Once the medical assessment has been completed, the physician must initiate the appropriate treatment. The medical management should be guided by the physical findings. Frequently, these children require hospitalization.

Although the specifics of the laws surrounding child abuse and neglect vary from state to state, every state does require that suspected cases be reported. 39 A verbal report is made initially to the police department and/or the child protection agency of the locality in which the abuse occurred. Law enforcement officers often appear in the emergency department, especially if the child does not require hospitalization. The child may be removed from the home and placed in protective custody, taken to a juvenile facility, placed temporarily with other relatives, or placed in a foster shelter home. The final disposition is dependent on a court hearing. The physician is also required to complete an official report detailing the specifics of the evaluation and giving his or her diagnostic opinion as to why the injuries or neglect are nonaccidental. The report should use nontechnical terms, e.g., bruise instead of ecchymosis, so the law enforcement and social service workers can understand the extent of the injuries.

Physicians are sometimes hesitant to report suspected cases. They are not "100 percent" certain. They are fearful of the parental response to the report. They are concerned about removing a child from the natural home. It is important to remember that physicians are required by law to report all suspected cases of abuse and neglect. Failure to report suspected cases can result in misdemeaner charges and lead to a fine or imprisonment. Additionally, physicians are protected by the law from legal retaliation by the parents.

Parental anger is a natural response to the filing of a report of suspected child abuse. The physician should refrain from being accusatory. Instead, the physician should note his or her concern about the child's well-being and advise the family that a physician is required by law to report any suspicions. The physician should verbally acknowledge the anger but persist in the role of child advocate. This job is facilitated in hospitals that have child abuse teams available to assist physicians in the emergency department.

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