Abstract

This article aims to analyze the prevalence of reporting and notification of violence in children and adolescents in the work of clinical health professionals. The search was performed in six electronic databases and the gray literature for studies published until June 1, 2022. Estimates of interest were calculated using random effects meta-analyses. Two reviewers independently evaluated the potentially eligible studies according to the following criteria: cross-sectional studies carried out with health professionals who provided clinical care for children and adolescents and dealt with violence cases. Two reviewers extracted data on included trial characteristics, methods, and outcomes. Expectations of interest were transformed using random effects meta-analyses. The meta-analysis of the prevalence of reports of violence performed with 42 articles was 41%. The notification meta-analysis occurred with 39 articles and was 30%. About one in two health professionals face situations of violence against children and adolescents in their clinical practice (41%), and approximately one in three health professionals report the cases (30%).

Key words:
Prevalence; Health professionals; Violence; Notification; Systematic review

Resumo

O objetivo do artigo é analisar a prevalência de relato e notificação de violência em crianças e adolescentes no trabalho de profissionais clínicos da saúde. A busca foi realizada em seis bases de dados eletrônicas e na literatura cinzenta para estudos publicados até 1º de junho de 2022. As estimativas de interesse foram calculadas usando meta-análises de efeitos aleatórios. Dois revisores avaliaram de maneira independente os estudos potencialmente elegíveis de acordo com os seguintes critérios: estudos transversais com profissionais da saúde que prestavam atendimentos clínicos voltados a crianças e adolescentes e que se depararam com casos de violência. Dois revisores extraíram dados sobre as características dos estudos incluídos, métodos e resultados. As estimativas de interesse foram calculadas usando meta-análises de efeitos aleatórios. A meta-análise de prevalência de relato de violência realizada com 42 artigos foi de 41%. A meta-análise da notificação ocorreu com 39 artigos e foi de 30%. Aproximadamente um a cada dois profissionais da saúde se deparam com situações de violência contra crianças e adolescentes em sua prática clínica (41%) e cerca de um a cada três profissionais da saúde notificam os casos (30%).

Palavras-chave:
Prevalência; Profissionais da saúde; Violência; Notificação; Revisão sistemática

Introduction

Intra-family violence against children and adolescents is a worldwide reality. It consists of any violent act committed by a family member, even without blood ties, against another member under 19 years of age. Defined based on family and affective relationships established between those involved and not by the physical space in which it occurs, this phenomenon is predominantly manifested through physical, sexual, and psychological violence, in addition to negligence attitudes¹1 World Health Assembly. Strengthening the role of the health system in addressing violence, in particular against women and girls, and against children [Internet]. 2014. [cited 2023 11 jun]. Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R15-en.pdf
https://apps.who.int/gb/ebwha/pdf_files/... . Worldwide, it is estimated that one in two children between the ages of 2 and 17 suffers some form of violence each year. That is, half of the children are victims of violence annually, which represents approximately 1 billion children around the planet²2 Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54(24):1451-1462..

This violence suffered in childhood can generate physical and emotional symptoms in the victim and delays in intellectual, motor, and language development. These consequences may appear with the time elapsed between the situation of violence and the appearance of health problems, with immediate, mediate, or long-term effects. Furthermore, some late manifestations are frequently observed, including suicidal behavior, anxiety, depression, sleep disturbances, heightened sexuality, criminality, and excessive use of illicit substances¹1 World Health Assembly. Strengthening the role of the health system in addressing violence, in particular against women and girls, and against children [Internet]. 2014. [cited 2023 11 jun]. Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R15-en.pdf
https://apps.who.int/gb/ebwha/pdf_files/... .

The world health organization describes that one of the risk factors for health problems until adulthood and the involvement of other forms of violence is mainly due to abuse experienced in the first decade of the child’s life. Sexual violence is the threshold of cases of depression, drug addiction, and suicide attempts³3 Costa KD, Tacsiy YRC. Percepções dos profissionais de saúde sobre a criança vítima de violência, em um município do sudoeste goiano. RSM 2020; 7(1):1-10.. Overall, the violent situations experienced by children lead them to develop harmful practices associated with smoking, high-risk sexual behavior, and eating disorders³3 Costa KD, Tacsiy YRC. Percepções dos profissionais de saúde sobre a criança vítima de violência, em um município do sudoeste goiano. RSM 2020; 7(1):1-10.. Therefore, the sooner the situation of violence is interrupted, the better the prognosis presented by the victim⁴4 Dodaj A, Krajina M, Sesar K, Simic N. The Effects of maltreatment in childhood on working memory capacity in adulthood. Eur J Psychol 2017; 13(4):618-632..

Health professionals are in a favorable position to identify probable situations of violence, given that victims often seek health services due to their symptoms⁵5 Magalhaes JRF, Gomes NP, Mota RS, Santos RMD, Pereira A, Oliveira JF. Repercussions of family violence: oral history of adolescents. Rev Bras Enferm 2020; 73(1):e20180228.. Pediatricians generally know their patients emotional, educational, and physical characteristics before the beginning of an eventual abuse⁶6 Ferreira AL. Acompanhamento de crianças vítimas de violência: desafios para o pediatra. J Pediatr (Rio J) 2005; 81(Supl. 5):173-180.. The dental surgeon, the speech therapist, and the psychologist are very close to the child and the family during the service, from the first consultation to filling out the clinical forms. This proximity helps these professionals to know the family routine of their patients. Thus, throughout clinical care, these professionals understand the family dynamics in which situations of violence may be present⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,88 Rover ALP, Oliveira GC, Nagata ME, Ferreira R, Molina AFC, Parreiras SO. Violência contra a criança: indicadores clínicos na odontologia. Braz J Dev 2020; 6(7):43738-43750..

No systematic literature review was found on reports of violence against children and adolescents identified by health professionals working in the clinical setting. Thus, this systematic review aims to analyze the prevalence of reporting and notification of violence in children and adolescents in the clinical work of health professionals.

Methodology

This systematic review was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Checklist (PRISMA)⁹9 Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, McKenzie JE. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021; 372:n160..

Eligibility criteria

Studies that met the criteria related to the acronym ‘PECOS’ were considered eligible for this systematic review:

P = health professionals; E = acting in a clinical environment and reporting care for children and/or adolescents; C = no comparison because it is a prevalence study; O = primary outcome: prevalence of reports of intrafamily violence; Secondary outcome: prevalence of notification of cases of intrafamily violence; S = Study design: cross-sectional studies.

Inclusion criteria

Cross-sectional studies involving health professionals who perform clinical care aimed at children and adolescents were included. Studies that portray the prevalence of reports of violence in childhood and adolescence and studies capable of indicating the prevalence of notification of cases of intrafamily violence against children and adolescents were also included.

