BACKGROUND: Development of guidelines for public health, health system, and health policy interventions demands complex systems thinking to understand direct and indirect effects of interventions within dynamic systems. The WHO-INTEGRATE framework, an evidence-to-decision framework rooted in the norms and values of the World Health Organization (WHO), provides a structured method to assess complexities in guidelines systematically, such as the balance of an intervention\'s health benefits and harms and their human rights and socio-cultural acceptability. This paper provides a worked example of the application of the WHO-INTEGRATE framework in developing the WHO guidelines on parenting interventions to prevent child maltreatment, and shares reflective insights regarding the value added, challenges encountered, and lessons learnt.
METHODS: The methodological approach comprised describing the intended step-by-step application of the WHO-INTEGRATE framework and gaining reflective insights from introspective sessions within the core team guiding the development of the WHO guidelines on parenting interventions and a methodological workshop.
RESULTS: The WHO-INTEGRATE framework was used throughout the guideline development process. It facilitated reflective deliberation across a broad range of decision criteria and system-level aspects in the following steps: (1) scoping the guideline and defining stakeholder engagement, (2) prioritising WHO-INTEGRATE sub-criteria and guideline outcomes, (3) using research evidence to inform WHO-INTEGRATE criteria, and (4) developing and presenting recommendations informed by WHO-INTEGRATE criteria. Despite the value added, challenges, such as substantial time investment required, broad scope of prioritised sub-criteria, integration across diverse criteria, and sources of evidence and translation of insights into concise formats, were encountered.
CONCLUSIONS: Application of the WHO-INTEGRATE framework was crucial in the integration of effectiveness evidence with insights into implementation and broader implications of parenting interventions, extending beyond health benefits and harms considerations and fostering a whole-of-society-perspective. The evidence reviews for prioritised WHO-INTEGRATE sub-criteria were instrumental in guiding guideline development group discussions, informing recommendations and clarifying uncertainties. This experience offers important lessons for future guideline panels and guideline methodologists using the WHO-INTEGRATE framework.

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The term Medical Child Abuse (MCA) describes a form of child abuse in which the medical system is \"abused\" by carrying out unnecessary medical procedures on a child. This abuse of the medical system occurs through misrepresentation, non-disclosure, fabrication, misinterpretation or active causation of symptoms by a parent. In this article, the construct ofmedical child abuse is defined and predisposing and motivational factors are examined. It also provides an overview of terms that are used synonymously or comparably in the literature and discusses the connection between MCA and Munchausen-by-proxy-syndrome.The core of the article is the presentation of an internal guideline, which was created by the interdisciplinary working group on MCA of the Clinics for Paediatric and Adolescent Medicine, the Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, the Child Protection Outpatient Clinic and the Social Services at the Charité. It also outlines possible interventions.
Zusammenfassung Der Begriff Medical Child Abuse (MCA) beschreibt eine Form der Kindesmisshandlung, in der das medizinische System „missbraucht“ wird, indem nicht notwendige medizinische Maßnahmen an einem Kind vorgenommen werden. Zu diesem Missbrauch des medizinischen Systems kommt es durch Fehldarstellen, Verschweigen, Erfinden, Fehlinterpretieren oder aktives Verursachen der Symptomatik durch in der Regel einen Elternteil. Im vorliegenden Artikel wird das Konstrukt Medical Child Abuse definiert und es werden prädisponierende bzw. motivationale Faktoren beleuchtet. Außerdem erfolgt ein Überblick über Begriffe, welche in der Literatur synonym oder komparabel verwendet werden und der Zusammenhang zwischen MCA und dem Münchhausen-by-proxy-Syndrom wird erörtert. Das Kernstück des Beitrages ist die Vorstellung eines internen Leitfadens, welcher durch die interdisziplinäre Arbeitsgruppe zu MCA der Kliniken für Kinder- und Jugendmedizin, der Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, der Kinderschutzambulanz und des Sozialdienstes an der Charité erstellt worden ist. Außerdem erfolgt eine Skizzierung möglicher Interventionen.

