During Children and Youth Affairs (DCYA) 2017). Tusla

During problem based learning we met David a
child who has Down Syndrome. David’s mother appeared to be struggling to cope
with his care and I was concerned about the effects this could have on David. My
fears for David’s safety peaked when a perforated eardrum and a bruise behind
his ear were noted by the GP. These injuries were reported to have occurred following
a fall at playgroup and the GP could corroborate this as he was on the
playgroup management committee so concerns of child abuse were dismissed. During
this case I considered however if the story could not be corroborated what
should the GP do?


A review of the relevant literature brings
clarity to what doctors must do if they suspect a child may be subject to abuse
such as neglect; emotional, physical or sexual abuse (Department of Children and Youth Affairs (DCYA) 2017). Tusla
should be informed once there are ‘reasonable grounds’ for concern but under
the Children First Act 2015 doctors have a statutory obligation to report child
protection issues if they know, believe, or have reasonable grounds to suspect,
based on information they obtain over the course of their employments that a
child has been, is being or is at risk of being harmed, or if this is disclosed
to them by the child (Children First Act 2015). The threshold at which harm
must be reported is when the child’s health, development or welfare have been, are
being or are likely to be seriously affected (DCYA
2017). It is not the role of doctors to discern if abuse has occurred but
they are obligated to report in line with the above guidance (DCYA 2017)

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The decision to report child abuse is not one
taken lightly considering the implications of being right or wrong, many
professionals admit to not reporting suspicions of child abuse, often due to
the many challenges it presents (Shanley et al. 2009). Healthcare
professionals such as doctors are often concerned about the effects such reports
could have including putting a family through potentially unnecessary turmoil
and damaging their relationship with them, it may also be difficult to identify
abuse due to short encounters and discontinuity of care (Buckley 2015). Similarly, abuse may be difficult to identify due
to ambiguous definitions and the wide variety of ways in which abuse may
present, often with a lack of solid evidence, which can make doctors reluctant
to submit reports (Bunting et al. 2009; Buckley 2015). Doctors may also consider the
potential for personal repercussions due to breaching confidentiality or a
mistaken report (Buckley 2015). While all
of the above present a challenge when considering reporting abuse they should
pale in significance to the welfare of a child which must be of primary concern
(DCYA 2017).  Perhaps doctors are not aware of the safety
nets which thankfully exist to protect them if they submit a report (McTavish et al.
2017), breaching confidentiality for example is justified when reporting
child abuse and once they have acted in good faith they are protected from
civil liability (Protection for ?Persons ?Reporting Child Abuse Act ?1998). These
protections could lessen the challenges faced when reporting abuse. The
Children First Guidelines (2017) clarify what
must be reported and advises concerns should be discussed with Tusla for
example if a mandated person is unsure whether or not the threshold for reporting
has been reached, discussing a case can assist doctors in deciding whether or
not a report is required (Shanley et al. 2009).


While doctors cannot be criminally sanctioned
for non-reporting under The Children First Act non-reporting may not be without
consequences (DCYA 2017). Most
importantly a child may remain at risk of harm (DCYA
2017). In addition Tusla can disclose non reporting to the National
Vetting Bureau of An Garda Síochána and to the Fitness to Practice Committee of
the Medical Council of Ireland (DCYA 2017).
Non-reporting doctors may also be charged with withholding information about a
serious offence (The Criminal Justice (Withholding of Information on Offences
against Children and Vulnerable Persons) Act 2012), or with reckless
endangerment of a child (The Criminal Justice Act 2006). These are all crucial
consequences, which must be considered if child abuse is not reported and
arguably greater than the consequences of submitting a report in good faith
which is mistaken. It is important to note however doctors are not obligated to
report sexual activity of a child aged between 15 and 17, provided their
partner is no more than 2 years older, of similar capacity and maturity and the
sexual activity is not intimidatory or exploitative and the child has made
known they do not wish it to be reported (Children First Act 2015). An
important exception given individuals of this age may be sexually active and
should not be deterred from attending their GP for contraceptive advice. This
remains a concern however for those who may be below or within this age bracket,
but their partner is not and presents a dilemma to doctors who are required by
law to report such events. This highlights how mandated reporting can lessen
the ability of doctors to exercise their clinical judgement to guide whether a
matter should be reported to Tusla.  As I
hope to work as a GP in future this is a worrying prospect for me and I will
likely need to seek legal advice should the situation arise.


From this reflection I have learned the welfare
of the child is paramount. It has also taught me to always be aware of the
possibility of abuse. While many challenges are faced by doctors when reporting
child abuse, I feel the Children First Act and Guidelines provides some clarity
regarding what should and must be reported, but mandated reporting can in some
instances reduce a doctors’ ability to use their clinical judgement to guide
this decision. I was glad to realise however there are no legal implications
for doctors should they make a report in good faith which is found to be mistaken
which I hope will help prevent non-reporting in tandem with the legal
implications of non-reporting. From this review I can see that in the case of
David, if the GP could not corroborate the story and physical abuse was
suspected on reasonable grounds they would be required to submit a report to