Texas Children’s and Baylor College of Medicine’s– Child Abuse
Pediatrics Statement
In our community and throughout the nation, child abuse and neglect
continue to be a serious problem. In the United States, some 7.5 million
children are the subject of child abuse inquiries and four children die as a
result of child abuse each day; half of those are under the age of 1 year.
An important part of Texas Children’s dedication to the health and well-being
of children is to minimize the impact of child abuse and neglect on children
of all ages. All of our providers are legally and morally obligated to ensure
children are safe and protected. The Child Abuse Pediatrics Program at
Texas Children’s employs an integrated and multidisciplinary approach to
prevent or minimize the impact of child abuse and neglect in our community,
through prevention, patient care and outreach.
Our child abuse pediatrics team sees hundreds of children a year where a
concern is raised about potential abuse or neglect. The vast majority of these
cases are resolved with no report to Child Protective Services (CPS) after a
careful, multi-disciplinary review; but, as a mandatory reporter, we are legally
required to inform CPS if a caregiver suspects abuse or neglect in any form.
Failure to report suspected abuse and neglect is a criminal offense. These
cases involve difficult determinations for our caregivers and are an obligation
we take very seriously.
Once a report is made, CPS follows an independent process to determine if
they suspect a child is the victim of abuse. If child abuse or neglect is
suspected, CPS initiates an investigation. Based on their findings and
investigation, CPS makes a recommendation to the court. The court has the
final say in whether a child is removed from the home, not Texas Children’s,
Baylor College of Medicine or any individual physician.
When physicians testify in court, they do so based on their professional
experience and with information obtained from direct physical examinations,
interviews, review of the case notes and consultation with other providers.
These cases are often complicated and lengthy, with multiple health care
providers involved and some medical records exceeding 10,000 pages. Like
any court testimony, their responses are restricted to the very narrow line of
questioning put to them by the attorneys on both sides of the case.

 When our doctors reach a conclusion that a child has been the subject of
abuse or neglect and is in danger, there are a number of ways they will
explain that to juries, depending on the questions they are asked. When
these comments are taken out of context and not presented within the full
testimony, they can potentially be misconstrued as overreaching. For
example, in a case where a baby has human bite marks, broken bones, is
beaten and close to death when he gets to our doors, a physician who is
asked to gauge the certainty with which she believes child abuse may be
indicated replies “100 percent.” Taken alone, that comment might appear
extreme, but in this circumstance, it seems appropriate.
Dr. Mark Kline, Physician-in-Chief at Texas Children’s, provided further
context: “When physicians testify in court, attorneys may ask for a
percentage of certainty regarding the likelihood of abuse, or the physician
may use a percentage as a clearer way of conveying their confidence in the
diagnosis. When extreme indications of child abuse are present, it is entirely
understandable and appropriate that the physician might assert 100 percent
confidence in the diagnosis.”
Furthermore, Dr. Christopher Greeley, the director of the Child Abuse
Pediatrics Program at Texas Children’s clarified, “While my preference is to
remain largely qualitative and not use percentages, many child abuse
pediatricians may use percentages for a lay audience or jury. I have
confidence in our Texas Children’s physicians who testify in these cases to
present a clear and accurate assessment of the patients’ conditions.”
"Our ultimate goal is to protect children and support families and, while we
are always looking for opportunities to better meet that goal, we have to keep
children's health and wellbeing front and center. While a court's decision to
remove a child from his or her home can be emotionally distressing, the
consequences of a child remaining in an abusive environment are clearly
worse. These cases are complex and sensitive and that's why the CPS
process exists."
Texas Children’s Hospital and Baylor College of Medicine are proud to have
six physicians board certified in child abuse pediatrics, one of the largest
groups of its kind in the country. We stand behind our medical professionals
and their genuine desire to give a voice to those too young to speak for
themselves.

 Our professionals are trained to evaluate cases across numerous medical
specialties to help separate accidents from abuse. For every case our
physicians report to CPS as potential abuse, there are many more in which
no suspicion of abuse is found.
Certain types of physical injuries to a child warrant a heightened sense of
scrutiny and are more likely associated with abuse than other injuries. For
example, often our physicians are referred skull fracture cases from
concerned family physicians who feel this kind of injury might indicate abuse.
The expertise of our physicians allows us to take a more comprehensive
view into these sometimes complex cases, with the result being most skull
fracture cases treated by physicians at Texas Children’s do not result in
referrals to CPS. In some cases, however, the specific indications as seen
by physicians with this expertise signify a greater likelihood of child abuse.
When a child presents with multiple fractures, and the explanation offered by
the parent is inconsistent with the type of fracture, or inconsistent or changing
stories are offered, or no explanation is given for the injury, suspicion for
physical abuse increases and a report to CPS is required.
Texas Children’s established its child abuse team and processes to assist
patients who come to us with symptoms consistent with abuse so they can
be identified, protected and cared for in a way that prevents further harm.
We stand by our medical professionals and their genuine desire to do what
is best for our patients.