Child maltreatment (CM) is a complex global public health issue with potentially devastating effects on individuals\' physical and mental health and well-being throughout the life course. A lack of uniform definitions hinders attempts to identify, measure, respond to, and prevent CM. The aim of this electronic Delphi (e-Delphi) study is to build consensus on definitions and types of CM for use in surveillance and multi-sectoral research in the 34 countries in the Euro-CAN (Multi-Sectoral Responses to Child Abuse and Neglect in Europe) project (COST Action CA19106).
The e-Delphi study will consist of a maximum of three rounds conducted using an online data collection platform. A multi-disciplinary expert panel consisting of researchers, child protection professionals (health and social care), police, legal professionals and adult survivors of CM will be purposefully recruited. We will approach approximately 100 experts, with between 50 and 60 of these anticipated to take part. Participants will rate their agreement with a range of statements relating to operational definitions and types of CM, and free-text comments on each of the statements to give further detail about their responses and areas of uncertainty. Consensus has been defined a priori as ≥70% of the panel agreeing or disagreeing with the statement after the final round. The responses to the open-ended questions will be analysed using a \'codebook\' approach to thematic analysis, and used to refine the statements between rounds where no consensus is reached.
Ethical approval has been granted from the Cardiff University School of Medicine ethics committee (reference number SMREC22/96). Results will be submitted for publication in a peer-reviewed journal and presented at workshops (including for the participants) and international academic conferences. The Euro-CAN network will also be used to disseminate the results, with results briefings and presentations to key public health and other relevant organisations in the field.

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The rate of child abuse has sharply increased worldwide, especially during the COVID-19 pandemic. As the media\'s role in addressing child abuse cases is crucial, several international and formal organizations have established child abuse reporting guidelines. This study investigated how closely journalists follow reporting guidelines in addressing child abuse cases. Five major Korean presses and 189 articles from January 1, 2018, to January 31, 2021, were selected using the keyword \"child abuse.\" Each article was analyzed using a guideline framework consisting of 13 items regarding the five principles of the Korean Ministry of Health and Welfare and Central Child Protection Agency reporting guidelines. This study identified a radical growth in media reporting on child abuse cases in South Korea; almost 60% of the articles analyzed came from 2020 and 2021. More than 80% of the articles analyzed did not provide abuse resources, and 70% did not provide factual information. 57.1% of the articles instigated negative stereotypes, and about 30% explicitly mentioned certain family types in the headlines. Nearly 20% of the articles provided excessive details about the method used. Approximately 16% exposed victims\' identities. Some articles (7.9%) also described victims as sharing responsibility for the abuse. This study indicates that the media reports of child abuse in South Korea did not follow the guidelines in many facets. The present study discusses the limitations of the current guidelines and suggests future directions for the news media in reporting on child abuse cases nationwide.

Child maltreatment is a phenomenon of great importance due to the significant socio-health implications related to it. Purpose of the study is assessing compliance child abuse clinical management with guidelines and suggest corrective actions to avoid false negative or false positive judgments. The data come from 34 medical records of child victims of suspected abuse hospitalized in a pediatric clinic. We examined diagnostic and medico-legal management through the analysis of pediatric, dermatological, ophthalmological (including fundus examination), and gynecological (only in some cases) consultations, brain and skeletal imaging, laboratory tests (with reference to the study of hemostasis), and medico-legal advice. Of 34 patients, the average age was 23 months, ranging from 1 month to 8 years. The judgment was positive for abuse for 20 patients and negative for 12 patients; in two cases it was not possible to express a conclusive judgment. Two children died because of the injuries sustained. We underline the need of clinical-diagnostic standardized protocols, coroner in emergency settings, short-distance follow-up, social worker support. We also suggest objectifying in a descriptive way (using a common and repeatable language) and with photographic documentation the results of all the investigations carried out, to evaluate signs of physical maltreatment and neglect.

Physical abuse is a common but preventable cause of long-term childhood morbidity and mortality. Despite the strong association between abuse in an index child and abuse in contact children, there is no guidance outlining how to screen the latter, significantly more vulnerable group, for abusive injuries. Consequently, the radiological assessment of contact children is often omitted, or variably performed, allowing occult injuries to go undetected and increasing the risk of further abuse.
To report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse.
This consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts. The modified Delphi consensus process comprised 3 meetings of the International Consensus Group on Contact Screening in Suspected Child Physical Abuse held between February and June 2021.
Contacts are defined as the asymptomatic siblings, cohabiting children, or children under the same care as an index child with suspected child physical abuse. All contact children should undergo a thorough physical examination and a history elicited prior to imaging. Contact children younger than 12 months should have neuroimaging, the preferred modality for which is magnetic resonance imaging, and skeletal survey. Contact children aged 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months. Follow-up skeletal survey with limited views should be performed if abnormal or equivocal at presentation. Contacts with positive findings should be investigated as an index child.
This Special Communication reports consensus recommendations for the radiological screening of contact children in the context of suspected child physical abuse, establishing a recognized baseline for the stringent evaluation of these at-risk children and providing clinicians with a more resilient platform from which to advocate for them.

Evaluation for Bleeding Disorders in Suspected Child Abuse RELEASE DATE: October 2022 PRIOR VERSION(S): 2013 DEVELOPER: American Academy of Pediatrics FUNDING SOURCE: American Academy of Pediatrics TARGET POPULATION: Children and infants with bruising or bleeding suspicious for physical abuse.