A neurologist from the Montreal Children’s Hospital told our pages Monday that parents are being wrongly accused because of an overdiagnosis of “shaken baby syndrome.” Do you think there is overdiagnosis?
No, the two pediatricians respond straight away. “These situations are the subject of a careful, rigorous evaluation, where we will think about all the possibilities, explore all the other avenues,” says the DD Karine Pépin, child abuse pediatrician at Sainte-Justine hospital and associate professor at the University of Montreal. There is a rational approach that exists. I don’t see that we are jumping to conclusions or rushing to this diagnosis. »
The DD Clara Low-Décarie, associate professor and pediatrician practicing abuse at the Sherbrooke University Hospital Center, rather refers to an underdiagnosis of cases of abuse. “It is estimated in Quebec that between 2.5% and 3.5% of the pediatric population will be the subject of a report retained by the DPJ. But when we do population surveys where we sit down with adults to question them about their experiences in childhood, between 25% and 35% will say they have experienced a form of mistreatment,” she says, citing in particular a Canadian study. “Our official statistics do not reflect the extent of the situation. »
How many cases of head trauma caused by child abuse do you see in your practice? Do they all have the same gravity?
Two to eight cases per year pass through Sainte-Justine hospital, according to the DD Seed. There is at least one per year in Sherbrooke, generally between one and five, says the DD Low-Décarie. If not all attacks have the same consequences for young victims, the mortality rate of TC-ME is among the highest in pediatrics, emphasize the two doctors. About 15 to 20% of babies will die from it. Of the survivors, a portion of the children “are well, seem to be back to normal” upon discharge from the hospital, says the DD Pépin, which does not exclude the possibility that they later suffer from developmental after-effects. The other group is heavily burdened, being able to “have motor difficulties, be paralyzed on one side, have difficulty eating, lose vision, lose hearing, have epilepsy…”
How is the diagnosis of trauma made? cranial caused by child abuse?
In several stages, respond the doctors.
Firstly, medically, the diagnosis is made in the same way as for any other health problem, indicates the DD Karine Pépin. “We do an assessment like any doctor. We will meet the child and his family. We will take a careful medical history. We will understand the symptoms well. Are there any events that could have caused injuries? Does this child have an illness? Could he have an infection? A malformation? We’re going to ask for exams. We will regularly need the help of specialists. » The diagnosis of TC-ME is never made “by default”, assures the DD Seed. “We don’t jump to conclusions. But we must also have the honesty to ask: is it possible that something inflicted has happened? When we have this reasonable doubt, the law requires us to transmit the information to the DPJ. »
Once this stage has been completed, the process begins towards a more judicial “diagnosis”, which will be made by the court at the end of the investigation by the DPJ and the police. “Ultimately, it is the Court which will decide the context in which this trauma occurred,” said the DD Low-Décarie. It’s a long process. The doctor can still say [qu’un cas] raises concerns, that it is possible, that it is probable. But the final diagnosis should come at the end of a multidisciplinary process. »
How do you approach the subject with families ?
“We are aware that we are dropping a bomb. We try to be transparent and respectful. Because the only way to give parents back some of the power that is being lost is to lay their cards on the table. To tell them: of all the possibilities we mention, this is one. I don’t want to tell you in two weeks when the police will show up at your house. I’m telling you now,” explains Clara Low-Décarie. “It is important that families, parents, as in any other situation, have all the information to understand their child’s situation and make appropriate decisions,” adds his colleague.
These are “difficult” and “emotional” conversations, which lead to all kinds of reactions: hurt, anger, even relief. “A relief to talk about the elephant in the room,” says Karine Pépin. Sometimes, people have felt that there is this suspicion. And sometimes, they too have concerns about abuse and there is a relief that we can talk about difficult things. »