent or guardian is the one who consents to medical care for a child and pays for the care, it is easy to forget that the physician–patient relationship runs to the child rather than to the parents. Physicians who have reason to think that a child is in danger should pursue all avenues of protection for that child. Physicians should be prepared to testify in court proceedings and to work with protective services. If the child is returned to the custody of an abusive parent under a restrictive order, the child’s physician should know the conditions and should contact protective services if there is any indication that the order is being violated.

If the child protection agency does not intend to pursue the case, a reporting physician should ask for a reasonable explanation of the injuries or conditions that led to the suspicion of child abuse. If the explanation is unsatisfactory or incomplete, the physician should discuss this fully with the person in charge of the agency. Clearing up misunderstandings may save a child’s life. The agency may also give more attention to a case in which a physician has serious concerns. Since the agency is not a court and must ask for court orders in serious cases, the support of the child’s physician may help them to convince the judge that legal actions are needed.