Abstract

Child abuse is a problem that affects children all over the world. The present study therefore aimed to identify and analyze the main findings relating to professional practices for dealing with situations of child maltreatment in articles published in Brazil. To this end, we conducted an integrative literature review of articles published between 2017 and 2022 based on searches of the following databases: Google Scholar, SciELO Brasil, the periodicals database of the Agency for the Improvement of Higher Education Personnel (CAPES), MEDLINE, the Virtual Health Library, and Electronic Journals in Psychology (PePSIC). A total of 24 publications were selected for the review after screening the titles and abstracts. The findings reveal several challenges to ensuring the protection of children caused by shortcomings in professional training, which have a negative influence on the identification and reporting of child maltreatment. The present study reveals the lack of priority given to the issue of child maltreatment in professional training and provides important inputs to inform future research on professional practices for dealing with child violence.

Key words:
Violence against children; Professional practices; Child protection; Mandated reporting; Integrative review

Introduction

Child maltreatment is characterized by the use of physical force or power by a parent or caregiver against a child. It constitutes the abuse of power and neglect of the duty to protect by the adult, as well as the delegitimization of the rights of the child, who becomes an object in the hands of those who should provide care and protection¹1 Bazon MR. Violências contra crianças e adolescentes: análise de quatro anos de notificações feitas ao Conselho Tutelar na cidade de Ribeirão Preto, São Paulo, Brasil. Cad Saude Publica 2008; 24(2):323-332..

What makes violence against children a delicate situation is the fact that children are vulnerable, having limited capacity to defend themselves and a high level of emotional and physical dependence on adults^{2, 3}. Violence against children is widespread, affecting the lives of millions of children all over the world, regardless of socioeconomic status³3 Nunes AJ, Sales MCV. Violence against children in Brazilian scenery. Cien Saude Colet 2016; 21(3):871-880.. According to data from the United Nations Children’s Fund (UNICEF)⁴4 Organização Mundial da Saúde (OMS). Relatório de situação de 2020 sobre a prevenção da violência contra as crianças na região Africana da OMS [Internet]. 2022. [acessado 2022 out 15]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/352479/9789290341437-por.pdf?sequence=1&isAllowed=y
https://apps.who.int/iris/bitstream/hand... , up to one billion children around the world aged 2-14 years are victims of violence, with long-lasting consequences. In Brazil, in 2019, the human rights abuse hotline, Disque 100⁵5 Brasil. Ouvidoria Nacional de Direitos Humanos, Ministério da Mulher, da Família e dos Direitos Humanos. Disque Direitos Humanos: Relatório 2019 [Internet]. 2019. [acessado 2022 out 20]. Disponível em: https://www.gov.br/mdh/pt-br/centrais-de-conteudo/disque-100/relatorio-2019_disque-100.pdf/view
https://www.gov.br/mdh/pt-br/centrais-de... , received 86,837 reports of child abuse involving neglect (38%), psychological violence (23%), and physical violence (21%).

These figures are of grave concern, given that exposure to violence has an array of harmful physical and psychological consequences that can endure into adulthood, including depression, aggressivity, anxiety, and social interaction and learning difficulties⁶6 Schek G, Silva MRS, Lacharité C, Cézar-Vaz MR, Bueno MEN, Ventura J. Práticas profissionais que silenciam a violência intrafamiliar contra crianças e adolescentes. Texto Contexto Enferm 2018; 27(1):e1680016.. Hillis et al.⁷7 Hillis S, Mercy J, Amobi A, Kress H. Global prevalence of past-year violence against children: a systematic review and minimum estimates. Pediatrics 2016; 137(3):e20154079. point out that experiencing violence during childhood can impair brain architecture, metabolic systems, immune status, and inflammatory responses.

Brazil’s Federal Constitution⁸8 Brasil. Constituição da República Federativa do Brasil. Brasília: Senado Federal; 1988. became an instrument of child protection by recognizing children as subjects of rights⁹9 Faraj SP, Siqueira AC, Arpini DM. Rede de proteção: o olhar de profissionais do Sistema de Garantia de Direitos. Temas Psicol 2016; 24(2):727-741.. In the same vein, the Child and Adolescent Statute¹⁰10 Brasil. Estatuto da Criança e do Adolescente. Brasília: Senado Federal; 1990. provides for the development of a network dedicated to the comprehensive protection of children¹¹11 Silva ACS, Alberto MFP. Fios soltos da Rede de Proteção dos Direitos das Crianças e Adolescentes. Psicol Cienc Prof 2019; 39:e185358. and makes it mandatory for health and education professionals to report maltreatment to child protection services.

The work of professionals who are trained and sensitized to identify and intervene in situations of violence against children is therefore essential to guarantee comprehensive protection and minimize suffering¹²12 Bannwart TH, Brino RF. Maus-tratos contra crianças e adolescentes e o papel dos profissionais de saúde. In: Habigzang LF, Koller SH, organizadores. Violência contra crianças e adolescentes: teoria, pesquisa e prática. Porto Alegre: Artmed; 2012. p. 255-265.^,1313 Ramos MS, Teodoro MLM. A importância da capacitação dos profissionais que trabalham com vítimas de violência na infância e na adolescência. In: Habigzang LF, Koller SH, organizadores. Violência contra crianças e adolescentes: teoria, pesquisa e prática. Porto Alegre: Artmed; 2012. p. 242-254.. However, research shows that the everyday practice of professionals involved in the care and education of children are not always geared towards protection and the prevention of child maltreatment⁶6 Schek G, Silva MRS, Lacharité C, Cézar-Vaz MR, Bueno MEN, Ventura J. Práticas profissionais que silenciam a violência intrafamiliar contra crianças e adolescentes. Texto Contexto Enferm 2018; 27(1):e1680016.^,1313 Ramos MS, Teodoro MLM. A importância da capacitação dos profissionais que trabalham com vítimas de violência na infância e na adolescência. In: Habigzang LF, Koller SH, organizadores. Violência contra crianças e adolescentes: teoria, pesquisa e prática. Porto Alegre: Artmed; 2012. p. 242-254.^,1414 Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Systematic review of studies on reports of violence against children and adolescents in Brazil. Cien Saude Colet 2019; 24(2):487-496..

Practice is understood as a processual concept whereby an individual actively transforms or reproduces an existing standard. A practice is the expression of a network formed of the individual’s own actions, motivations, desires, resistance, discourse, and meanings¹⁵15 Nicolini D. Practice theory, work, and organization: an introduction. University Press: Oxford; 2013.. Hence, the study of practice provides important insights into how professionals recognize, produce, and formulate the scenes and regulations of everyday work¹⁶16 Gherardi S. Organizational learning: the sociology of practice [Internet]. 2011. [cited 2021 dez 28]. Available from: https://www.researchgate.net/publication/285761877_Organizational_learning_The_sociology_of_practice
https://www.researchgate.net/publication... .

Most studies of child maltreatment in Brazil focus on the categorization and description of types of violence, procedures, and the institutions responsible for child protection. Qualitative research addressing intervention practices to prevent and respond to child violence is therefore scarce¹1 Bazon MR. Violências contra crianças e adolescentes: análise de quatro anos de notificações feitas ao Conselho Tutelar na cidade de Ribeirão Preto, São Paulo, Brasil. Cad Saude Publica 2008; 24(2):323-332.^,1414 Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Systematic review of studies on reports of violence against children and adolescents in Brazil. Cien Saude Colet 2019; 24(2):487-496.. Nunes et al.³3 Nunes AJ, Sales MCV. Violence against children in Brazilian scenery. Cien Saude Colet 2016; 21(3):871-880. undertook a study to characterize child violence in Brazil according to type, victim, perpetrator, and place of occurrence.

