The impacts on paediatricians testifying in cases of child maltreatment: A systematic scoping review

Abstract

Background

Paediatricians serve as expert witnesses in child maltreatment cases, informing decision-makers about injury mechanisms, likely injury-dates, and consequences. Despite paediatricians' multifaceted role in responding to child maltreatment, the impacts on paediatricians of their involvement in legal processes are not well understood.

Objective

This systematic scoping review identified and synthesized scientific research findings on the benefits and harms to doctors, particularly paediatricians, who testify in child maltreatment cases.

Population, concept and context

Included studies focused on doctors (paediatricians and paediatricians-in -training) who were subpoenaed and/or testified in court on child maltreatment cases.

Methods

Following PRISMA-ScR guidelines, six databases were searched: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts, and the Cochrane Library. Data were extracted and categorized across four levels of impact: individual, relational, professional, and societal.

Results

Testifying posed significant psychological, professional, and systemic challenges for paediatricians. Individually, they reported stress and dissatisfaction stemming from fears of discreditation, negative courtroom experiences, and perceptions of legal systems failing to protect children. Professionally, inadequate training and low confidence in testifying, coupled with financial losses and disruptions to clinical schedules, further compounded these difficulties. Systemically, strained relationships with legal professionals and insufficient familiarity with court procedures, alongside broader concerns about the legal process, contributed to a reduced willingness among paediatricians to report and engage in child maltreatment cases.

Conclusion

This review highlighted the range of the impacts on paediatricians who were subpoenaed and/or testified in child maltreatment cases and absence of interventions that reduce negative personal and professional impacts. Across the profession there is a need for greater education and training, policy/practice reform to better support paediatricians in their roles as expert witnesses, and intervention research to evaluate strategies that might reduce negative impacts.