what is this?

LEAP Resources

Pediatric Patient Providers

padiatric patient careExposure to adulthood IPV and child abuse are closely linked. Studies estimate that in 30-60% of families in which there is adult IPV, children are also directly abused. Even when children are not directly abused, the exposure to adult IPV can be highly damaging to a child’s emotional, behavioral, and physical health. Childhood exposure to adult IPV can create developmental problems and inappropriate risk-taking behaviors that persist into adolescence and beyond. The ACE study demonstrates that this childhood exposure to adult IPV (and other traumatic childhood events) results in more risky health practices and poorer health for the exposed child as an adult. Intimate partner violence is often passed on from one generation to the next.

Learn How to Address IPV and Childhood Exposure to IPV

The Role of the Pediatric Provider in Addressing IPV and Childhood Exposure to IPV

Pediatricians play a crucial role in screening parents and guardians for IPV and providing strong educational messages about how childhood exposure to adult violence and abuse impact children adversely in long-lasting ways. The American Academy of Pediatrics has stated that “the abuse of women is a pediatric issue”. Pediatricians have an opportunity to interact in supportive ways with mothers and female guardians who, if victimized by their intimate partner, may not be free to seek healthcare for themselves.

The pediatrician has a multifaceted role in addressing IPV by:

  • Screening mothers and female guardians (and male guardians who are suspected of being victimized) for IPV victimization.
  • Screening mature middle childhood age children and all adolescents directly for exposure to adulthood IPV.
  • Screening adolescents (both boys and girls) for involvement in violent and abusive dating relationships.
  • Providing educational messages to all parents and children about the harmful effects of witnessing IPV on children.
  • Linking children who have been exposed to IPV with appropriate treatment services (preferably dyadic treatment with the victimized parent/guardian).

Caring for the Children of Pregnant Women and Newborns

Pediatric providers also care for the children of women who are pregnant. Pregnant women may begin experiencing IPV before, during, or after pregnancy. IPV has multiple adverse affects on pregnant women and newborns including an increased risk of hypertension and hospitalization of the pregnant woman, pre-term labor, low birth weight babies, and neonatal intensive care hospitalization. IPV is also associated with approximately a doubling of the STD rate. ACOG and CDC have prepared a slide show that addresses IPV in pregnancy that can be viewed on the CDC website. Download our “IPV and pregnancy” brochures for your patients.

Maintaining Safety and Confidentiality

Pediatric providers face challenges to maintaining safety and confidentiality when addressing IPV when both parents accompany children to an appointment. Although there are heterosexual men who are victimized by their female partner this is the exception rather than the rule. It is recommended that the mother or female guardian of the child be asked about IPV victimization in non-judgmental terms in complete privacy. In order to maintain safety, most experts recommend that inquiry about IPV should not be done in front of children who have the capacity to communicate what happened during the visit. This is an area of controversy as it can be difficult to separate children from their parent(s) during a visit.

Techniques for separation include inquiring about IPV when a child is occupied with a hearing or vision check or play activity. Rarely, either children or mothers will raise the topic of IPV or family violence when they are together in the exam room. In this case, we suggest that you preface your inquiry to the mother with a statement like, “I would like to ask you questions about your relationship with your partner and your safety in that relationship. Should we have your child wait outside the room?” A full discussion of this dilemma can be found in the FVPF guidelines: Identifying and Responding to Domestic Violence: Consensus Recommendations for Child and Adolescent Health.

Inquiring about IPV with Men

There are no trials of how to discuss IPV with men in pediatric practices. If pediatric providers embark upon inquiring about IPV with men, they should design the IPV program in such a way that it is clear that the program is “routine” and that a particular patient is not being screened for perpetration due to something revealed by their victimized partner. New pilot guidelines on addressing IPV with men and the accompanying review article may be helpful.

It is important for pediatricians to discuss and model healthy relationships for children and to present fathers with information on how witnessing violence is harmful to children.

Helpful materials for fathers can be found here.

Information for adolescents on teen dating violence and family violence can be found here.