However, there is a lack of literature in Brazil on professional practices and child maltreatment. Maia et al.¹⁷17 Maia MA, Silva MAC, Paiva ACO, Silva DM, Alves M. Professional practices in situations of violence in home care: An integrative review. Cien Saude Colet 2020; 25(9):3587-3596. carried out an integrative review of the practices of in-home caregivers of children, older people, and women in situations of violence, while Rosa et al.¹⁸18 Rosa ACMA, Miasato JM, Teixeira DA, Oliveira LMC, Silva LAH, Tesch FC. The dentist's conduct towards child abuse: A literature review. Rev UNINGÁ 2021; 58, eUJ3585-eUJ3585. investigated the conduct of dental surgeons in the face of child abuse, identifying a lack of guidelines for dealing with such situations. In the same vein, Wyzykowski et al.¹⁹19 Wyzykowski C, Pereira D, Boaventura M. Atuação do enfermeiro frente a situações de maus-tratos à criança: revisão integrativa. Rev Enferm 2021; 14(14):1-10. concluded that weaknesses in nurse training result in deficiencies in dealing with violence against children.

Given the complex nature of child maltreatment, interventions to address this problem require coordination and cooperation between the different institutions and practitioners who are working to strengthen a network capable of protecting children’s rights²2 Barcellos TMT, Góes FGB, Silva ACSS, Souza AN, Camilo LA, Goulart MCL. Violência contra crianças: descrição dos casos em município da baixada litorânea do Rio de Janeiro. Esc Anna Nery 2021; 25(4):e20200485.^,66 Schek G, Silva MRS, Lacharité C, Cézar-Vaz MR, Bueno MEN, Ventura J. Práticas profissionais que silenciam a violência intrafamiliar contra crianças e adolescentes. Texto Contexto Enferm 2018; 27(1):e1680016.. This article seeks to contribute to understanding practices across different professions by answering the following question: “How are professional practices in situations of child maltreatment addressed in Brazil?”. The aim of this study was to identify and analyze the main results of articles published in Brazil addressing the practices adopted across different professions for dealing with situations of child maltreatment.

Method

Study type

An integrative review is a method that draws together empirical or theoretical studies to gain a more comprehensive understanding of and indicating new directions for future research¹⁷17 Maia MA, Silva MAC, Paiva ACO, Silva DM, Alves M. Professional practices in situations of violence in home care: An integrative review. Cien Saude Colet 2020; 25(9):3587-3596.^,2020 Botelho LLR, Cunha CCA, Macedo M. O método da revisão integrativa nos estudos organizacionais. Gestao Socied 2011; 5(11):121..

Data collection

The study was conducted following a protocol describing the different a particular phenomenon by analyzing existing knowledge on the topic stages of an integrative review²⁰20 Botelho LLR, Cunha CCA, Macedo M. O método da revisão integrativa nos estudos organizacionais. Gestao Socied 2011; 5(11):121.. First, we defined the topic and then formulated the problem, which guided the other stages.

The second stage of the review was conducted in accordance with the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, comprising a 27-item checklist and stages to be followed in systematic reviews²¹21 Galvão TF, Pansani TSA. Principais itens para relatar revisões sistemáticas e meta-análises: a recomendação PRISMA. Epidemiol Serv Saude 2015; 24(2):335-342..

We then searched for health science descriptors (DeCS/MeSH) on the website https://decs.bvsalud.org/ to identify suitable keywords for the review. Keywords are useful research tools as they permit the identification of terms used to index articles and perform database searches²²22 Pompei LM. Descritores ou palavras-chave nas bases de dados de artigos científicos. FEMINA 2010; 38(5)231-232..

The following keywords were used in combination with the Boolean operators AND and OR: Child maltreatment; Intervention; Prevention; Professional practices. First, we performed a search using the term Child maltreatment combined with the Boolean operator OR and Child abuse to increase the breadth of the search, followed by a search using the keyword Child maltreatment combined with the Boolean operator AND and the other terms.

We searched for articles in multidisciplinary databases (Google Scholar, SciELO, and the periodicals database of the Agency for the Improvement of Higher Education Personnel - CAPES), and health and medical databases (MEDLINE, the Virtual Health Library - VHS, and Electronic Psychology Journals - PePSIC). The searches were performed between August 2021 and October 2022.

In the first stage of the article selection process, we screened the article titles. We then screened the article abstracts to assess whether the publications met the following inclusion criteria: a) studies whose central theme was child maltreatment associated with some type of professional practice (identification, reporting, referrals, care, interventions); b) studies conducted in Brazil; c) target population were children aged 0-12 years; d) full-text version of the article written in any language available online or for download; e) peer-reviewed articles; and f) articles published in the last six years (2017 to 2022). Studies conducted outside Brazil, involving both children and adolescents, and focusing on child-on-child violence or the consequences of child maltreatment in adulthood were excluded. Duplicate articles were then excluded.

The following data were extracted from the abstracts: title, author(s), year of publication, periodical, type of article, and study region in Brazil.

Data processing and analysis

The studies were characterized after reading the full-text version of the selected articles, focusing on the following aspects: study objective, sample, main results, and themes related to the role played by professionals in situations of child maltreatment. The reading of the full-text versions of the articles allowed us to extract relevant information and create categories, comparing studies to identify similarities and differences²³23 Bardin L. Análise de conteúdo. Lisboa: Edições 70; 1988. using Microsoft Excel and ATLAS.ti version 7.3.

Results

The database searches identified 40.146 records: Google Scholar (n = 34.919), SciELO Brasil (n = 66), CAPES periodical database (n = 3.034), MEDLINE (n = 1.571), VHL (n = 523), and PePSIC (n = 33). A total of 254 articles were selected for screening of the titles. Of these, 71 were duplicates, 21 addressed non-relevant topics, and 58 were not freely accessible, resulting in 104 publications.

The abstracts of the selected articles were screened to assess whether they met the inclusion criteria, resulting in the selection of 24 articles for reading of the full-text version. The article selection process is summarized in Figure 1.

Characterization of the articles

The main study characteristics are shown in Chart 1. With regard to year of publication, the years that accounted for the most and least articles were 2019 (six articles) and 2022 (with only two articles), respectively.

The articles were published in different national and international journals, with the Revista Ciência & Saúde Coletiva publishing 5 articles²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92.

25 Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: Autores, vítimas e consequências. Cien Saude Colet 2018; 23(4):1019-1031.

26 Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção dos maus tratos infantis. Cien Saude Colet 2019; 24(11):3997-4008.

27 Martins-Júnior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge MLR. Abuso físico de crianças e adolescentes: os profissionais de saúde percebem e denunciam. Cien Saude Colet 2019; 24(7):2609-2616.^-2828 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022. and Revista da Abeno (journal published by the Brazilian Association of Dental Education) publishing three articles²⁹29 Busato CA, Pereira TCR, Guaré RO. Maus-tratos infantis na perspectiva de acadêmicos de Odontologia. Rev ABENO 2018; 18(1):84-92.

