Screening for Intimate Partner Violence

Intimate partner violence is a major problem affecting children. About one in every four households is exposed to domestic violence, and as many as 10 million children witness domestic violence every year.

"Domestic violence is a significant problem in the community," said Denise Dowd, MD, MPH, pediatric emergency medicine specialist at Children's Mercy Hospital in Kansas City. "Intimate partner violence crosses all socioeconomic lines and all ethnic lines. And pediatricians are in a position to help both the children and the parent who are victims."

The typical presentation is a parent, usually a mother, who brings an injured child to the emergency department, Dr. Dowd said. Whether the parent is also injured is immaterial, she said. Fewer than 25% of women who are injured by an intimate partner see medical attention for themselves, but nearly 100% seek care for their injured child.

"Kids are canaries in the coal mine when it comes to intimate partner violence," she said. "Domestic violence is a family event, and kids show the effects very quickly."

Even if children are not injured physically, they suffer emotional and psychological wounds, Dr. Dowd continued. Posttraumatic stress disorder, depression, behavioral problems, anxiety disorders, hypervigilance, nightmares, and somatic complaints are common complications of domestic violence. Long-term effects include suicide, depression, alcoholism, and poor physical health.

AAP recognized the abuse of women as a pediatric issue in 1998, she noted. In 2002, the Academy endorsed guidelines developed with other physician and domestic violence advocacy groups that call on pediatricians to screen for domestic violence, and respond appropriately.

"It's a great idea, but you need tools to do it," Dr. Dowd said. "At this point, there is no gold standard for assessing intimate partner violence or for responding appropriately."

The goal, she said, is universal screening of children and parents for intimate partner violence. Screening can be done verbally, in writing, by computer, even by audio recording, depending on what works best for any particular practice.

The response to a potentially positive finding of domestic violence is even more important, Dr. Dowd noted. Disclosure is the most dangerous time in a violent household situation, she explained. Women who admit to suffering violence or ask for help need an immediate response.

"You don't have to solve intimate partner violence," she said. "But you have to identify it, and you have to make the appropriate referrals. Think of it like cardiovascular disease. You can't solve it, but you can--you must--refer the patient to the appropriate specialist to deal with the problem."