Background. In the last decades some improvements in the protection of children have been achieved in Germany. Nevertheless, forensic pathologists are still confronted time and time again with cases in which no medical consultation appears in the patient medical history, despite clear indications of a child welfare risk. Objective. Within the framework of a third party funded study, a systematic examination was carried out on the frequency of medical consultations and the selection of the medical discipline in cases suspected by youth offices of posing a risk to child welfare. Material and methods. In this study 452 cases suspected of being a child welfare risk over a 10-year investigation period (2003-2012) were included, which were from two selected youth office districts in Saxony-Anhalt. Research on this was conducted locally. Following collation of the sociodemographic factors of the persons involved, the risk factors for endangerment of child welfare and the case processing by the youth office, the data on the frequency of medical consultation and selection of the medical discipline were analyzed. Results. From the 452 cases of suspected child welfare risk, only 158 (35.0%) had a medical consultation, whereas in almost two thirds of the cases no medical consultation occurred. The quality of documentation of medical findings showed significant inadequacies; the proportion of exact medical records in cases of suspected physical abuse was only 4.8%. When medical consultations were carried out, these were isolated instances of involvement of a single specialist area. Primarily, consultations were carried out by consulting physicians in pediatrics and pediatric and adolescent psychiatry. Forensic medical consultations were significantly underrepresented. In the case of infants and adolescents, doctors were involved more often, whereas such consultations were seen more rarely in cases of toddlers and children of primary school age. Conclusion. In both youth office districts significant shortcomings could be identified in the specialist medical consultations and in interdisciplinary case management. From this the conclusion can be drawn that for the practical implementation of the positive development in child protection services in Germany, additional measures are required. These include comprehensive financing of medical outpatient clinics dedicated to child protection. The success of measures that are already in place and future measures to improve child protection should be verified using further systematic studies.