Exclusion criteria

Publications were excluded following four pre-established criteria: 1 - studies carried out with data from the coroner’s office, hospitals, waiting, or with university students. 2 - studies that did not respond to the stipulated research question. 3 - reviews, letters, books, conference abstracts, case reports, research reports, case series, opinion articles, articles and technical guidelines, brief and/or ethnographic communications. 4 - studies that were not found to be read in full, even when requested to the authors via email.

Information sources and research strategies

The following databases were used to identify the studies: EMBASE, Latin American and Caribbean Literature on Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, and Web of Science. In addition, a search of the gray literature was performed on Google Scholar, MedRxiv, OpenGrey, and Proquest Dissertations & Theses. The complete search used for each database is described in Appendix 1 (available from: https://doi.org/10.48331/scielodata.159ACH).

EndNote® software was used to organize and remove duplicate references.

Selection of studies

The selection of studies eligible for the review was performed by two independent reviewers (A.B.P. and L.J.). In order to calibrate the reviewers before starting the selection, an independent pre-selection was performed based on a partial literature search, and the value of the Kappa coefficient of agreement was calculated. The definitive reading started after obtaining agreement values ​​> 0.8 between the two reviewers.

The study selection process was carried out independently and in two phases. In the first phase, titles and abstracts of retrieved references were evaluated, and potentially eligible studies were selected for a full reading. In the second phase, the full text was evaluated to confirm eligibility. The selection process was carried out through the website Rayyan - Intelligent Systematic Review, promoting blinding between the reviewers in all evaluations. A team member (C.M.A) did not participate in the selection and performed the moderation. Disagreements were decided by consensus, with a third reviewer (G.A.A.M).

Data collect

Two reviewers (A.B.P. and L.J.) collected information from the included studies, which was discussed. The data collected consisted of the following aspects: study characteristics (authors, year of publication, and country), population characteristics (sample size and health professionals included), evaluation characteristics (instruments used), results characteristics (results presented in outcome), and main conclusions.

When data were missing or incomplete in the article, the authors were contacted via email to obtain the relevant information. In these cases, three attempts were made with all the article’s authors, with a time interval of one week. When there was no response, the article was excluded with due justification.

Risk of bias assessment

The included studies were evaluated for methodological quality with the “Meta-Analysis of Statistics Assessment and Review Instrument” (MASTARI) tool¹⁰10 Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Health 2015; 13(3):147-153.. Two reviewers (A.B.P and L.J) separately performed the risk of bias assessment and judged the included articles, marking each evaluation criterion with “yes”, “no”, “uncertain”, and “not applicable”. The risk of bias was classified as high when the study reached 49% “Yes”; moderate when the study reached 50% to 69% “Yes”; and low when the study reached more than 70% “Yes”¹¹11 Araújo CM, Schroder AGD, Araújo BMM, Cavalcante-Leão BL, Stechman-Neto J, Zeigelboim BS, Santos RS, Guariza-Filho O. Impact of orthodontic-surgical treatment on quality of life: a meta-analysis. Eur J Orthod 2020; 42(3):281-289.. Disagreements were resolved through discussion with a third reviewer (C.M.A) when necessary. Revman 5.4 Software was used to create the figures.

Data items and effect measure

The number of events and the total sample size for the outcomes of interest were extracted from the included studies. The global prevalence for the reporting and notification of domestic violence against children and adolescents was then calculated, with the respective 95% confidence intervals (95%CI).

Strategy for data synthesis

A meta-analysis of proportions with a random effect model was performed using the inverse variance method and the DerSimonian and Laird estimator. Heterogeneity was evaluated using the inconsistency index (I²). The Freeman-Tukey double arcsine transformation method was used so that the data followed an approximately normal distribution. Confidence intervals of 95% (95%CI) were calculated using the Clopper-Pearson method.

Assessment of reporting bias

Publication bias was assessed through visual analysis of the funnel plot and the Egger test, considering a significance level of 5%. A sensitivity analysis was also performed to evaluate the estimates based on studies with a sample size with sufficient statistical power to assess this outcome in the population. Thus, a sample calculation was performed considering the global estimate of mean prevalence for each outcome evaluated, taking into account an infinite population, a sampling error of 10%, and a confidence level of 95%. A subgroup analysis was performed in the presence of heterogeneity, considering the category of professionals participating in the study.

Assessment of the certainty of cumulative evidence

The certainty of the evidence was evaluated using the “Grading of Recommendations Assessment, Development and Evaluation tool” (GRADE)¹²12 Schünemann H, Brozek J, Guyatt G, Oxman A. GRADE Handbook [Internet]. 2013. [cited 2023 jun 11]. Available from: https://gdt.gradepro.org/app/handbook/handbook.html
https://gdt.gradepro.org/app/handbook/ha... . This tool considers five domains to assess the certainty of evidence: risk of bias, inconsistency of results, indirect evidence, imprecision, and publication bias. Then, it judges the cumulative evidence generated as not serious, serious, and very serious. The GRADE level of evidence was determined by three authors (L.J, C.M.A, and K.V.M.T.), and the consensus was reached by discussion. A ‘Summary of Findings’ table was produced using GRADEpro software.

Results

Selection of studies

The databases retrieved 6181 references. After the repeated studies removal, 4285 references remained. After completing the first phase, 4213 references were removed, which did not meet the inclusion criteria, thus leaving 72 studies for the second phase. In the search update in June 2022, 842 references were retrieved, ten selected, totaling 82 studies for the second phase.

The reading of the full text of the 82 references excluded 30 studies, as they did not meet the eligibility criteria (Appendix 2, available at: https://doi.org/10.48331/scielodata.159ACH). Thus, 52 studies met the inclusion criteria and were selected for this review (Figure 1).

Characteristics of the studies

Of the 52 selected studies, 30 were carried out in Brazil⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,1313 Almeida LH, Santos J, Silva AM. Conhecimento do cirurgião-dentista acerca de maus-tratos à criança e ao adolescente. REV/FO 2019; 24(2):250-255.

14 Carvalho AA, Wada RS, Francesquini Júnior L, Daruge Júnior E, Bittar TO, Paranhos LR. Análise da conduta ética do pediatra frente a crianças vítimas de maus tratos. HU Rev 2010; 36(3)183-187.

15 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.

16 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.

17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.

18 Cavalcanti AL, Farias CMM, Barbosa JC, Mouden LD. Conhecimentos e atitudes dos cirurgiões-dentistas da cidade de João Pessoa frente ao abuso infantil. J Bras Odontopediatr Odonto Bebe 2002; 5(28):470-474.

19 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.

20 Tornavoi DC, Galo R, Silva RHA. Conhecimento de profissionais de Odontologia sobre violência doméstica. RSBO (Online) 2011; 8(1):54-59.

21 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.

