Suspected non-accidental injury: mandatory reporting

The pattern here is highly suspicious for physical abuse. Accidental bruises in a mobile child occur over bony prominences: shins, knees, forehead. Bruises on the buttocks, thighs and upper arms, in several stages of healing, with finger-mark patterns, do not fit 'clumsiness'. A child who goes quiet when asked about injuries is another warning sign. Normal coagulation studies have already excluded the main medical alternative.

In every Australian state and territory, doctors are mandatory reporters of suspected child abuse. The threshold is a reasonable belief or suspicion that a child has been, or is at risk of being, physically or sexually abused (the exact categories vary between jurisdictions). The doctor does not need proof, does not need to identify the perpetrator, and must not investigate before reporting. Reporters who act in good faith are protected from liability and their identity is confidential.

The report goes to the state child protection service (for example, the Department of Communities and Justice in New South Wales, or Child Safety in Queensland) by phone and in writing. In a hospital, the child protection unit or social work team is involved at once. The child is examined fully, injuries are documented with body maps and photographs, and a skeletal survey is considered in children under 2. Admission is appropriate if the child is not safe to go home while the assessment proceeds.

The RACGP White Book (Abuse and violence: working with our patients in general practice) sets out the general practitioner's role and emphasises that the duty to report overrides confidentiality.

Parents are told, in a non-accusatory way, that the doctor is required to report injuries of this kind, unless doing so would put the child at greater risk.