30 Costa AP, Tinoco RLR. Maus-tratos infantis no currículo dos cursos de odontologia do Rio de Janeiro. Rev ABENO 2019; 19(2):54-62.^-3131 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.. Three of the studies published by the Revista Ciência & Saúde Coletiva were conducted with health professionals working with children²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92.^,2727 Martins-Júnior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge MLR. Abuso físico de crianças e adolescentes: os profissionais de saúde percebem e denunciam. Cien Saude Colet 2019; 24(7):2609-2616.^,2828 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022., while the Revista da Abeno published two studies with dental graduates^{29, 30} and one with dental surgeons³¹31 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077..

Brazil’s South region accounted for the largest number of publications (nine articles²⁵25 Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: Autores, vítimas e consequências. Cien Saude Colet 2018; 23(4):1019-1031.^,3131 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.

32 Schek G, Silva MRS, Lacharité C, Bueno MEM. Organization of professional practices against intrafamily violence against children and adolescents in the institutional context. Rev Lat Am Enferm 2017; 25:e2889.

33 Hohendorff JV, Patias ND. Violência sexual contra crianças e adolescentes: Identificação, consequência e indicações de manejo. Rev Barbarói 2017; 49:239-257.

34 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02.

35 Silva PA, Lunardi VL, Meucci, RD, Algeri S, Silva MP, Franciscatto FP. (In)visibilidade das notificações de violência contra crianças e adolescentes registradas em um município do Sul do Brasil. Invest Educ Enferm 2019; 37(2):e11.

36 Guimarães APA, Machado L, Ormeño GIR. Conhecimento de educadoras a respeito dos maus-tratos infantis: Identificação e notificação de casos. Dialogia 2020; 36:518-531.

37 Trindade AA, Hohendorff JV. Efetivação da Lei Menino Bernardo pelas redes de proteção e de atendimento a crianças e adolescentes. Cad Saude Publica 2020; 36(10):e00193919.^-3838 Corrêa F, Hohendorff JV. Atuação da delegacia de proteção à criança e ao adolescente em casos de violência sexual. Estud Pesq Psicol 2020; 20(1):9-29. plus two studies in the South and Southeast²⁹29 Busato CA, Pereira TCR, Guaré RO. Maus-tratos infantis na perspectiva de acadêmicos de Odontologia. Rev ABENO 2018; 18(1):84-92.^,3939 Apostólico MR, Egry EY, Fornari LF, Gessner R. Acurácia de diagnósticos de enfermagem para o enfrentamento da violência doméstica infantil. Rev Esc Enferm USP 2017; 51:e03290.). The North region accounted for only two articles⁴⁰40 Santos LF, Costa, MM, Javae ACRS, Mutti CF, Pacheco LR. Fatores que interferem no enfrentamento da violência infantil por conselheiros tutelares. Saude Debate 2019; 43(120):137-149.^,4141 Marques DO, Monteiro KS, Santos CS, Oliveira NF. Violência contra crianças e adolescentes: atuação da enfermagem. Rev Enferm UFPE 2021; 15:e246168..

The studies encompassed the areas of education, health, public security, social services, and child protection networks. The area of health accounted for the largest number of studies, with 12 articles²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92.^,2727 Martins-Júnior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge MLR. Abuso físico de crianças e adolescentes: os profissionais de saúde percebem e denunciam. Cien Saude Colet 2019; 24(7):2609-2616.

28 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022.

29 Busato CA, Pereira TCR, Guaré RO. Maus-tratos infantis na perspectiva de acadêmicos de Odontologia. Rev ABENO 2018; 18(1):84-92.

30 Costa AP, Tinoco RLR. Maus-tratos infantis no currículo dos cursos de odontologia do Rio de Janeiro. Rev ABENO 2019; 19(2):54-62.^-3131 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.^,3939 Apostólico MR, Egry EY, Fornari LF, Gessner R. Acurácia de diagnósticos de enfermagem para o enfrentamento da violência doméstica infantil. Rev Esc Enferm USP 2017; 51:e03290.^,4141 Marques DO, Monteiro KS, Santos CS, Oliveira NF. Violência contra crianças e adolescentes: atuação da enfermagem. Rev Enferm UFPE 2021; 15:e246168.

42 Silva Junior GB, Rolim ACA, Moreira, GAR, Corrêa CRS, Vieira LJES. Identificação e notificação de maus-tratos em crianças e adolescentes por médicos de família no Ceará. Trab Educ Saude 2017; 15(2):469-484.

43 Batista MKB, Quirino TRL. Debatendo a violência contra crianças na saúde da família: Reflexões a partir de uma proposta de intervenção em saúde. Saude Soc 2020; 29(4):e180843.

44 Cota ALS, Queiroz AMC, Remígio MMCJ, Reis DA, Kabengele DC. Conduta do cirurgião-dentista frente à suspeita de maus-tratos contra crianças e adolescentes. J Health Sci 2019; 21(1):58-64.^-4545 Rios EB, Rodrigues GS, Rocha AS, Oliveira LFB. Conhecimento dos cirurgiões dentistas que atuam em unidades básicas de saúde frente aos abusos e maus-tratos infantis. Rev APS 2022; 25(1):47-57. plus two articles involving both health and social services^{32, 35}. The areas of education³⁶36 Guimarães APA, Machado L, Ormeño GIR. Conhecimento de educadoras a respeito dos maus-tratos infantis: Identificação e notificação de casos. Dialogia 2020; 36:518-531. and public security³⁸38 Corrêa F, Hohendorff JV. Atuação da delegacia de proteção à criança e ao adolescente em casos de violência sexual. Estud Pesq Psicol 2020; 20(1):9-29. accounted only for 1 article each.

Thematic categories

The similarities between the studies are presented in the following categories: a) factors associated with the identification and reporting of child maltreatment; b) work-related difficulties; and c) deficiencies in professional training.

Factors associated with the identification and reporting of child maltreatment

The identification and reporting of suspected or confirmed child maltreatment was one of the central themes of articles. The studies^{27,28,30,39,42,43,46} reveal that most professionals are not adequately trained to identify violence against children, showing difficulties diagnosing child maltreatment due to lack of theoretical information on the theme and poor knowledge of the child, his/her history, and family relations. Two studies⁴¹41 Marques DO, Monteiro KS, Santos CS, Oliveira NF. Violência contra crianças e adolescentes: atuação da enfermagem. Rev Enferm UFPE 2021; 15:e246168.^,4343 Batista MKB, Quirino TRL. Debatendo a violência contra crianças na saúde da família: Reflexões a partir de uma proposta de intervenção em saúde. Saude Soc 2020; 29(4):e180843. reported that professionals diagnose predominantly physical and sexual violence.

Once abuse has been identified, professionals face difficulties in filing a mandated report (MR) of violence to the child protection services. Most professionals showed that they were either unaware of the requirement or did not know how to fill in the form correctly or possible types of referral for victims²⁵25 Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: Autores, vítimas e consequências. Cien Saude Colet 2018; 23(4):1019-1031.^,2828 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022.^,3131 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.^,4242 Silva Junior GB, Rolim ACA, Moreira, GAR, Corrêa CRS, Vieira LJES. Identificação e notificação de maus-tratos em crianças e adolescentes por médicos de família no Ceará. Trab Educ Saude 2017; 15(2):469-484.^,4343 Batista MKB, Quirino TRL. Debatendo a violência contra crianças na saúde da família: Reflexões a partir de uma proposta de intervenção em saúde. Saude Soc 2020; 29(4):e180843.. In addition, one of the studies⁴⁵45 Rios EB, Rodrigues GS, Rocha AS, Oliveira LFB. Conhecimento dos cirurgiões dentistas que atuam em unidades básicas de saúde frente aos abusos e maus-tratos infantis. Rev APS 2022; 25(1):47-57. found that professionals were unaware of which institution they could refer cases of child maltreatment to.