22 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.

23 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.

24 Lima KA, Colares V, Cabral HM. Avaliação da conduta dos odontopediatras de Recife com relação ao abuso infantil. Rev Odonto Cienc - Fac Odonto/PUCRS 2005; 20(49):231-236.

25 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.

26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.

27 Moreira GAR, Rolim ACA, Saintrain MVdL, Vieira LJES. Atuação do cirurgião-dentista na identificação de maus-tratos contra crianças e adolescentes na atenção primária. Saude Debate 2015; 39(Esp.):257-267.

28 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.

29 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.

30 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.

31 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. TES 2017; 15(2):469-484.

32 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.

33 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.

34 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.

35 Moreira GA, Vieira LJ, Deslandes SF, Pordeus MA, Gama IS, Brilhante AV. Factors associated with the report and adolescent abuse in primary healthcare. Cien Saude Colet 2014; 19(10):4267-4276.

36 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.

37 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.

38 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.

39 Dalledone M, Paola APB, Correr GM, Pizzatto E, Souza JF, Losso EM. Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil. Braz. J Oral Sci 2015; 14(3):224-229.

40 Lima BBS, Pieri A. Avaliação do conhecimento de docentes de odontologia da universidade do estado do Amazonas sobre maus-tratos infantis. RBOL 2021; 8(1):43-54.^-4141 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EFE, Zarzar P. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(Supl. 3):5013-5022., five in the United States⁴²42 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.

43 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146.

44 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.

45 Tilden VP, Schmidt TA, Limandri BJ, Chiodo GT, Garland MJ, Loveless PA. Factors that influence clinicians' assessment and management of family violence. Am J Public Health 1994; 84(4):628-633.^-4646 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286., two in Norway⁴⁷47 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632., two in Australia49, 50), and the 13 remaining studies were conducted in Saudi Arabia⁵¹51 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50., Colombia⁵²52 Vergara KMA, Cárdenas SD, Martínez FG. Maltrato infantil: conocimientos, actitudes y prácticas de estudiantes de odontología de Cartagena, Colombia. Rev Clin Med Fam 2014; 7(2):103-111., Croatia⁵³53 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450., Egypt⁵⁴54 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55., Greece⁵⁵55 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71., India⁵⁶56 Sunitha S, Vidya GD, Sushma R. Knowledge and awareness about identification of domestic violence, abuse and neglect of victim among dentists. Indian J Forensic Med Toxicol 2021; 15(2):3619-3624., Northern Ireland⁵⁷57 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338., Netherlands⁵⁸58 Van Dam BA, Van der Sanden WJ, Bruers JJ. Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists. BMC Oral Health 2015; 15:159., New Zealand⁵⁹59 Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37(3):240-243., Pakistan⁶⁰60 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799., Sweden⁶¹61 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26., Turkey⁶²62 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001., and a multicenter study carried out in 22 European countries⁶³63 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105..

The 52 studies were cross-sectional and for data collection. Eight studies used validated instruments, with five studies²⁸28 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.^,3636 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.^,3737 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.^,4141 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EFE, Zarzar P. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(Supl. 3):5013-5022. relying on the Questionnaire on Childhood Trauma (QUESI)⁶⁴64 Grassi-Oliveira R, Stein LM, Pezzi JC. Tradução e validação de conteúdo da versão em português do Childhood Trauma Questionnaire. Rev Saude Publica 2006; 40(2):249-255.. In two studies, the authors developed the validation of a new questionnaire⁵⁶56 Sunitha S, Vidya GD, Sushma R. Knowledge and awareness about identification of domestic violence, abuse and neglect of victim among dentists. Indian J Forensic Med Toxicol 2021; 15(2):3619-3624.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001.. A survey used the ISPCAN Child Abuse Screening Tool⁶³63 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105., and the other studies used non-validated self-administered instruments.

The sample size ranged from 19²¹21 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159. to 1,200⁴⁷47 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632. participants. Regarding the professionals included, 24 studies with physicians¹⁴14 Carvalho AA, Wada RS, Francesquini Júnior L, Daruge Júnior E, Bittar TO, Paranhos LR. Análise da conduta ética do pediatra frente a crianças vítimas de maus tratos. HU Rev 2010; 36(3)183-187.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2525 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.^,2626 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.

31 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. TES 2017; 15(2):469-484.^-3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.

35 Moreira GA, Vieira LJ, Deslandes SF, Pordeus MA, Gama IS, Brilhante AV. Factors associated with the report and adolescent abuse in primary healthcare. Cien Saude Colet 2014; 19(10):4267-4276.

36 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.^-3737 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.

43 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146.

44 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.

45 Tilden VP, Schmidt TA, Limandri BJ, Chiodo GT, Garland MJ, Loveless PA. Factors that influence clinicians' assessment and management of family violence. Am J Public Health 1994; 84(4):628-633.^-4646 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286.^,4949 Schweitzer RD, Buckley L, Harnett P, Loxton NJ. Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia. Aust Health Rev 2006; 30(3):298-304.^,5151 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,5959 Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37(3):240-243.^,6161 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105., three studies with speech therapists⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,1515 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48., 38 studies with dentists¹³13 Almeida LH, Santos J, Silva AM. Conhecimento do cirurgião-dentista acerca de maus-tratos à criança e ao adolescente. REV/FO 2019; 24(2):250-255.^,1616 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.

17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.

18 Cavalcanti AL, Farias CMM, Barbosa JC, Mouden LD. Conhecimentos e atitudes dos cirurgiões-dentistas da cidade de João Pessoa frente ao abuso infantil. J Bras Odontopediatr Odonto Bebe 2002; 5(28):470-474.

19 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.

20 Tornavoi DC, Galo R, Silva RHA. Conhecimento de profissionais de Odontologia sobre violência doméstica. RSBO (Online) 2011; 8(1):54-59.

21 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.

22 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.

23 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.

24 Lima KA, Colares V, Cabral HM. Avaliação da conduta dos odontopediatras de Recife com relação ao abuso infantil. Rev Odonto Cienc - Fac Odonto/PUCRS 2005; 20(49):231-236.

25 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.

26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.

27 Moreira GAR, Rolim ACA, Saintrain MVdL, Vieira LJES. Atuação do cirurgião-dentista na identificação de maus-tratos contra crianças e adolescentes na atenção primária. Saude Debate 2015; 39(Esp.):257-267.^-2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.

33 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.

34 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.

35 Moreira GA, Vieira LJ, Deslandes SF, Pordeus MA, Gama IS, Brilhante AV. Factors associated with the report and adolescent abuse in primary healthcare. Cien Saude Colet 2014; 19(10):4267-4276.

36 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.

37 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.

38 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.

