Children and Domestic Violence

Child exposure to domestic violence is a term encompassing a wide range of experiences for children whose caregivers are being abused physically, sexually, or emotionally by an intimate partner. This term includes the child who actually observes his/her parents being harmed, threatened or murdered, who overhears this behavior in the home, or who is exposed to the short or long term physical or emotional aftermath of the caregiver’s abuse.

Prevalence in America

Estimates indicate that between 3.3 and 10 million children are exposed to domestic violence per year. Studies have found that child abuse occurs in up to 70% of families that experience domestic violence.

Children who are exposed to domestic violence are more likely to exhibit behavioral and physical health problems.

Infants and Toddlers

  • Excessive irritability
  • Immature behavior
  • Sleep disturbances
  • Emotional distress
  • Fears of being alone
  • Regression in toileting and language


PTSD

85% of children exposed to domestic violence exhibited moderate to severe symptoms of posttraumatic stress disorder, including repeated re-experiencing of the traumatic event, avoidance, numbing of responsiveness, and increased arousal.

The most important resource for protecting children from the impact of violence is a competent, caring adult. Since maternal emotional availability may be preoccupied with staying safe or depression, domestic violence can have a detrimental impact to exposed children.

Importance of Screening Caretakers in the Pediatric Setting

In some domestic violence cases, the pediatric setting may be the only window of intervention available to abused mothers and their children. Perpetrators may restrict medical healthcare of the women, but not the children. Providers may intervene to help patients understand their options, live more safely within the relationship, or safely leave the relationship. They also have the opportunity to educate parents about the adverse physical, emotional, and behavioral effects that domestic violence has on children.

Mandatory Reporting Laws

When domestic violence is disclosed, physicians need to be aware of the possibility of child abuse and their legal obligation as mandatory reporters.

Before screening for domestic violence, it is important to know your state’s child abuse reporting laws. Some states have stringent laws that require mandated reporters to notify Child Protection Services whenever a child in the home has been exposed to a parent’s abuse, whether or not the child has been directly abused. In other states, exposure to domestic violence does not automatically require mandatory reporting. Physicians are left more discretion as to whether the child is being abused or is at risk of imminent harm.

Mandatory reporting issues will be addressed throughout this training. In "additional materials" is a chart with each state’s child abuse reporting laws that is available to print.

Most providers agree that if the child is under the age of three, asking the mother about domestic violence and safety issues is appropriate.

Do not assess for domestic violence if both parents accompany the child.

For mothers who need interpreters, do not assess for domestic violence if the interpreter is a child, friend, or member of the family.

For older children, it is best to assess for domestic violence without children in the room. If it is possible, have the child wait in a supervised playroom or under the supervision of another staff member. If there is no option to see the mother alone, ask very general questions (ex. How are things at home?) or make arrangements to talk to the mother by telephone or at follow-up visits.

As always, it is best to start the assessment with a framing question.

Example:

  • “Violence is an issue that unfortunately effects many people today and thus I have begun to ask all families in my practice about exposure to violence.
  • May I ask you a few questions?”


Direct Questions

  • "Have you been hit, kicked, punched, or otherwise hurt by someone within the past year?”
  • “Do you feel safe in you current relationship?”
  • “Is there a partner from a previous relationship who is making you feel unsafe? How?”

Discussing Child Exposure to Domestic Violence
Questions to Ask

  • Has the child/children been exposed to the fighting in the household?
  • Has the child/children been physically or emotionally abused by your partner?
  • Has your partner made threats towards the children?


Disclosure of Domestic Violence

If domestic violence is disclosed, explain to the patient your role as a mandated reporter before discussing child exposure to the domestic violence. Depending on the state, if child abuse is disclosed, you might have an obligation to break confidentiality and report the abuse to Child Protection Services.

When child exposure is disclosed, state mandatory reporting laws determine the next steps of intervention.

In states that have Mandatory Reporting Requirements for Child Exposure to Domestic Violence:

  • Inform the parent of your obligation to report to Child Protection Services
  • Recommend that the victim place the phone call herself from the office, therefore protecting her from charges of “failure to protect.”
  • Give CPS specific information about the perpetrator, the incidences of violence, and the potential for danger.
  • Access the victim’s safety needs: Does she have a place to go? Does she need shelter?
  • Refer the victim to the appropriate domestic violence resources, such as shelter, counseling, children services and legal resources.


In States With Less Specific Reporting Requirements for Child Exposure to Domestic Violence

Deciding Whether to File a Report with Child Protection Services is based on:

  • Injuries of Abuse to the Children Potential for Danger (threats, weapons, substance abuse)
  • Mother’s Ability to plan for children’s safety Assessment of support and connections to the community


If provider decides to report, follow the steps outlined before. If the decision is to not report:

  • Communicate concern and provide validating messages
  • Provide Information about Domestic Violence and its impact on child exposure
  • Assess the safety of the victim and children, and provide safety planning and resources that are available to victims and children of domestic violence
  • Schedule a follow up appointment

A perpetrator can legally have access to a child’s chart if he is a biological or custodial parent. Discovering disclosure of abuse can put the victim and children at risk of harm.

Some options are available for documenting abuse; however, these alternatives need to be approved by the medical institution before being used.

  • Document the abuse in mother’s chart or social work notes
  • Use a code term, such as “+wtv” to indicate domestic violence
  • Maintain a confidential section of the chart that is not released upon request