Pediatricians in Israel: Factors which affect the diagnosis and reporting of maltreated children

Objectives: First, to examine what Israeli pediatricians consider to be abuse or neglect of children, second, to examine their willingness to report child maltreatment, and third, to examine the factors which may affect their approach. Method: A quantitative cross-sectional survey research design was employed. One hundred and thirty-five pediatricians responded to a specially constructed instrument sent to a systemic, randomly chosen sample. The participants rated 40 vignettes of abuse and neglect according to their perception of the extent of the risk to the welfare of the child and their willingness to report these situations. They also rated 15 signs according to their perception of the extent to which each sign could lead to a suspicion of maltreatment. Results: Situations which fell within the biomedical perspective were ranked as containing a higher level of risk to the child than situations which were not (i.e., psychological abuse and educational neglect). Situations describing explicit signs or negative consequences of an act were ranked higher than those in which rationalization by the parent was included. These findings indicate that concrete evidence affects pediatricians judgement of what constitute maltreatment. The pediatricians were less willing to report situations of child maltreatment to the police than to the welfare department. Conclusions: Certain situations of abuse or neglect might be overlooked by pediatricians in the process of diagnosing maltreated children. This may be explained by inadequate awareness of the psychosocial factors needed to identify maltreated children. Pediatricians' willingness to report seemed to depend on their altitude toward the receiving professional, and situations requiring involvement of the police may be disregarded.