39 Dalledone M, Paola APB, Correr GM, Pizzatto E, Souza JF, Losso EM. Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil. Braz. J Oral Sci 2015; 14(3):224-229.

40 Lima BBS, Pieri A. Avaliação do conhecimento de docentes de odontologia da universidade do estado do Amazonas sobre maus-tratos infantis. RBOL 2021; 8(1):43-54.^-4141 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EFE, Zarzar P. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(Supl. 3):5013-5022.^,4545 Tilden VP, Schmidt TA, Limandri BJ, Chiodo GT, Garland MJ, Loveless PA. Factors that influence clinicians' assessment and management of family violence. Am J Public Health 1994; 84(4):628-633.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632.^,5050 Kugananthan S, Nguyen T, Patel J, Anthonappa R. Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia. Aust Dent J 2021; 66(2):194-200.

51 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50.

52 Vergara KMA, Cárdenas SD, Martínez FG. Maltrato infantil: conocimientos, actitudes y prácticas de estudiantes de odontología de Cartagena, Colombia. Rev Clin Med Fam 2014; 7(2):103-111.

53 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.

54 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55.

55 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71.

56 Sunitha S, Vidya GD, Sushma R. Knowledge and awareness about identification of domestic violence, abuse and neglect of victim among dentists. Indian J Forensic Med Toxicol 2021; 15(2):3619-3624.

57 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^-5858 Van Dam BA, Van der Sanden WJ, Bruers JJ. Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists. BMC Oral Health 2015; 15:159.^,6060 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001., and a study with psychologists (45). The year of publication of these studies ranged from 1978⁴³43 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146. to 2022⁵⁴54 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001.. Table 1 shows the characteristics description of the included studies.

Risk of bias

Regarding the overall risk of bias, of the 52 studies included in this review, nine were classified as low risk of bias⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3636 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.^,3737 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.^,4141 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EFE, Zarzar P. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(Supl. 3):5013-5022.^,5151 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50.^,5454 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55.^,6060 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001., 28 were classified as moderate risk of bias¹⁵15 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.

16 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.

17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^-1818 Cavalcanti AL, Farias CMM, Barbosa JC, Mouden LD. Conhecimentos e atitudes dos cirurgiões-dentistas da cidade de João Pessoa frente ao abuso infantil. J Bras Odontopediatr Odonto Bebe 2002; 5(28):470-474.^,2121 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.^,2323 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.

24 Lima KA, Colares V, Cabral HM. Avaliação da conduta dos odontopediatras de Recife com relação ao abuso infantil. Rev Odonto Cienc - Fac Odonto/PUCRS 2005; 20(49):231-236.

25 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.^-2626 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.

31 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. TES 2017; 15(2):469-484.

32 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.

33 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.^-3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,3636 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.^,3939 Dalledone M, Paola APB, Correr GM, Pizzatto E, Souza JF, Losso EM. Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil. Braz. J Oral Sci 2015; 14(3):224-229.^,4040 Lima BBS, Pieri A. Avaliação do conhecimento de docentes de odontologia da universidade do estado do Amazonas sobre maus-tratos infantis. RBOL 2021; 8(1):43-54.^,4444 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.

45 Tilden VP, Schmidt TA, Limandri BJ, Chiodo GT, Garland MJ, Loveless PA. Factors that influence clinicians' assessment and management of family violence. Am J Public Health 1994; 84(4):628-633.^-4646 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632.^,4949 Schweitzer RD, Buckley L, Harnett P, Loxton NJ. Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia. Aust Health Rev 2006; 30(3):298-304.^,5252 Vergara KMA, Cárdenas SD, Martínez FG. Maltrato infantil: conocimientos, actitudes y prácticas de estudiantes de odontología de Cartagena, Colombia. Rev Clin Med Fam 2014; 7(2):103-111.^,5353 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.^,5555 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71.^,5858 Van Dam BA, Van der Sanden WJ, Bruers JJ. Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists. BMC Oral Health 2015; 15:159.^,6161 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26.^,6565 Moreira TNF, Martins CL, Feuerwerker LCM, Schraiber LB. A construção do cuidado: o atendimento às situações de violência doméstica por equipes de Saúde da Família. Saude Soc 2014; 23(3):814-827., and 15 as high risk of bias¹⁴14 Carvalho AA, Wada RS, Francesquini Júnior L, Daruge Júnior E, Bittar TO, Paranhos LR. Análise da conduta ética do pediatra frente a crianças vítimas de maus tratos. HU Rev 2010; 36(3)183-187.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2020 Tornavoi DC, Galo R, Silva RHA. Conhecimento de profissionais de Odontologia sobre violência doméstica. RSBO (Online) 2011; 8(1):54-59.^,2222 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.^,2727 Moreira GAR, Rolim ACA, Saintrain MVdL, Vieira LJES. Atuação do cirurgião-dentista na identificação de maus-tratos contra crianças e adolescentes na atenção primária. Saude Debate 2015; 39(Esp.):257-267.^,3535 Moreira GA, Vieira LJ, Deslandes SF, Pordeus MA, Gama IS, Brilhante AV. Factors associated with the report and adolescent abuse in primary healthcare. Cien Saude Colet 2014; 19(10):4267-4276.^,3838 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.^,4343 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,5050 Kugananthan S, Nguyen T, Patel J, Anthonappa R. Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia. Aust Dent J 2021; 66(2):194-200.^,5656 Sunitha S, Vidya GD, Sushma R. Knowledge and awareness about identification of domestic violence, abuse and neglect of victim among dentists. Indian J Forensic Med Toxicol 2021; 15(2):3619-3624.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,5959 Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37(3):240-243.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105. (Appendix 3, available at: https://doi.org/10.48331/scielodata.159ACH).

Individual study results

Regarding the identification or suspicion of cases of violence against children and adolescents, most studies were carried out with dentists¹³13 Almeida LH, Santos J, Silva AM. Conhecimento do cirurgião-dentista acerca de maus-tratos à criança e ao adolescente. REV/FO 2019; 24(2):250-255.^,1616 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.

17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.

18 Cavalcanti AL, Farias CMM, Barbosa JC, Mouden LD. Conhecimentos e atitudes dos cirurgiões-dentistas da cidade de João Pessoa frente ao abuso infantil. J Bras Odontopediatr Odonto Bebe 2002; 5(28):470-474.

19 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.

20 Tornavoi DC, Galo R, Silva RHA. Conhecimento de profissionais de Odontologia sobre violência doméstica. RSBO (Online) 2011; 8(1):54-59.

21 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.

22 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.

23 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.

24 Lima KA, Colares V, Cabral HM. Avaliação da conduta dos odontopediatras de Recife com relação ao abuso infantil. Rev Odonto Cienc - Fac Odonto/PUCRS 2005; 20(49):231-236.

25 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.

26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.