Some studies^{24, 29, 44} reveal that when child maltreatment is diagnosed, professionals file a MR, recognizing the importance of this process for protecting the child and resolving the situation. In contrast, other studies show that many professionals undervalue the importance of MR, being skeptical that this type of intervention would help the victim³⁰30 Costa AP, Tinoco RLR. Maus-tratos infantis no currículo dos cursos de odontologia do Rio de Janeiro. Rev ABENO 2019; 19(2):54-62.^,3434 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02.^,3535 Silva PA, Lunardi VL, Meucci, RD, Algeri S, Silva MP, Franciscatto FP. (In)visibilidade das notificações de violência contra crianças e adolescentes registradas em um município do Sul do Brasil. Invest Educ Enferm 2019; 37(2):e11..

Sometimes professionals failed to file a MR for fear of retaliation by family members, the perpetrator, or the community, or because they were afraid that it would harm the victim given that the child may remain with the perpetrator even after filing a MR due to lack of intervention³⁶36 Guimarães APA, Machado L, Ormeño GIR. Conhecimento de educadoras a respeito dos maus-tratos infantis: Identificação e notificação de casos. Dialogia 2020; 36:518-531.^,4343 Batista MKB, Quirino TRL. Debatendo a violência contra crianças na saúde da família: Reflexões a partir de uma proposta de intervenção em saúde. Saude Soc 2020; 29(4):e180843.^,4646 Costa VS, Aguiar RS. Percepção da equipe multidisciplinar acerca dos cuidados à criança e ao adolescente vítima de violência. Res Soc Dev 2020; 9(4): e161943038..

Work-related difficulties

Caring for victims of child maltreatment is a complex process. A number of obstacles arise in practice, such as lack of communication between professionals³⁴34 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02. and scarce human and material resources, hampering the provision of adequate care. An example is the lack of a computerized system in child protection services, which slows down the intervention process and restricts follow-up, compromising effectiveness⁴⁰40 Santos LF, Costa, MM, Javae ACRS, Mutti CF, Pacheco LR. Fatores que interferem no enfrentamento da violência infantil por conselheiros tutelares. Saude Debate 2019; 43(120):137-149..

Caring for victims of child maltreatment can have an impact on professionals. The studies show that professionals often felt irritable, powerless, sick, and pressured when dealing with cases³²32 Schek G, Silva MRS, Lacharité C, Bueno MEM. Organization of professional practices against intrafamily violence against children and adolescents in the institutional context. Rev Lat Am Enferm 2017; 25:e2889.^,3838 Corrêa F, Hohendorff JV. Atuação da delegacia de proteção à criança e ao adolescente em casos de violência sexual. Estud Pesq Psicol 2020; 20(1):9-29.^,4040 Santos LF, Costa, MM, Javae ACRS, Mutti CF, Pacheco LR. Fatores que interferem no enfrentamento da violência infantil por conselheiros tutelares. Saude Debate 2019; 43(120):137-149., seeing themselves as unable to care for and protect the victim³⁴34 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02.. In this respect, the existence of professional support networks was seen as a positive factor that can improve interventions to address child abuse⁴⁶46 Costa VS, Aguiar RS. Percepção da equipe multidisciplinar acerca dos cuidados à criança e ao adolescente vítima de violência. Res Soc Dev 2020; 9(4): e161943038..

Moreover, professional practice is often based on power relations, with some professionals not seeing themselves as responsible for intervening or filing a MR³²32 Schek G, Silva MRS, Lacharité C, Bueno MEM. Organization of professional practices against intrafamily violence against children and adolescents in the institutional context. Rev Lat Am Enferm 2017; 25:e2889.^,3636 Guimarães APA, Machado L, Ormeño GIR. Conhecimento de educadoras a respeito dos maus-tratos infantis: Identificação e notificação de casos. Dialogia 2020; 36:518-531. and simply passing on the responsibility to colleagues, leading to fragmented and ineffective interventions³²32 Schek G, Silva MRS, Lacharité C, Bueno MEM. Organization of professional practices against intrafamily violence against children and adolescents in the institutional context. Rev Lat Am Enferm 2017; 25:e2889..

Deficiencies in professional training

Twenty of the 24 articles analyzed by this study mentioned deficiencies in professional training and lack of continuous training on child maltreatment. Shortcomings in professional training begin to emerge at degree level, where the topic of child maltreatment is undervalued and often not included in course curriculums²⁸28 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022.^,2929 Busato CA, Pereira TCR, Guaré RO. Maus-tratos infantis na perspectiva de acadêmicos de Odontologia. Rev ABENO 2018; 18(1):84-92.^,3131 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.^,3333 Hohendorff JV, Patias ND. Violência sexual contra crianças e adolescentes: Identificação, consequência e indicações de manejo. Rev Barbarói 2017; 49:239-257.^,4242 Silva Junior GB, Rolim ACA, Moreira, GAR, Corrêa CRS, Vieira LJES. Identificação e notificação de maus-tratos em crianças e adolescentes por médicos de família no Ceará. Trab Educ Saude 2017; 15(2):469-484.^,4545 Rios EB, Rodrigues GS, Rocha AS, Oliveira LFB. Conhecimento dos cirurgiões dentistas que atuam em unidades básicas de saúde frente aos abusos e maus-tratos infantis. Rev APS 2022; 25(1):47-57..

Two studies³⁰30 Costa AP, Tinoco RLR. Maus-tratos infantis no currículo dos cursos de odontologia do Rio de Janeiro. Rev ABENO 2019; 19(2):54-62.^,3131 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077. show that despite receiving training on child maltreatment during their degree, some professionals do not see themselves as responsible for identifying and reporting the problem. Furthermore, the inclusion of child abuse on undergraduate and postgraduate course curriculums does not necessarily guarantee the adoption of best practices as professionals may feel capable of recognizing violence against children but do not know what to do or how to act³¹31 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.^,4545 Rios EB, Rodrigues GS, Rocha AS, Oliveira LFB. Conhecimento dos cirurgiões dentistas que atuam em unidades básicas de saúde frente aos abusos e maus-tratos infantis. Rev APS 2022; 25(1):47-57..

Three studies²⁵25 Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: Autores, vítimas e consequências. Cien Saude Colet 2018; 23(4):1019-1031.^,2828 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022.^,3434 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02. highlighted the need for continuous training due to the complex nature of working with victims of child violence, one of which²⁸28 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022. mentioned that childcare training and experience with caring for children were factors that facilitated the identification and reporting of violence. Most studies concluded that professional training should encompass protocols for service providers to recognize types of violence and make sure that professionals are prepared to communicate violence and refer cases through the correct channels to protect the victim²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92.

25 Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: Autores, vítimas e consequências. Cien Saude Colet 2018; 23(4):1019-1031.

26 Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção dos maus tratos infantis. Cien Saude Colet 2019; 24(11):3997-4008.

