Often it is the faces and affect of abused children that tell us the adverse emotional consequences of their abuse. Other times a physician may actually witness emotionally abusive interactions in the waiting room or examination room. Like all forms of abuse, it is sometimes difficult to draw a line between acceptable but harsh parental verbal discipline and emotional abuse, but clearly comments such as "You did not deserve to be born," "You are a good for nothing/stupid/evil child," and other forms of threat and intimidation cross the line into the realm of abuse. When such behavior is witnessed first hand, office staff should notify the ophthalmologist who can then approach the parent in a nonconfrontational, nonaccusatory way saying something like "Your child seems to be particularly challenging today" or "You seem to be feeling very angry with your child." The patient's entry into the examination room should be prioritized and the observed behaviors addressed in a fashion that explores the parental feelings rather than condemns them for their actions. Enlisting the support of social work or nursing services can be very helpful. Reporting to child protective services is indicated if emotional abuse is observed or suspected.
• Potentially abusive behavior by a child's caretaker that is observed by an ophthalmologist or their staff must be addressed
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