Pediatric mistreated child care paths: criteria for hospital care

Background: Pediatric services are on the front line when there is an emergency, safety and placement provisions are applied to minors. Likewise, when the clinical lesions are so serious that they require often intensive somatic management, the issue of monitoring the child once somatically "healed" is crucial.
Method: In addition to intra-family mistreatment situations which can be followed on an outpatient basis, there are clinical situations relating to child mistreatment which require a medico-psycho-social assessment in the hospital. Because the hospital is not a place for a child to live, this type of care must meet strict criteria. The Cellule Maltraitance pediatric unit of the CHU Liège pediatric service, provides this type of care. An assessment can be initiated according to three different care paths identified as follows:
- The request for a hospital assessment by the SAJ or the Justice Department.
- The arrival of the child via the emergency room.
- Screening for a situation of mistreatment or at risk of being mistreated on one of the sites of the CHU Liège pediatric service.
However, in order to offer an effective therapeutic transition, it is necessary to take into account specific hospitalization criteria:
- Failure of a prior outpatient assessment
- The physical and / or psychological danger to which the child is exposed at home, thus preventing any possible outpatient work.
- The need for the child to be supported in a multidisciplinary manner in a neutral environment in order to free and respect his word without any contamination or possible influence. - The need for intensive care both individually and in terms of family dynamics for which the various hospital specialties are required.
- The need for a strict framework allowing effective parental collaboration.
- The lack of a reception structure currently available from which care could be taken.
Results: Around 50 to 60 assessments are carried out per year within the Cellule Maltraitance service. On average, we observe: - 53% physical abuse - 14% sexual abuse - 11.5% serious neglect - 21.5% psychological abuse, parental conflicts. The required hospital stay is rarely exceeded (less than 5%). On average, the orientation given is 70% return to the family and 30% long-term placement orientation.
Conclusion: The care path for an abused child must be considered according to criteria that will allow adequate care and a beneficial development.