27 Martins-Júnior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge MLR. Abuso físico de crianças e adolescentes: os profissionais de saúde percebem e denunciam. Cien Saude Colet 2019; 24(7):2609-2616.^-2828 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022.^,3434 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02.^,3636 Guimarães APA, Machado L, Ormeño GIR. Conhecimento de educadoras a respeito dos maus-tratos infantis: Identificação e notificação de casos. Dialogia 2020; 36:518-531.^,3838 Corrêa F, Hohendorff JV. Atuação da delegacia de proteção à criança e ao adolescente em casos de violência sexual. Estud Pesq Psicol 2020; 20(1):9-29.^,3939 Apostólico MR, Egry EY, Fornari LF, Gessner R. Acurácia de diagnósticos de enfermagem para o enfrentamento da violência doméstica infantil. Rev Esc Enferm USP 2017; 51:e03290.^,4242 Silva Junior GB, Rolim ACA, Moreira, GAR, Corrêa CRS, Vieira LJES. Identificação e notificação de maus-tratos em crianças e adolescentes por médicos de família no Ceará. Trab Educ Saude 2017; 15(2):469-484.^,4444 Cota ALS, Queiroz AMC, Remígio MMCJ, Reis DA, Kabengele DC. Conduta do cirurgião-dentista frente à suspeita de maus-tratos contra crianças e adolescentes. J Health Sci 2019; 21(1):58-64.^,4646 Costa VS, Aguiar RS. Percepção da equipe multidisciplinar acerca dos cuidados à criança e ao adolescente vítima de violência. Res Soc Dev 2020; 9(4): e161943038.^,4747 Ricks L, Tuttle M, Ellison SE. Child abuse reporting: understanding factors impacting veteran school counselors. Professional Counselor 2022; 12(2). [cited 2022 out 13]. Available from: https://tpcjournal.nbcc.org/child-abuse-reporting-understanding-factors-impacting-veteran-school-counselors/?utm_source=rss&utm_medium=rss&utm_campaign=child-abuse-reporting-understanding-factors-impacting-veteran-school-counselors
https://tpcjournal.nbcc.org/child-abuse-... .

Professional training is also weak when it comes to network and multidisciplinary approaches. Studies²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92.^,2626 Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção dos maus tratos infantis. Cien Saude Colet 2019; 24(11):3997-4008.^,2727 Martins-Júnior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge MLR. Abuso físico de crianças e adolescentes: os profissionais de saúde percebem e denunciam. Cien Saude Colet 2019; 24(7):2609-2616.^,3333 Hohendorff JV, Patias ND. Violência sexual contra crianças e adolescentes: Identificação, consequência e indicações de manejo. Rev Barbarói 2017; 49:239-257.^,3434 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02.^,4040 Santos LF, Costa, MM, Javae ACRS, Mutti CF, Pacheco LR. Fatores que interferem no enfrentamento da violência infantil por conselheiros tutelares. Saude Debate 2019; 43(120):137-149. show that victim protection is provided by a network of professionals but that actions are fragmented. This hinders the continuity of interventions and solutions, indicating an urgent need to strengthen interdisciplinary working. Studies²⁸28 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022. also highlight the need to incorporate a broader and integrative approach to health into professional training to help promote the development of actions in coordination with other assistance services and institutions.

The lack of a protocol of actions or guidelines for the flow of victim assistance also emerged as a weakness in everyday practice³⁵35 Silva PA, Lunardi VL, Meucci, RD, Algeri S, Silva MP, Franciscatto FP. (In)visibilidade das notificações de violência contra crianças e adolescentes registradas em um município do Sul do Brasil. Invest Educ Enferm 2019; 37(2):e11.^,4444 Cota ALS, Queiroz AMC, Remígio MMCJ, Reis DA, Kabengele DC. Conduta do cirurgião-dentista frente à suspeita de maus-tratos contra crianças e adolescentes. J Health Sci 2019; 21(1):58-64.^,4646 Costa VS, Aguiar RS. Percepção da equipe multidisciplinar acerca dos cuidados à criança e ao adolescente vítima de violência. Res Soc Dev 2020; 9(4): e161943038.^,4747 Ricks L, Tuttle M, Ellison SE. Child abuse reporting: understanding factors impacting veteran school counselors. Professional Counselor 2022; 12(2). [cited 2022 out 13]. Available from: https://tpcjournal.nbcc.org/child-abuse-reporting-understanding-factors-impacting-veteran-school-counselors/?utm_source=rss&utm_medium=rss&utm_campaign=child-abuse-reporting-understanding-factors-impacting-veteran-school-counselors
https://tpcjournal.nbcc.org/child-abuse-... . However, even when guidelines did exist, professionals often failed to follow the guidance²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92. and observe relevant legal provisions³¹31 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.^,3737 Trindade AA, Hohendorff JV. Efetivação da Lei Menino Bernardo pelas redes de proteção e de atendimento a crianças e adolescentes. Cad Saude Publica 2020; 36(10):e00193919., creating their own flow within their respective organizations.

Discussion

The analysis of the selected articles shows that professional practices for dealing with violence against children were investigated mainly from a health perspective, with this area accounting for the largest number of publications.

The Child and Adolescent Statute¹⁰10 Brasil. Estatuto da Criança e do Adolescente. Brasília: Senado Federal; 1990. provides for mandated reporting of cases of child maltreatment by health and education professionals. The larger number of publications in the area of health demonstrates that health professionals seek a broader understanding of child maltreatment and the intervention process, while the scarcity of studies in the area of education may indicate that professionals in this field pay less attention to this issue.

Dornelles et al.⁴⁸48 Dornelles TM, Macedo ABT, Antoniolli L, Vega EAU, Damaceno AN, Souza SBC. Características da violência contra crianças no município de Porto Alegre: análise das notificações obrigatórias. Esc Anna Nery 2021; 25(2):e20200206. highlight that although hospitals and primary care facilities account for the largest number of reports of child maltreatment, many care providers do not know what procedures to follow in cases of maltreatment and fail to file MR, compounding underreporting⁶6 Schek G, Silva MRS, Lacharité C, Cézar-Vaz MR, Bueno MEN, Ventura J. Práticas profissionais que silenciam a violência intrafamiliar contra crianças e adolescentes. Texto Contexto Enferm 2018; 27(1):e1680016.^,1414 Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Systematic review of studies on reports of violence against children and adolescents in Brazil. Cien Saude Colet 2019; 24(2):487-496.^,1818 Rosa ACMA, Miasato JM, Teixeira DA, Oliveira LMC, Silva LAH, Tesch FC. The dentist's conduct towards child abuse: A literature review. Rev UNINGÁ 2021; 58, eUJ3585-eUJ3585..

Most of the selected articles address child abuse in a general manner²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92.^,2626 Ferreira CLS, Côrtes MCJW, Gontijo ED. Promoção dos direitos da criança e prevenção dos maus tratos infantis. Cien Saude Colet 2019; 24(11):3997-4008.^,2929 Busato CA, Pereira TCR, Guaré RO. Maus-tratos infantis na perspectiva de acadêmicos de Odontologia. Rev ABENO 2018; 18(1):84-92.

30 Costa AP, Tinoco RLR. Maus-tratos infantis no currículo dos cursos de odontologia do Rio de Janeiro. Rev ABENO 2019; 19(2):54-62.

31 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.^-3232 Schek G, Silva MRS, Lacharité C, Bueno MEM. Organization of professional practices against intrafamily violence against children and adolescents in the institutional context. Rev Lat Am Enferm 2017; 25:e2889.^,3434 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02.

35 Silva PA, Lunardi VL, Meucci, RD, Algeri S, Silva MP, Franciscatto FP. (In)visibilidade das notificações de violência contra crianças e adolescentes registradas em um município do Sul do Brasil. Invest Educ Enferm 2019; 37(2):e11.^-3636 Guimarães APA, Machado L, Ormeño GIR. Conhecimento de educadoras a respeito dos maus-tratos infantis: Identificação e notificação de casos. Dialogia 2020; 36:518-531.^,3939 Apostólico MR, Egry EY, Fornari LF, Gessner R. Acurácia de diagnósticos de enfermagem para o enfrentamento da violência doméstica infantil. Rev Esc Enferm USP 2017; 51:e03290.

