How Should Clinicians and Students Cope With Secondary Trauma When Caring for Children Traumatized by Abuse or Neglect?

When health care professionals encounter child abuse and neglect, they can experience a range of emotions, such as anger, sadness, and frustration. Such feelings can cloud judgment, compromise care, or even undermine one’s capacity to complete evaluation of a child. This article discusses key ethical values of honesty, objectivity, compassion, professionalism, respect for persons, and justice, which can be used to guide one’s approaches to navigating secondary trauma during and after clinical interactions with children who have suffered abuse or neglect. Strategies for coping with intense feelings, especially during interactions with abused and neglected children’s families, are also offered herein.

Witnessing Abuse and Neglect

In fiscal year 2020, child protective services agencies received 3.9 million referrals alleging child abuse and neglect. Approximately 618 000 children were identified as victims, with the highest rates for infants. Roughly 12% of reports to child protective services were made by medical personnel.1 As mandatory reporters in all 50 states, health care professionals are often required to complete child abuse education training in mandated reporting. However, there is no universal training program for teaching health care professionals—including students and trainees—how to manage and cope with their emotions in these cases, which can make it difficult to adhere to ethical standards, including honesty, objectivity, and respect and empathy for caregivers who might be suspected perpetrators of child abuse and neglect. Here, we offer recommendations for communication strategies health care professionals can employ in cases of suspected child abuse and neglect and discuss approaches to managing secondary trauma that such cases might evoke.


When child abuse or neglect is being considered, it is best practice for health care professionals to communicate this concern to families in an open and honest way. For instance, the statement, “I am concerned someone may have harmed your child,” is an appropriate expression of concern, especially if a diagnosis of abuse is not certain. Alternatively, if the child is battered or has pathognomonic, multiorgan injury that can only be the result of abuse, it is appropriate to clearly state that the child is a victim of abuse. Sometimes staff do not know the appropriate language to use to convey concern, or they might worry about angering or offending parents or other caregivers or simply feel uncomfortable with confrontation. In consequence, staff might not communicate appropriately with families or might avoid communication with families, which can affect families’ perceptions of how they are treated. In a study that examined parental perceptions of care during young children’s hospitalization for traumatic injuries, parents who were evaluated for possible abuse by the hospital child protection team— even when the injury was determined to be nonabusive—reported feeling less informed by staff and were less likely to feel that they were treated honestly or respectfully than parents for whom abuse was not considered. Additionally, parents of children who were abused were more likely to feel that the diagnosis of abuse changed the way they were treated by hospital staff. These perceptions may be due to parents thinking that they are being negatively judged by the hospital staff or to their recognizing the hesitancy of staff who are uncomfortable caring for families of children who might have, or who have, been abused. Potentially, both factors contribute to these perceptions, highlighting the need for repeated communication with families. It is often helpful for clinicians to begin the conversation with concerns about possible abuse and ask parents whether they have any concerns that someone might have hurt their child. This is a nonjudgmental way to begin an open dialogue.

It is also ethically important not to “hide” behind one’s mandate to report child abuse when discussing concerns with families. That is, clinicians blaming a decision to report on the law (eg, “I don’t think it’s abuse, but I am mandated to report”) rather than taking full responsibility for acting on their discernment and concern obscure the best reasons they have for reporting. Transparency with families is too important for professionals to invite such obfuscation into an already complex and emotionally fraught discussion. In fact, families in most cases likely deserve to know the specific roles clinicians play on a team—whether consultant or admitting physician, trainee, or supervising clinician. Families should be introduced to the various members of the medical team, just as in any other patient-clinician interaction, and know that the team members take their responsibilities seriously. It is also important to educate trainee team members to be forthcoming about their role as a trainee.

Expressing concerns about child abuse and neglect to a family can be unsettling for any health care professional, but it is especially unsettling for trainees. Trainees may never have encountered child abuse and neglect before and may have minimal experience with challenging patient interactions. Just as mentors would not send trainees independently to deliver bad news without modeling how to do so, so they should not send trainees independently to discuss child abuse and neglect concerns without adequate preparation. To better prepare trainees for these patient encounters, we recommend modeling communication with families prior to having trainees lead the discussion. We also recommend emphasizing the importance of explaining medical terminology using language that is easily understood by patients and families. In addition, trainees should be taught to inform families that a report of suspected abuse is needed to further investigate the cause of the child’s injury or condition. We often tell families that we will evaluate for underlying medical explanations while asking child protective services to investigate the possibility of abuse or neglect. In general, health care professionals are expected to report those cases in which there is reasonable suspicion that a child was a victim of abuse or neglect by an individual whose care they were under.


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