27 Moreira GAR, Rolim ACA, Saintrain MVdL, Vieira LJES. Atuação do cirurgião-dentista na identificação de maus-tratos contra crianças e adolescentes na atenção primária. Saude Debate 2015; 39(Esp.):257-267.^-2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.

33 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.

34 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.

35 Moreira GA, Vieira LJ, Deslandes SF, Pordeus MA, Gama IS, Brilhante AV. Factors associated with the report and adolescent abuse in primary healthcare. Cien Saude Colet 2014; 19(10):4267-4276.

36 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.

37 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.

38 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.

39 Dalledone M, Paola APB, Correr GM, Pizzatto E, Souza JF, Losso EM. Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil. Braz. J Oral Sci 2015; 14(3):224-229.

40 Lima BBS, Pieri A. Avaliação do conhecimento de docentes de odontologia da universidade do estado do Amazonas sobre maus-tratos infantis. RBOL 2021; 8(1):43-54.^-4141 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EFE, Zarzar P. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(Supl. 3):5013-5022.^,4545 Tilden VP, Schmidt TA, Limandri BJ, Chiodo GT, Garland MJ, Loveless PA. Factors that influence clinicians' assessment and management of family violence. Am J Public Health 1994; 84(4):628-633.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632.^,5050 Kugananthan S, Nguyen T, Patel J, Anthonappa R. Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia. Aust Dent J 2021; 66(2):194-200.

51 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50.

52 Vergara KMA, Cárdenas SD, Martínez FG. Maltrato infantil: conocimientos, actitudes y prácticas de estudiantes de odontología de Cartagena, Colombia. Rev Clin Med Fam 2014; 7(2):103-111.

53 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.

54 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55.

55 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71.

56 Sunitha S, Vidya GD, Sushma R. Knowledge and awareness about identification of domestic violence, abuse and neglect of victim among dentists. Indian J Forensic Med Toxicol 2021; 15(2):3619-3624.

57 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^-5858 Van Dam BA, Van der Sanden WJ, Bruers JJ. Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists. BMC Oral Health 2015; 15:159.^,6060 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001. and physicians¹⁴14 Carvalho AA, Wada RS, Francesquini Júnior L, Daruge Júnior E, Bittar TO, Paranhos LR. Análise da conduta ética do pediatra frente a crianças vítimas de maus tratos. HU Rev 2010; 36(3)183-187.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2525 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.^,2626 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.

31 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. TES 2017; 15(2):469-484.^-3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.

35 Moreira GA, Vieira LJ, Deslandes SF, Pordeus MA, Gama IS, Brilhante AV. Factors associated with the report and adolescent abuse in primary healthcare. Cien Saude Colet 2014; 19(10):4267-4276.

36 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.^-3737 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.

43 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146.

44 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.

45 Tilden VP, Schmidt TA, Limandri BJ, Chiodo GT, Garland MJ, Loveless PA. Factors that influence clinicians' assessment and management of family violence. Am J Public Health 1994; 84(4):628-633.^-4646 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286.^,4949 Schweitzer RD, Buckley L, Harnett P, Loxton NJ. Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia. Aust Health Rev 2006; 30(3):298-304.^,5151 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,5959 Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37(3):240-243.^,6161 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105.. The professionals with the highest rates of suspicion, identification, and notification of cases were doctors and dentists.

The identification and notification of cases included professionals with more than ten years of training. Female professionals were the ones who most identified and reported cases of violence¹⁴14 Carvalho AA, Wada RS, Francesquini Júnior L, Daruge Júnior E, Bittar TO, Paranhos LR. Análise da conduta ética do pediatra frente a crianças vítimas de maus tratos. HU Rev 2010; 36(3)183-187.

15 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.

16 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.

17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^-1818 Cavalcanti AL, Farias CMM, Barbosa JC, Mouden LD. Conhecimentos e atitudes dos cirurgiões-dentistas da cidade de João Pessoa frente ao abuso infantil. J Bras Odontopediatr Odonto Bebe 2002; 5(28):470-474.^,2020 Tornavoi DC, Galo R, Silva RHA. Conhecimento de profissionais de Odontologia sobre violência doméstica. RSBO (Online) 2011; 8(1):54-59.^,2626 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.^,3333 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.^,3636 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.

37 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.

38 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.^-3939 Dalledone M, Paola APB, Correr GM, Pizzatto E, Souza JF, Losso EM. Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil. Braz. J Oral Sci 2015; 14(3):224-229.^,4444 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.^,4545 Tilden VP, Schmidt TA, Limandri BJ, Chiodo GT, Garland MJ, Loveless PA. Factors that influence clinicians' assessment and management of family violence. Am J Public Health 1994; 84(4):628-633.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632.^,5252 Vergara KMA, Cárdenas SD, Martínez FG. Maltrato infantil: conocimientos, actitudes y prácticas de estudiantes de odontología de Cartagena, Colombia. Rev Clin Med Fam 2014; 7(2):103-111.

53 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.^-5454 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,6161 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26.. The identifications occurred due to body marks on the child or adolescent⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,1515 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.

16 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.^-1717 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2121 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.^,2323 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.^,2525 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.^,2626 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.^,3333 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,3636 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.

37 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.^-3838 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,5151 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50.^,5353 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.^,5555 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,5959 Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37(3):240-243.^,6060 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001., emotional symptoms⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,1616 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.^,1717 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2121 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.^,2222 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.^,2424 Lima KA, Colares V, Cabral HM. Avaliação da conduta dos odontopediatras de Recife com relação ao abuso infantil. Rev Odonto Cienc - Fac Odonto/PUCRS 2005; 20(49):231-236.

25 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.^-2626 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3333 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.^,3838 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.^,4343 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632.^,5353 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.^,5555 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71.^,6666 Cavalcanti AL, Mouden LD. Recognition and reporting of child abuse the dentist's role. Pesq Bras Odontoped Clin Integr 2001;1(2):42-46., patient’s own reports⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.^,3939 Dalledone M, Paola APB, Correr GM, Pizzatto E, Souza JF, Losso EM. Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil. Braz. J Oral Sci 2015; 14(3):224-229.^,4444 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29., absences from appointments⁴⁷47 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29., treatment abandonment⁴³43 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146.^,5858 Van Dam BA, Van der Sanden WJ, Bruers JJ. Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists. BMC Oral Health 2015; 15:159., suspicious social behavior⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,1717 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^,2222 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3333 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.^,4040 Lima BBS, Pieri A. Avaliação do conhecimento de docentes de odontologia da universidade do estado do Amazonas sobre maus-tratos infantis. RBOL 2021; 8(1):43-54.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632.^,4949 Schweitzer RD, Buckley L, Harnett P, Loxton NJ. Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia. Aust Health Rev 2006; 30(3):298-304.^,5858 Van Dam BA, Van der Sanden WJ, Bruers JJ. Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists. BMC Oral Health 2015; 15:159., and inappropriate clothing⁴⁶46 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286..