40 Santos LF, Costa, MM, Javae ACRS, Mutti CF, Pacheco LR. Fatores que interferem no enfrentamento da violência infantil por conselheiros tutelares. Saude Debate 2019; 43(120):137-149.

41 Marques DO, Monteiro KS, Santos CS, Oliveira NF. Violência contra crianças e adolescentes: atuação da enfermagem. Rev Enferm UFPE 2021; 15:e246168.

42 Silva Junior GB, Rolim ACA, Moreira, GAR, Corrêa CRS, Vieira LJES. Identificação e notificação de maus-tratos em crianças e adolescentes por médicos de família no Ceará. Trab Educ Saude 2017; 15(2):469-484.

43 Batista MKB, Quirino TRL. Debatendo a violência contra crianças na saúde da família: Reflexões a partir de uma proposta de intervenção em saúde. Saude Soc 2020; 29(4):e180843.

44 Cota ALS, Queiroz AMC, Remígio MMCJ, Reis DA, Kabengele DC. Conduta do cirurgião-dentista frente à suspeita de maus-tratos contra crianças e adolescentes. J Health Sci 2019; 21(1):58-64.

45 Rios EB, Rodrigues GS, Rocha AS, Oliveira LFB. Conhecimento dos cirurgiões dentistas que atuam em unidades básicas de saúde frente aos abusos e maus-tratos infantis. Rev APS 2022; 25(1):47-57.

46 Costa VS, Aguiar RS. Percepção da equipe multidisciplinar acerca dos cuidados à criança e ao adolescente vítima de violência. Res Soc Dev 2020; 9(4): e161943038.^-4747 Ricks L, Tuttle M, Ellison SE. Child abuse reporting: understanding factors impacting veteran school counselors. Professional Counselor 2022; 12(2). [cited 2022 out 13]. Available from: https://tpcjournal.nbcc.org/child-abuse-reporting-understanding-factors-impacting-veteran-school-counselors/?utm_source=rss&utm_medium=rss&utm_campaign=child-abuse-reporting-understanding-factors-impacting-veteran-school-counselors
https://tpcjournal.nbcc.org/child-abuse-... without specifying the type of violence. In the studies that reported type of violence, the most common types were physical^{27, 28,37} and sexual²⁵25 Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: Autores, vítimas e consequências. Cien Saude Colet 2018; 23(4):1019-1031.^,3333 Hohendorff JV, Patias ND. Violência sexual contra crianças e adolescentes: Identificação, consequência e indicações de manejo. Rev Barbarói 2017; 49:239-257.^,3838 Corrêa F, Hohendorff JV. Atuação da delegacia de proteção à criança e ao adolescente em casos de violência sexual. Estud Pesq Psicol 2020; 20(1):9-29. violence. The literature shows that while there are various types of maltreatment (physical, psychological, sexual, institutional violence, and neglect¹⁴14 Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Systematic review of studies on reports of violence against children and adolescents in Brazil. Cien Saude Colet 2019; 24(2):487-496.^,4949 Brasil. Lei nº 13.431, de 4 de abril de 2017. Estabelece o sistema de garantia de direitos da criança e do adolescente vítima ou testemunha de violência e altera a Lei nº 8.069, de 13 de julho de 1990 (Estatuto da Criança e do Adolescente). Diário Oficial da União 2017; 5 abr.), professionals tend to be more aware of physical violence and view it differently as it leaves visible marks on the victim’s body or triggers feelings of disgust, especially in cases of sexual violence, which can have an even greater emotional impact on professionals²2 Barcellos TMT, Góes FGB, Silva ACSS, Souza AN, Camilo LA, Goulart MCL. Violência contra crianças: descrição dos casos em município da baixada litorânea do Rio de Janeiro. Esc Anna Nery 2021; 25(4):e20200485..

Research highlights that the victims of sexual violence are predominantly girls²2 Barcellos TMT, Góes FGB, Silva ACSS, Souza AN, Camilo LA, Goulart MCL. Violência contra crianças: descrição dos casos em município da baixada litorânea do Rio de Janeiro. Esc Anna Nery 2021; 25(4):e20200485., which is confirmed by some of the studies in our sample²⁵25 Platt VB, Back IC, Hauschild DB, Guedert JM. Violência sexual contra crianças: Autores, vítimas e consequências. Cien Saude Colet 2018; 23(4):1019-1031.^,3333 Hohendorff JV, Patias ND. Violência sexual contra crianças e adolescentes: Identificação, consequência e indicações de manejo. Rev Barbarói 2017; 49:239-257.. Researchers stress that while physical violence is more easily recognizable, it is seen as a way of disciplining children, making it a socially acceptable, and often underreported, practice²2 Barcellos TMT, Góes FGB, Silva ACSS, Souza AN, Camilo LA, Goulart MCL. Violência contra crianças: descrição dos casos em município da baixada litorânea do Rio de Janeiro. Esc Anna Nery 2021; 25(4):e20200485.^,5050 Ormeno GR, Berlini LF. Maus-tratos infantis e Lei "Menino Bernardo". In: Gomide PIC, organizador. Introdução à psicologia forense. Curitiba: Juruá; 2016. p. 121-133..

With regard to neglect, professionals are largely unaware or fail to identify this type of violence. This is shown by one of the studies²⁹29 Busato CA, Pereira TCR, Guaré RO. Maus-tratos infantis na perspectiva de acadêmicos de Odontologia. Rev ABENO 2018; 18(1):84-92., in which professionals recognized only physical, psychological, sexual violence, and abandonment. In this regard, the literature shows that neglect is the type of maltreatment that professionals find hardest to recognize and value least²2 Barcellos TMT, Góes FGB, Silva ACSS, Souza AN, Camilo LA, Goulart MCL. Violência contra crianças: descrição dos casos em município da baixada litorânea do Rio de Janeiro. Esc Anna Nery 2021; 25(4):e20200485.^,4848 Dornelles TM, Macedo ABT, Antoniolli L, Vega EAU, Damaceno AN, Souza SBC. Características da violência contra crianças no município de Porto Alegre: análise das notificações obrigatórias. Esc Anna Nery 2021; 25(2):e20200206..

Some of the studies show that deficiencies in professional training and continuous professional development are a weakness in efforts to combat child maltreatment, highlighting that most professionals did not receive training or information on child maltreatment during their degree²⁹29 Busato CA, Pereira TCR, Guaré RO. Maus-tratos infantis na perspectiva de acadêmicos de Odontologia. Rev ABENO 2018; 18(1):84-92.^,3131 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.^,4242 Silva Junior GB, Rolim ACA, Moreira, GAR, Corrêa CRS, Vieira LJES. Identificação e notificação de maus-tratos em crianças e adolescentes por médicos de família no Ceará. Trab Educ Saude 2017; 15(2):469-484.^,4545 Rios EB, Rodrigues GS, Rocha AS, Oliveira LFB. Conhecimento dos cirurgiões dentistas que atuam em unidades básicas de saúde frente aos abusos e maus-tratos infantis. Rev APS 2022; 25(1):47-57.. In this regard, Nilchian et al.⁵¹51 Nilchian F, Tarrahi MJ, Zare N. A sistematic review and meta-analysis of failure to take history as a barrier of reporting child abuse by dentists in private and state clinics. Dental Res J 2021; 18:41. presented data from a study in Korea showing that nurses with adequate knowledge of violence against children showed higher levels of detection and reporting of abuse.

