April is National Child Abuse Awareness Month, and there are plenty of ways in which pharmacists can help prevent the disturbing problem.

Mary E. Jones, MD, a child advocacy physician at Loyola University Health System, provided Pharmacy Times with several important observations pharmacists should make to stop child abuse and neglect.

Most of her tips stem from recognizing the signs of 4 central types of child abuse: physical abuse, neglect, sexual abuse, and emotional maltreatment. These often occur in combination, though.
First and foremost, Dr. Jones stressed the importance of protecting the child. While no parent is happy when a report is made, a pharmacist may have to bend or break the relationship with the parent in order to protect the child.

“As health care providers, we have a responsibility to improve our knowledge, our skill, and our ability to recognize potential abuse and neglect in children,” Dr. Jones told Pharmacy Times.

For pharmacists working in an outpatient or stand-alone pharmacy setting, it is important to acknowledge behaviors suggestive of abuse, such as a parent hitting a child. In health-system settings, the onsite child abuse expert can address any follow-up questions a pharmacist may have.

Sometimes, Dr. Jones said, the easiest thing for a pharmacist to do is to step in and ask if there’s anything the parent needs assistance with. Giving parents some time to cool off is often effective, she noted.

Parents who neglect to present their child’s prescription can be cause for concern, especially if the treatment is vital, such as a seizure medication. If a pharmacist notices a prescription of that nature is not being filled, Dr. Jones suggests calling the pediatrician to follow-up.

Another important sign of abuse is parents who visit the pharmacy believing they can medicate their child, even when they know the problem is much worse. A parent who asks for help with dressings or medications provides a pharmacist with an opportunity to learn what happened to the child and how it happened. If the child is with the parent, or if the injury is in an unusual location, a pharmacist may suggest that it should not be treated at home.

“There’s a possibility that they are not going to the emergency room for a reason and they’re trying to self-medicate, especially with things like burns,” Dr. Jones said. “We see kids show up in the emergency room 4 or 5 days later, because the parents tried to treat it with Neosporin and they didn’t want to bring the child in, and now they have an infection.”

Of course, kids do get bruises and scrapes from running around and playing, but those injuries are generally on bony surfaces. Injuries in places like the thigh or back can indicate suspicious activity.
“[The pharmacist] can just say, out of curiosity, ‘Oh my goodness, what happened?’” Dr. Jones suggested. “Sometimes, [the parents will] tell you, or sometimes, what they’ll tell you doesn’t make sense. That can raise suspicion.”