The most common type of violence was physical⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,1515 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.^,2121 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.^,2525 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.^,3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.

33 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.^-3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,3636 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.^,3737 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.^,3939 Dalledone M, Paola APB, Correr GM, Pizzatto E, Souza JF, Losso EM. Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil. Braz. J Oral Sci 2015; 14(3):224-229.

40 Lima BBS, Pieri A. Avaliação do conhecimento de docentes de odontologia da universidade do estado do Amazonas sobre maus-tratos infantis. RBOL 2021; 8(1):43-54.^-4141 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EFE, Zarzar P. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(Supl. 3):5013-5022.^,4444 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.^,4646 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4949 Schweitzer RD, Buckley L, Harnett P, Loxton NJ. Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia. Aust Health Rev 2006; 30(3):298-304.^,5353 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.^,5454 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55.^,5656 Sunitha S, Vidya GD, Sushma R. Knowledge and awareness about identification of domestic violence, abuse and neglect of victim among dentists. Indian J Forensic Med Toxicol 2021; 15(2):3619-3624.

57 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.

58 Van Dam BA, Van der Sanden WJ, Bruers JJ. Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists. BMC Oral Health 2015; 15:159.

59 Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37(3):240-243.^-6060 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105., neglect and/or abandonment⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,1515 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.^,2222 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.^,4444 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4949 Schweitzer RD, Buckley L, Harnett P, Loxton NJ. Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia. Aust Health Rev 2006; 30(3):298-304.^,5050 Kugananthan S, Nguyen T, Patel J, Anthonappa R. Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia. Aust Dent J 2021; 66(2):194-200.^,5353 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.^,5555 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71.

56 Sunitha S, Vidya GD, Sushma R. Knowledge and awareness about identification of domestic violence, abuse and neglect of victim among dentists. Indian J Forensic Med Toxicol 2021; 15(2):3619-3624.^-5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,5959 Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37(3):240-243.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105., sexual violence⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,2525 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,4343 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146.^,4444 Saulsbury FT, Campbell RE. Evaluation of child abuse reporting by physicians. Am J Dis Child 1985; 139(4):393-395.^,4646 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4949 Schweitzer RD, Buckley L, Harnett P, Loxton NJ. Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia. Aust Health Rev 2006; 30(3):298-304.^,5050 Kugananthan S, Nguyen T, Patel J, Anthonappa R. Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia. Aust Dent J 2021; 66(2):194-200.^,5454 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55.^,5858 Van Dam BA, Van der Sanden WJ, Bruers JJ. Recognizing and reporting domestic violence: attitudes, experiences and behavior of Dutch dentists. BMC Oral Health 2015; 15:159.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105., and psychological violence⁷7 Noguchi MS. O dito, o não dito e o mal-dito o fonoaudiólogo diante da violência familiar contra crianças e adolescentes [tese]. Rio de Janeiro: Escola Nacional de Saúde Pública - Fundação Oswaldo Cruz; 2005.^,2121 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.^,5454 El Tantawi M, Nabil N, Mahmoud SH, Elhendawy F. Capability, opportunity, motivation, and behaviour (COM-B) model association with Egyptian dentists' reporting of suspected abuse. BMC Oral Health 2022; 22(1):55.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105.. Females predominated among the victims¹³13 Almeida LH, Santos J, Silva AM. Conhecimento do cirurgião-dentista acerca de maus-tratos à criança e ao adolescente. REV/FO 2019; 24(2):250-255.^,1515 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.

16 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.^-1717 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2020 Tornavoi DC, Galo R, Silva RHA. Conhecimento de profissionais de Odontologia sobre violência doméstica. RSBO (Online) 2011; 8(1):54-59.^,2222 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.^,2525 Lima MCCS, Costa MCO, Bigras M, Santana MAO, Alves TDB, Nascimento OC, Silva MR. Atuação profissional da atenção básica de saúde face à identificação e notificação da violência infanto-juvenil. RBSP 1970; 35(Supl.1):118-137.^,2727 Moreira GAR, Rolim ACA, Saintrain MVdL, Vieira LJES. Atuação do cirurgião-dentista na identificação de maus-tratos contra crianças e adolescentes na atenção primária. Saude Debate 2015; 39(Esp.):257-267.^,3030 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.^,3232 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.

33 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.

34 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.

35 Moreira GA, Vieira LJ, Deslandes SF, Pordeus MA, Gama IS, Brilhante AV. Factors associated with the report and adolescent abuse in primary healthcare. Cien Saude Colet 2014; 19(10):4267-4276.

36 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.

37 Silva-Oliveira F, Ferreira RC, Alencar GP, Ferreira EF, Zarzar PM. Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors. Child Abuse Negl 2020; 107:104571.

38 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.^-3939 Dalledone M, Paola APB, Correr GM, Pizzatto E, Souza JF, Losso EM. Child abuse: perception and knowledge by Public Health Dentistry teams in Brazil. Braz. J Oral Sci 2015; 14(3):224-229.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.^,4343 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146.^,4646 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,5252 Vergara KMA, Cárdenas SD, Martínez FG. Maltrato infantil: conocimientos, actitudes y prácticas de estudiantes de odontología de Cartagena, Colombia. Rev Clin Med Fam 2014; 7(2):103-111.^,5353 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,5959 Denny SJ, Grant CC, Pinnock R. Epidemiology of Munchausen syndrome by proxy in New Zealand. J Paediatr Child Health 2001; 37(3):240-243.^,6161 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26.^,6666 Cavalcanti AL, Mouden LD. Recognition and reporting of child abuse the dentist's role. Pesq Bras Odontoped Clin Integr 2001;1(2):42-46.^,6767 Silva PA, Lunardi VL, Meucci RD, Algeri S, Silva MP, Franciscatto FP. (In)visibility of notifications of violence against children and adolescents registered in a municipality in southern Brazil. Invest Educ Enferm 2019; 37(2):e11.. The aggressors were fathers, mothers, stepfathers, stepmothers, uncles, or close relatives of the victim¹⁶16 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.

17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^-1818 Cavalcanti AL, Farias CMM, Barbosa JC, Mouden LD. Conhecimentos e atitudes dos cirurgiões-dentistas da cidade de João Pessoa frente ao abuso infantil. J Bras Odontopediatr Odonto Bebe 2002; 5(28):470-474.^,2222 Granville-Garciaa AF, Menezes VA, Silva PFRM. Maus-tratos infantis: percepção e responsabilidade do cirurgião do cirurgião-dentista. Rev Odonto Cienc 2008; 23(1):35-39.