Weaknesses in professional training pose a barrier to identifying violence and often mean that practitioners are unaware of the existence of child protection services and/or the role they play in child protection, indicating the need to address this issue on degree and specialist training courses²⁹29 Busato CA, Pereira TCR, Guaré RO. Maus-tratos infantis na perspectiva de acadêmicos de Odontologia. Rev ABENO 2018; 18(1):84-92.^,3030 Costa AP, Tinoco RLR. Maus-tratos infantis no currículo dos cursos de odontologia do Rio de Janeiro. Rev ABENO 2019; 19(2):54-62.^,3939 Apostólico MR, Egry EY, Fornari LF, Gessner R. Acurácia de diagnósticos de enfermagem para o enfrentamento da violência doméstica infantil. Rev Esc Enferm USP 2017; 51:e03290.^,4545 Rios EB, Rodrigues GS, Rocha AS, Oliveira LFB. Conhecimento dos cirurgiões dentistas que atuam em unidades básicas de saúde frente aos abusos e maus-tratos infantis. Rev APS 2022; 25(1):47-57.. One of the articles³⁶36 Guimarães APA, Machado L, Ormeño GIR. Conhecimento de educadoras a respeito dos maus-tratos infantis: Identificação e notificação de casos. Dialogia 2020; 36:518-531. reported that a pedagogy degree failed to address child maltreatment and violence against women, people with disabilities, and older persons when addressing violence in general.

Other factors that contribute to the detection of child maltreatment include complementary childcare training and experience with caring for children, as shown by one of the studies²⁸28 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EF, Zarzar PMPA. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(3):5013-5022.. Green⁵²52 Green M. Nurses' adherence to mandated reporting of suspected cases of child abuse. J Pediatric Nurs 2020; 54:109-113. suggests that limited experience can generate uncertainty, which may make the professional defer suspected cases of child abuse and reporting to colleagues who are usually more experienced or senior in rank. Tiyyagura et al.⁵³53 Tiyyagura GK, Gawel M, Alphonso A, Koziel J, Bilodeau K, Bechtel K. Barriers and facilitators to recognition and reporting of child abuse by prehospital providers. Prehosp Emerg Care 2016; 21(1):46-53. also reported that one of the barriers to recognition is uncertainty about the diagnosis of maltreatment and fear of wrongly reporting a case.

According to Maia et al.¹⁷17 Maia MA, Silva MAC, Paiva ACO, Silva DM, Alves M. Professional practices in situations of violence in home care: An integrative review. Cien Saude Colet 2020; 25(9):3587-3596., a correct diagnosis is essential for the professional to decide the appropriate measures and referral for maltreatment. In this regard, the effective communication of child maltreatment via a MR enables professionals to coordinate actions to ensure the child receives adequate care and assistance¹⁰10 Brasil. Estatuto da Criança e do Adolescente. Brasília: Senado Federal; 1990..

Despite being mandatory, it appears that many professionals lack of knowledge of MR, given that they often fill out the form incorrectly or fail to complete it, hampering not only interventions but also the characterization of violence and development of strategies to address the problem²2 Barcellos TMT, Góes FGB, Silva ACSS, Souza AN, Camilo LA, Goulart MCL. Violência contra crianças: descrição dos casos em município da baixada litorânea do Rio de Janeiro. Esc Anna Nery 2021; 25(4):e20200485.^,1414 Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Systematic review of studies on reports of violence against children and adolescents in Brazil. Cien Saude Colet 2019; 24(2):487-496.. It is important to highlight that some studies³⁵35 Silva PA, Lunardi VL, Meucci, RD, Algeri S, Silva MP, Franciscatto FP. (In)visibilidade das notificações de violência contra crianças e adolescentes registradas em um município do Sul do Brasil. Invest Educ Enferm 2019; 37(2):e11.^,4141 Marques DO, Monteiro KS, Santos CS, Oliveira NF. Violência contra crianças e adolescentes: atuação da enfermagem. Rev Enferm UFPE 2021; 15:e246168.

42 Silva Junior GB, Rolim ACA, Moreira, GAR, Corrêa CRS, Vieira LJES. Identificação e notificação de maus-tratos em crianças e adolescentes por médicos de família no Ceará. Trab Educ Saude 2017; 15(2):469-484.^-4343 Batista MKB, Quirino TRL. Debatendo a violência contra crianças na saúde da família: Reflexões a partir de uma proposta de intervenção em saúde. Saude Soc 2020; 29(4):e180843. showed that many professionals were unaware of or unfamiliar with mandated reporting of child maltreatment or that MR forms were not available in their workplace, making it impossible to communicate violence.

In addition, sometimes professionals do not see themselves as part of the child protection network, deferring the responsibility for reporting to colleagues⁶6 Schek G, Silva MRS, Lacharité C, Cézar-Vaz MR, Bueno MEN, Ventura J. Práticas profissionais que silenciam a violência intrafamiliar contra crianças e adolescentes. Texto Contexto Enferm 2018; 27(1):e1680016.^,1818 Rosa ACMA, Miasato JM, Teixeira DA, Oliveira LMC, Silva LAH, Tesch FC. The dentist's conduct towards child abuse: A literature review. Rev UNINGÁ 2021; 58, eUJ3585-eUJ3585.. This happens in the case of dental surgeons and nurses, who pass on the decision to file a report to doctors because they do not see themselves as responsible for reporting violence³¹31 Demarco GT, Silva-Júnior IF, Azevedo MS. Conhecimentos e atitudes de cirurgiões-dentistas da rede pública de Pelotas-RS frente aos maus-tratos infantis. Rev ABENO 2021; 21(1):1077.^,3232 Schek G, Silva MRS, Lacharité C, Bueno MEM. Organization of professional practices against intrafamily violence against children and adolescents in the institutional context. Rev Lat Am Enferm 2017; 25:e2889..

Article 83 of the Child and Adolescent Statute¹⁰10 Brasil. Estatuto da Criança e do Adolescente. Brasília: Senado Federal; 1990. provides for the creation of the Sistema de Garantia de Direitos or “rights guarantee system”, which consists of a network of government and non-governmental actors who come together to implement joint actions to promote child defense and assistance⁹9 Faraj SP, Siqueira AC, Arpini DM. Rede de proteção: o olhar de profissionais do Sistema de Garantia de Direitos. Temas Psicol 2016; 24(2):727-741.. Child protection therefore involves education, health, social assistance, public security services, and the justice system working together in a planned manner¹⁰10 Brasil. Estatuto da Criança e do Adolescente. Brasília: Senado Federal; 1990.^,1414 Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Systematic review of studies on reports of violence against children and adolescents in Brazil. Cien Saude Colet 2019; 24(2):487-496.. However, it is interesting to note that the areas of education³⁶36 Guimarães APA, Machado L, Ormeño GIR. Conhecimento de educadoras a respeito dos maus-tratos infantis: Identificação e notificação de casos. Dialogia 2020; 36:518-531. and public security³⁸38 Corrêa F, Hohendorff JV. Atuação da delegacia de proteção à criança e ao adolescente em casos de violência sexual. Estud Pesq Psicol 2020; 20(1):9-29. accounted for only one article each in this review and that none of the articles investigated the justice services, indicating possible weaknesses in these areas of the protection network.

