How does child abuse suspicion arise in general practice?

Wednesday, April 10th, 2019

Accepted abstract EGPRN Tampere 2019

by Erik Stolper, Jan Paul Verdenius, Geert Jan Dinant, Margje van de Wiel


Child abuse is wide spread, occurs in all cultures and communities and remains undiscovered in 90% of the cases. 80% of reported child abuse concerns emotional ill-treatment. In the Netherlands, at least 3% (118.000) of children are victims of child abuse resulting in 50 deaths each year. Only 1-3% of abuse cases are reported by general practitioners (GPs) to the Child Protective Services agency (CPS). To explain this low reporting rate we examined GPs’ experiences with child abuse.

Research question

How does the suspicion of child abuse arise in GPs’ diagnostic reasoning? How do they act upon their suspicion and what kind of barriers do they experience in their management?


In total 26 GPs (16 females) participated in four focus groups. We used purposive sampling to include GPs with different levels of experience in rural and urban areas spread over the Netherlands. We used NVivo for thematic content analysis.


Suspected child abuse arose based on common triggers and a gut feeling that ‘something is wrong here’. GPs acted upon their suspicion by gathering more data by history taking and physical examination. They often found it difficult to decide whether a child was abused because parents, despite their good intentions, may lack parenting skills and differ in their norms and values. Clear signs of sexual abuse and physical violence are reported by GPs to CPS. However, in less clear-cut cases they followed-up and built a supporting network around the family. Most GPs highly valued the patient-doctor relationship while recognizing the risk of pushing boundaries.


A low child abuse reporting rate by GPs to CPS does not mean a low detection rate. GPs use patients’ trust in their doctor to improve a child’s situation by involving other professionals.