23 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.^-2424 Lima KA, Colares V, Cabral HM. Avaliação da conduta dos odontopediatras de Recife com relação ao abuso infantil. Rev Odonto Cienc - Fac Odonto/PUCRS 2005; 20(49):231-236.^,2727 Moreira GAR, Rolim ACA, Saintrain MVdL, Vieira LJES. Atuação do cirurgião-dentista na identificação de maus-tratos contra crianças e adolescentes na atenção primária. Saude Debate 2015; 39(Esp.):257-267.^,2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,3636 Silva-Oliveira F, Andrade CI, Guimaraes MO, Ferreira RC, Ferreira EF, Zarzar PM. Recognition of child physical abuse by a group of Brazilian primary care health professionals. Int J Paediatr Dent 2019; 29(5):624-634.^,3838 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.^,4545 Tilden VP, Schmidt TA, Limandri BJ, Chiodo GT, Garland MJ, Loveless PA. Factors that influence clinicians' assessment and management of family violence. Am J Public Health 1994; 84(4):628-633.^,4747 Brattabo IV, Bjorknes R, Astrom AN. Reasons for reported suspicion of child maltreatment and responses from the child welfare - a cross-sectional study of Norwegian public dental health personnel. BMC Oral Health 2018; 18(1):29.^,4848 Brattabo IV, Iversen AC, Astrom AN, Bjorknes R. Experience with suspecting child maltreatment in the Norwegian public dental health services, a national survey. Acta Odontol Scand 2016; 74(8):626-632.^,5151 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50.^,5353 Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, Drvaric I, Boric B, Kopic V, Krupic I, Bakarcic D, Budimir M, Welbury RR. Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015; 25(6):444-450.^,5555 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71..

Regarding speech therapists, the most common type of violence identified by this professional was physical¹⁵15 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.. Language delay was the victim’s most frequently reported speech-language pathology complaint²⁹29 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48.. In most cases, treatment was abandoned¹⁵15 Acioli RML, Lima MLC, Braga MC, Pimentel FC, Castro AG. Violência intrafamiliar contra crianças e adolescentes: identificação, manejo e conhecimento da rede de referência por fonoaudiólogo em serviços públicos de saúde. RBSMI 2011; 11(1):21-28.^,2929 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48..

Regarding physicians, a significant percentage did not have the conditions to recognize, evaluate, and refer victims of child abuse¹⁴14 Carvalho AA, Wada RS, Francesquini Júnior L, Daruge Júnior E, Bittar TO, Paranhos LR. Análise da conduta ética do pediatra frente a crianças vítimas de maus tratos. HU Rev 2010; 36(3)183-187.^,3131 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. TES 2017; 15(2):469-484.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105.. Small-town physicians, recent college graduates, and physicians who attended child abuse workshops were more likely and more confident to recognize victims of violence⁴⁶46 Badger LW, Tuscaloosa A. Reporting of child abuse: influence of characteristics of physician, practice, and community. South Med J 1989; 82(3):281-286..

Most physicians said they had not received information about violence during graduation¹⁹19 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,3131 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. TES 2017; 15(2):469-484.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105.. Furthermore, the training on child abuse provided specifically in the residency in pediatrics was insufficient⁶³63 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105.. Professionals did not know the means of notification nor the institutions that assist children and adolescents victims of abuse²⁶26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,3131 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. TES 2017; 15(2):469-484.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105.. They also stated that the subject was not the focus of training and discussion in the work environment itself²⁶26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,3131 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. TES 2017; 15(2):469-484.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,6363 Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47(1):105..

Physicians pointed out difficulties in notifying the cases to the responsible bodies. These difficulties include the lack of knowledge about the laws and processes for reporting cases²⁶26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101.^,6161 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26., negative experiences with child service agencies³⁰30 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.^,4242 Gunn VL, Hickson GB, Cooper WO. Factors affecting pediatricians' reporting of suspected child maltreatment. Ambul Pediatr 2005; 5(2):96-101., distrust in victim protection bodies³⁰30 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108.^,6161 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26., the fear of legal involvement³⁴34 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616., uncertainty about the veracity of the violence²⁶26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,5151 Merwass R, Aboalshamat K, Bashkail F, Alsalhi R, Alsolami A, Alqadi R, Al-Motairi B, Alamoudi R. Knowledge and attitudes toward child abuse and neglect (CAN) among dental and medical practitioners in Saudi Arabia. J Res Med Dent Sci 2021; 5: 9(10):43-50.^,6161 Talsma M, Bengtsson Bostrom K, Ostberg AL. Facing suspected child abuse - what keeps Swedish general practitioners from reporting to child protective services? Scand J Prim Health Care 2015; 33(1):21-26., or even the fact of working exclusively in the private sector³⁰30 Pires JM, Goldani MZ, Vieira EM, Nava TR, Feldens L, Castilhos K, Simas V, Franzon NS. Barreiras, para a notificação pelo pediatra, de maus-tratos infantis. Rev Bras Saude Mater Infant 2005; 5(1):103-108..

The training time was significant for physicians to notify cases²⁶26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.. Likewise, knowing the notification form and how to refer cases increases the chances of professionals reporting situations of abuse in children and adolescents⁶⁵65 Moreira TNF, Martins CL, Feuerwerker LCM, Schraiber LB. A construção do cuidado: o atendimento às situações de violência doméstica por equipes de Saúde da Família. Saude Soc 2014; 23(3):814-827..

In the case of dentists, these professionals they recognize the importance of their profession regarding the recognition of situations of violence against children. However, they have difficulties in identifying and in the procedures to be carried out in these situations¹⁷17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2020 Tornavoi DC, Galo R, Silva RHA. Conhecimento de profissionais de Odontologia sobre violência doméstica. RSBO (Online) 2011; 8(1):54-59.^,2323 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.^,5050 Kugananthan S, Nguyen T, Patel J, Anthonappa R. Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia. Aust Dent J 2021; 66(2):194-200.^,5252 Vergara KMA, Cárdenas SD, Martínez FG. Maltrato infantil: conocimientos, actitudes y prácticas de estudiantes de odontología de Cartagena, Colombia. Rev Clin Med Fam 2014; 7(2):103-111.^,6060 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799.. In other studies, it was observed that dentists’ knowledge is focused on orofacial characteristics and findings indicative of different types of violence²³23 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.^,3838 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11.^,4040 Lima BBS, Pieri A. Avaliação do conhecimento de docentes de odontologia da universidade do estado do Amazonas sobre maus-tratos infantis. RBOL 2021; 8(1):43-54.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001..