The literature⁹9 Faraj SP, Siqueira AC, Arpini DM. Rede de proteção: o olhar de profissionais do Sistema de Garantia de Direitos. Temas Psicol 2016; 24(2):727-741.^,1414 Macedo DM, Foschiera LN, Bordini TCPM, Habigzang LF, Koller SH. Systematic review of studies on reports of violence against children and adolescents in Brazil. Cien Saude Colet 2019; 24(2):487-496. shows that the child protection network is disjointed, fragmented, and ineffective in preventing child maltreatment, holding perpetrators accountable, and protecting victims. Some of the studies analyzed by this review³³33 Hohendorff JV, Patias ND. Violência sexual contra crianças e adolescentes: Identificação, consequência e indicações de manejo. Rev Barbarói 2017; 49:239-257.^,3434 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02.^,4242 Silva Junior GB, Rolim ACA, Moreira, GAR, Corrêa CRS, Vieira LJES. Identificação e notificação de maus-tratos em crianças e adolescentes por médicos de família no Ceará. Trab Educ Saude 2017; 15(2):469-484.^,3434 Silva PA, Lunardi VL, Meucci RD, Algeri S. Protection of children and adolescents victims of violence: the views of the professionals of a specialized service. Invest Educ Enferm 2018; 36(3):e02. point out that the network faces a number of challenges because it depends on a series of actions coordinated by a range of different professionals, with fragmentation across services hampering the continuity of actions.

Many professionals view the network as an independent institution responsible for receiving referrals and promoting child protection, demonstrating their lack of knowledge of the Sistema de Garantia de Direitos and the role it plays in the protection network¹¹11 Silva ACS, Alberto MFP. Fios soltos da Rede de Proteção dos Direitos das Crianças e Adolescentes. Psicol Cienc Prof 2019; 39:e185358.. This lack of knowledge results not only in difficulties in everyday practice, but also the need for multidisciplinary training and development for professionals, prioritizing the coordination of violence prevention actions and harm reduction, as shown by two studies²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92.^,3535 Silva PA, Lunardi VL, Meucci, RD, Algeri S, Silva MP, Franciscatto FP. (In)visibilidade das notificações de violência contra crianças e adolescentes registradas em um município do Sul do Brasil. Invest Educ Enferm 2019; 37(2):e11..

In the same vein, one of the studies reported that the lack of access to or knowledge of identification and reporting protocols represented a weakness in professional practice and that this knowledge can help improve outcomes among maltreated children⁴⁷47 Ricks L, Tuttle M, Ellison SE. Child abuse reporting: understanding factors impacting veteran school counselors. Professional Counselor 2022; 12(2). [cited 2022 out 13]. Available from: https://tpcjournal.nbcc.org/child-abuse-reporting-understanding-factors-impacting-veteran-school-counselors/?utm_source=rss&utm_medium=rss&utm_campaign=child-abuse-reporting-understanding-factors-impacting-veteran-school-counselors
https://tpcjournal.nbcc.org/child-abuse-... . One of the articles³⁰30 Costa AP, Tinoco RLR. Maus-tratos infantis no currículo dos cursos de odontologia do Rio de Janeiro. Rev ABENO 2019; 19(2):54-62. highlighted that the absence of protocols guiding actions and explaining what to do and how to approach situations of child maltreatment generated uncertainty and undermined legal requirements. On the other hand, gaps between the guidance set out in protocols and actual practice suggest weaknesses in training, as shown by one of the studies²⁴24 Egry EY, Apostólico MR, Morais TC. Notificação da violência infantil, fluxos de atenção e processo de trabalho dos profissionais da atenção primária em saúde. Cien Saude Colet 2018; 23(1):83-92..

Finally, it is worth noting that one of the studies³⁷37 Trindade AA, Hohendorff JV. Efetivação da Lei Menino Bernardo pelas redes de proteção e de atendimento a crianças e adolescentes. Cad Saude Publica 2020; 36(10):e00193919. suggests that combating violence goes beyond improvements in professional training, also involving parent education and public awareness campaigns. Another study⁴⁶46 Costa VS, Aguiar RS. Percepção da equipe multidisciplinar acerca dos cuidados à criança e ao adolescente vítima de violência. Res Soc Dev 2020; 9(4): e161943038. highlights that strengthening parent-child relationships and actions that bring together families and communities are factors that facilitate the work of professionals dealing with child violence and promoting child protection.

Final considerations

Despite being the topic matter of integrative reviews³3 Nunes AJ, Sales MCV. Violence against children in Brazilian scenery. Cien Saude Colet 2016; 21(3):871-880.^,1717 Maia MA, Silva MAC, Paiva ACO, Silva DM, Alves M. Professional practices in situations of violence in home care: An integrative review. Cien Saude Colet 2020; 25(9):3587-3596.

18 Rosa ACMA, Miasato JM, Teixeira DA, Oliveira LMC, Silva LAH, Tesch FC. The dentist's conduct towards child abuse: A literature review. Rev UNINGÁ 2021; 58, eUJ3585-eUJ3585.^-1919 Wyzykowski C, Pereira D, Boaventura M. Atuação do enfermeiro frente a situações de maus-tratos à criança: revisão integrativa. Rev Enferm 2021; 14(14):1-10., there is a lack of literature on practices for dealing with violence against children in Brazil. This review therefore provides important new insights into these practices across different professional contexts. Our findings show that practices have been investigated predominantly from the perspective of health professionals, with other areas being underrepresented in the literature, which may hamper the promotion of interdisciplinary working.

The results also show that professional practices have a fragile structure and are marked by deficiencies, indicating that, despite public policies⁸8 Brasil. Constituição da República Federativa do Brasil. Brasília: Senado Federal; 1988.^,1010 Brasil. Estatuto da Criança e do Adolescente. Brasília: Senado Federal; 1990.^,4949 Brasil. Lei nº 13.431, de 4 de abril de 2017. Estabelece o sistema de garantia de direitos da criança e do adolescente vítima ou testemunha de violência e altera a Lei nº 8.069, de 13 de julho de 1990 (Estatuto da Criança e do Adolescente). Diário Oficial da União 2017; 5 abr. designed to protect children, shortcomings in training and lack of professional development hamper the prevention of this type of violence. Professionals whose task it is to protect children are therefore ill-equipped to identify and report child maltreatment, contributing to the underreporting and perpetuation of violence.

The articles analyzed in this review show that most professionals do not follow theoretical or practical guidance, either due to the lack of identification, reporting and care protocols or lack of knowledge/non-compliance with these guidelines when they do exist. Our findings indicate directions for future research, including how violence against children is approached in the curriculums of undergraduate and postgraduate degrees taken by professionals involved in caring for children and further in-depth studies to understand professional practices for dealing with violence against children, identifying initiatives to develop or strengthen protocols that can serve as a frame of reference.

It is also essential to investigate professionals’ perceptions and degree of certainty regarding the reporting of violence as well as the dynamics of the violence that pervades Brazilian society and the consequences for tackling child maltreatment. Finally, it is important to assess how distrust in child protection agencies and the justice system contribute to the underreporting of child maltreatment.

This study contributes to a broader understanding of professional practices for dealing with child maltreatment in Brazil, underlining barriers to comprehensive child protection and the provision of care and assistance that minimizes the suffering of victims and their families. It is important to highlight that given the scarcity of publications in different professional areas, this study focused mainly on articles in the area of health. This is a potential limitation insofar as the sample may not represent a full understanding of professional practices for dealing with violence against children.

References

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