Action Guide v2.7: Guardian of Childhood

Mission 1: The Art of Suspicion

Case: Arnau, 4 years old, comes to your office for a check-up. Upon examination, you see several small bruises on both legs. His mother explains to you that "he is very active and is always falling in the park."

Physical Indicators

Injuries in "protected" places (back, thighs, cheeks).
Hematomas of different colors (different healing phases).
Injuries with defined shapes (belt marks, cigarette burns).

Behavioral Indicators

Incongruent or memorized story by caregivers.
The child appears fearful, withdrawn, or excessively complacent.
Lack of reaction to pain.

Check what you've learned!

Bruises on Arnau's legs are common in active children. What additional information would make you raise the level of suspicion significantly?

Mission 2: The Key Conversation

Case: You decide to talk to Arnau alone while he plays with some dolls. You ask him about the "pupa" on his arm. He looks down and says quietly, "Dad gets really angry when I don't eat."

Interview Guidelines:

Private and secure environment.
Open, non-directed questions: "Explain to me what happened here?"
Emotional validation: "I see this makes you sad." Don't judge.
Verbatim documentation: Write down the exact phrases in quotes.

Check what you've learned!

After Arnau's revelation, what is your next step in the conversation with him?

Mission 3: The Duty to Act

Case: The combination of injuries in different stages of healing and Arnau's revelation generate a well-founded suspicion of physical abuse. There does not appear to be an imminent life-threatening risk, but the situation requires intervention. Your obligation is to communicate.

RISK Situation

Communicate to the DGAIA and/or to the Social Services of the area.

HOMELESS/CRIME Situation

URGENT notification to Guard Court / Prosecutor's Office and to the DGAIA. If there is danger, call 112.

Check what you've learned!

In the case of Arnau, what is the correct notification circuit?

Mission 4: Build the Perfect Report

Now you must document Arnau's case. Your report is the key piece for the protection of the child. It must be objective, descriptive and precise. Drag the correct phrases to the report template.

Available Phrases

"Patient has multiple bruises of purplish and yellowish color."

"I think the father is the abuser."

"The family seems unstructured."

"During the alone exploration, the child literally says: 'Dad gets very angry when I don't eat.'"

"The mother attributes the injuries to 'falls in the park'."

"The injuries are clearly a case of child abuse."

Medical Report Template

Drag the OBJECTIVE and DESCRIPTIVE phrases here.

Mission 5: Complex Cases and Your Support Network

Not all abuse leaves visible marks. You must be alert to more subtle situations. And remember: you are not alone. Lean on your team.

Vicarious Violence

A child exposed to gender violence at home suffers psychological abuse. Indicators: anxiety, behavioral problems, somatizations.

Münchhausen syndrome by proxy

A caregiver invents or provokes symptoms in the child to subject him to medical interventions. Be suspicious if symptoms only occur in the presence of the caregiver and are not confirmed by testing.

Your Professional Support Network

When faced with a complex case, remember that you can and should:

Make a interconsultation with other pediatricians or specialists.
Coordinate with him/her Social Worker from your center.
Consult with him Care Ethics Committee or the hospital legal department.

Check what you've learned!

The mother of a 6-year-old patient insists that her daughter has a severe food allergy not confirmed by any testing, putting her on an extremely restrictive diet that affects her growth. What type of abuse might you suspect?

Final Test: Are you a Guardian?

You have completed your training. Show your knowledge and get your badge.

1. What is the most suspicious physical indicator of abuse in a 6-month-old baby?

A common cold.

A femur fracture.

A scratch on the hand.

2. If a teenager confesses to you that he suffers psychological abuse at home but asks you not to say anything, what do you do?

Respect your wish for confidentiality.

Explain your legal obligation to communicate the situation to protect them and act accordingly.

Call your parents for a meeting.

3. The obligation to report suspicion of abuse is...

An ethical recommendation, but not mandatory.

A legal duty for all professionals who work with minors.

Only mandatory for public health professionals.

4. When writing a report, what is most important?

Give your expert opinion on the cause of the injuries.

Be objective, descriptive and do not include value judgments.

Use very complex technical language.

5. When faced with a disclosure of acute sexual abuse, what is the priority?

Urgent notification to the Court of Duty/Prosecutor's Office and referral to the reference hospital for examination.

Schedule a follow-up visit.

Talk to the family to compare the information.

6. A child has multiple bruises in different stages of healing. This is highly suggestive of...

A coagulation disease.

Non-accidental injuries and recurrent physical abuse.

That the boy is simply very clumsy.

7. Is it appropriate to interview a child about a possible suspicion in front of his or her parents?

Yes, so that parents can clarify what the child is saying.

No, whenever possible and the child's age allows, the interview should be alone to ensure a safe environment.

Only if the parents seem nice.

8. What does "literal documentation" mean?

Write a summary of what you think the child meant.

Record the conversation with your mobile.

Write down the child's exact words, in quotes.

9. Who is notified of a situation of risk or negligence that does not appear to constitute an immediate crime?

Exclusively to the police.

To Social Services and/or DGAIA.

Nobody waits to see if the situation gets worse.

10. The guiding principle in all action in the event of suspicion of child abuse is...

Protect the reputation of the hospital.

The best interests of the minor.

Maintain a good relationship with the family.

Childhood Guardian

Training Progress

Evolutionary Case Study

Mission 1: The Art of Suspicion

Physical Indicators

Behavioral Indicators

Check what you've learned!

Mission 2: The Key Conversation

Interview Guidelines:

Check what you've learned!

Mission 3: The Duty to Act

RISK Situation

HOMELESS/CRIME Situation

Check what you've learned!

Mission 4: Build the Perfect Report

Available Phrases

Medical Report Template

Mission 5: Complex Cases and Your Support Network

Your Professional Support Network

Check what you've learned!

Final Test: Are you a Guardian?

Tool Box