Response to battered mothers in the pediatric emergency department: A call for an interdisciplinary approach to family violence

Background. Child abuse and wife abuse are linked. Studies indicate 30% to 59% of mothers of children reported for child abuse also are battered. In homes where domestic violence occurs, the children are at increased risk of physical abuse or neglect. Children who witness battering of their mothers are at risk for psychosocial sequelae including developmental delays and posttraumatic stress disorder. Objective. To determine pediatric emergency medicine fellows' level of preparedness to respond to battered mothers, and to assess obstacles and attitudinal barriers to their effective response. Study Design. Self-reported written survey. Methods. A 30-item anonymous questionnaire was mailed to 162 pediatric emergency medicine fellows in the United States and Canada in 1995. A response rate of 77.2% (n = 125) was achieved. Results. Before fellowship, 97.6% of respondents had training (including formal courses, conferences, and direct patient contact) on child abuse/neglect although only 29.6% received similar instruction on woman battering. There was a marked disparity between patient contact experience for child abuse/neglect and woman battering throughout training. Before fellowship, 89/122 (73%) reported direct involvement in at least 10 cases of child abuse/neglect. Seventy-one (57.3%) of 124 fellows had not handled any cases of woman battering before fellowship; 106/124 (85.5%) had been directly involved in fewer than 10 cases. During fellowship 81 (67.5%) of 120 respondents had been involved in at least 10 cases of child abuse/neglect and 46/120 (38.3%) had handled at least 20 cases. In contrast, 72 (73.5%) of the 98 responding fellows had not handled any cases of woman battering during fellowship. Furthermore, 86/100 fellows reported no formal training on woman battering in their fellowship curricula. Only 5/118 (4.2%) reported having protocols in place for responding to battered women in the pediatric emergency department. Items most frequently selected from a list of potential obstacles to responding to battered women included: lack of a protocol (82/113), lack of formal training in the field (103/118), and lack of experience with woman battering cases (100/117). The majority, 75/118 (63.6%), believed that responding to battered mothers did not belong in the purview of pediatrics. Potential attitudinal barriers confirmed with the greatest frequency included: frustration that nothing could be done and lack of time to respond appropriately to battered mothers in the pediatric emergency department. Conclusions. Battered mothers are rarely identified in the pediatric emergency department even though the physicians report handling a significant number of child abuse/neglect cases. Education on domestic violence, including the implications of woman battering for childrens' health, should be incorporated in the training curricula of pediatric emergency department physicians to raise awareness of the need to explore for the presence of concurrent abuse in both children and their mothers. Identifying battered women through their children will impact greatly on the welfare of both mother and child.