Catherine Skellern

A parent-completed developmental questionnaire: follow up of ex-premature infants

Objective: Premature infants are at increased risk of developmental disability. Early identification of problems allows intervention to ameliorate or attenuate problems. A reliable screening tool allows triage of children in this high‐risk population by identifying those unlikely to need full developmental assessment. To explore the test characteristics of an established parent‐completed developmental assessment questionnaire ‘Ages and Stages Questionnaire’ (ASQ) in follow up of an Australian population of premature infants.

From complexity to category: Responding to diagnostic uncertainties of autistic spectrum disorders

Objective: Recent data from Education Queensland has identified rising numbers of children receiving diagnoses of autistic spectrum disorder (ASD). Faced with funding diagnostic pressures, in clinical situations that are complex and inherently uncertain, it is possible that specialists err on the side of a positive diagnosis. This study examines the extent to which possible overinclusion of ASD diagnosis may exist in the presence of uncertainty and factors potentially related to this practice in Queensland.

Diagnosis of autistic spectrum disorders in Queensland: variations in practice.

Objective: For both paediatricians and child psychiatrists, referrals to assess possible autistic spectrum disorders (ASD) are increasing. This study examines current practices of medical specialists in the assessment of these disorders.

Role of the tertiary child protection paediatrician: expert and advocate.

Aim:  The role of the child protection paediatrician is varied. This study examines perceptions of how tertiary child protection (tCP) paediatricians view their multifaceted roles, perceived adequacy of length of pre‐FRACP training and how this relates to confidence and satisfaction in their roles.

Suspicious childhood injury: Formulation of forensic opinion

Child protection paediatricians have a role as forensic experts in the context of suspicious childhood injury. The task of forensic evaluation of suspicious injury is to reach a conclusion to support legal proceedings. For each injury, one of four conclusions should be reached:

Medical experts and the law: Safeguarding children, the public and the profession

Paediatricians working in child protection are sometimes required to act as expert witnesses in legal proceedings. Given the significant influence of opinion evidence on the jury, it is imperative that they understand their responsibilities to the court in this medico‐legal interface and recognise their boundaries of expertise. Recent cases in the United Kingdom and in Australia have thrown the spotlight on paediatricians working as forensic experts in legal proceedings which has led to much public scrutiny and intervention by medical disciplinary bodies placing practice sanctions on child protection paediatricians. These decisions have had a significant impact on the workforce, with fewer paediatricians and those in training now willing to work in the field because of fears of disciplinary sanctions being instigated by those adversely affected by unfavourable forensic opinions. This article includes a detailed summary of these cases including excerpts from legal judgments, which highlight critical issues for the expert witness, which have had a significant impact on individuals, the profession and impacted on public confidence in the profession. In Australia, it is timely that we reflect on these lessons learnt and look to development of educational standards and forensic credentialing to enable continuity of a skilled paediatric workforce in child protection.

Defining standards for medico-legal reports in forensic evaluation of suspicious childhood injury

Expert opinions in the form of medico-legal reports are requested by police investigators and statutory child protection officers from child protection/forensic paediatricians to help them to make child protection and prosecution decisions. These reports must be understood and able to be correctly interpreted by a range of professionals and as well as comply with the requirements of expert court reports. There is currently much variation in report construction. Having a medico-legal report framework which defines structure and standards assists report-writers to achieve objectivity, can be useful for training, peer review audits and ensures optimal standards in opinion formulation. Using legal judgements relating to child abuse proceedings, author experience and the limited existing literature, a tool is presented which defines report standards specifically in relation to the assessment of suspicious injuries.

Child protection: a 50-year perspective.

It has been 50 years since Kempe et al. published ‘The Battered Child Syndrome’, describing harm from inflicted injury mechanisms derived from parents and care givers. Since then, there has emerged a rapidly expanding literature on paediatric forensic medicine and child protection, which has offered new insights into injury mechanisms, informed us of the sequelae of abuse and neglect, aided diagnosis and guided clinical practice in the treatment and management of children who become involved in the child protection system. Through the scrutiny of government inquiries and at times uncomfortable media exposure, there have been improvements in child protection and forensic practices resulting in recognition of need for specialised forensic training, improved funding, development of resources and development of professional standards that support accountable, objective, safe and robust practice. From the perspective of an Australian child protection paediatrician, this paper chronicles some of the most significant and at times controversial research in the last 50 years in child protection that have played a key role in shaping our current understanding of child abuse and neglect.

Paediatricians in the courtroom: Becoming an expert witness: Paediatricians in the courtroom

At various times within their professional career, a paediatrician can expect to be asked to provide evidence within legal proceedings. In some instances, the provision of evidence will be limited to providing a report but in some cases it may require attendance in court to provide oral evidence. A subpoena is a legal order compelling a witness to produce documents, attend court or both. Failure to comply with the subpoena can result in penalties being applied to the witness. For many paediatricians, this type of professional experience may make them feel anxious or even resentful of having to participate in such proceedings. These feelings may arise because being compelled to provide evidence in court takes the medical specialist well outside of their usual familiar working environment into what may appear to be a complex and confusing experience. An understanding of the procedures and rules that govern legal proceedings may help the medical witness improve their ability to be helpful to the court. Being able to provide reliable evidence in court should be considered a useful and important skill for paediatricians and can also be taught to paediatricians-intraining.