The barriers pointed out by dentists for non-reporting include fear (34, 53, 60), the uncertainty surrounding the diagnosis of violence^{23,34,50,53,55,62}, fear of legal consequences³⁴ , the lack of legal support³⁴34 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,4040 Lima BBS, Pieri A. Avaliação do conhecimento de docentes de odontologia da universidade do estado do Amazonas sobre maus-tratos infantis. RBOL 2021; 8(1):43-54., the lack of preparation to make the complaint¹⁶16 Campos PCM. Odontopediatras e violência contra crianças e adolescentes: como eles atuam? Rev Flum Odontol 2010; 16(34): 49-54.^,2121 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.^,2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,3434 Martins-Junior PA, Ribeiro DC, Peruch GSO, Paiva SM, Marques LS, Ramos-Jorge ML. Physical abuse of children and adolescents: do health professionals perceive and denounce? Cien Saude Colet 2019; 24(7):2609-2616.^,5050 Kugananthan S, Nguyen T, Patel J, Anthonappa R. Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia. Aust Dent J 2021; 66(2):194-200.^,5656 Sunitha S, Vidya GD, Sushma R. Knowledge and awareness about identification of domestic violence, abuse and neglect of victim among dentists. Indian J Forensic Med Toxicol 2021; 15(2):3619-3624.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,6060 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799., or even inadequate knowledge about notification protocols²¹21 Fracon ET, Silva RHA, Bregagnolo JC. Avaliação da conduta do cirurgião-dentista ante a violência doméstica contra crianças e adolescentes no município de Cravinhos (SP). RSBO (Online) 2011; 8(2):153-159.^,2828 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230.^,5050 Kugananthan S, Nguyen T, Patel J, Anthonappa R. Knowledge, experiences and attitudes of dental health professionals towards reporting child abuse in Western Australia. Aust Dent J 2021; 66(2):194-200.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,6060 Saleem MN, Raja HZ, Shakoor A, Rashid H, Nasir H, Yusuf E. Knowledge, attitude, and practices of dental practitioners regarding domestic violence in Pakistan. Inquiry 2021; 58:469580211060799.^. In this sense, many professionals reported that they did not receive information about violence during their undergraduate¹⁷17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^,1919 Cavalcanti AL, Martins VM. Percepções e conhecimentos de médicos pediatras e cirurgiões-dentistas sobre maus-tratos infantis. RBCS 2009; 13(3):41-48.^,2020 Tornavoi DC, Galo R, Silva RHA. Conhecimento de profissionais de Odontologia sobre violência doméstica. RSBO (Online) 2011; 8(1):54-59.^,2323 Gurgel C, Carvalho A, Barros S, Alves A. Maus-tratos contra crianças: atitudes e percepção do cirurgião-dentista. Pesq Bras Odontopediatria Clin Integr 2001; 1(2):23-28.^,2424 Lima KA, Colares V, Cabral HM. Avaliação da conduta dos odontopediatras de Recife com relação ao abuso infantil. Rev Odonto Cienc - Fac Odonto/PUCRS 2005; 20(49):231-236.^,3333 Losso EM, Marengo G, El Sarraf MC, Baratto-Filho F. Child abuse: perception and management of the Brazilian endodontists. RSBO (Online) 2012; 9(1):62-69.^,5555 Laud A, Gizani S, Maragkou S, Welbury R, Papagiannoulis L. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013; 23(1):64-71.^,5757 Russell M, Lazenbatt A, Freeman R, Marcenes W. Child physical abuse: health professionals' perceptions, diagnosis and responses. Br J Community Nurs 2004; 9(8):332-338.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001. or graduate programs¹⁷17 Carvalho LMF, Galo R, Silva RHA. O cirurgião-dentista frente à violência doméstica: conhecimento dos profissionais em âmbito público e privado. Med (Ribeirao Preto) 2013; 46(3):297-304.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001..

In general, the identification of cases of violence and the highest number of notifications were associated with professionals who took courses and/or graduate programs focused on childcare³²32 Silva-Oliveira F, Andrade CI, Guimarães MO, Ferreira RC, Ferreira EF, Zarzar PM. Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos. Arq Odonto 2017; 53:1-8.^,4141 Nunes LS, Silva-Oliveira F, Mattos FF, Maia FBF, Ferreira EFE, Zarzar P. Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors. Cien Saude Colet 2021; 26(Supl. 3):5013-5022.^,6262 Buldur B, Buyukkok C, Cavalcanti AL. Knowledge, attitudes, and perceptions regarding child abuse and neglect among dentists in Turkey. Braz Oral Res 2022; 36:e001.. There was also a significant association between the act of notifying and the professional’s participation in training on violence²⁸28 Moreira GA, Vasconcelos AA, Marques LA, Vieira LJ. Training and knowledge of professionals of the health family team on reporting mistreatment of children and adolescents. Rev Paul Pediatr 2013; 31(2):223-230..

Summary of results

The meta-analysis was carried out with 42 articles, which included data on the prevalence of reports of violence in children and adolescents in the clinical work of health professionals, and 39 articles, which included data on the prevalence of reports of cases by health professionals.

The prevalence of reports of violence by different health professionals was 41% (95%CI = 34%-48%, I² = 97%). Sensitivity analysis was performed only with sample-size studies with adequate statistical power. Considering a sampling error of 10% and 95%CI, the minimum sample size was ≥ 95. The combined prevalence of total reported violence was 40% (95%CI = 32%-48%; I² = 98%). When considering the professional who reported the case, the estimated prevalence was 32% (95%CI; 14%-54%, I² = 97%) for speech therapists, 27% (95%CI; 23%-32%, I² = 97%) for dentists, 65% (95%CI; 52%-78%, I² = 97%) for physicians, and 49% (95%CI; 36%-62%, I² = 97%) for when only one category was not a specified professional (Figure 2).

The total combined prevalence of reports of violence was 30% (95%CI; 21%-38%, I² = 98%). Based on the sample size, the sensitivity analysis estimated a 28% (95%CI = 20%-37%; I² = 99%) prevalence. When separating the studies according to the category of professionals who reported violence, the estimated combined prevalence of reports was 2% (95%CI; 1%-4%, I² = 98%) for speech therapists, 21% (95%CI; 11%-32%, I² = 98%) for dentists, 58% (95%CI; 44%-72%, I² = 98%) for physicians, and 31% (95%CI; 20%-43%, I² = 98%) for mixed professionals (various health professionals) (Figure 3).

Reporting bias

No publication bias was identified, and there was no statistical significance when evaluating the asymmetry of the funnel plot using the Egger test (p > 0.05) (Figure 4). Furthermore, a broad search strategy was used, including six electronic databases, one in a language other than English, in addition to the gray literature.

Confidence in cumulative evidence

The level of certainty of the evidence for both outcomes was judged to be very low. The factors that led to a decrease in the certainty of evidence related to the risk of bias (sampling bias, uncontrolled confounding factors, lack of detail in the description of the analyzed population, and way of measuring the evaluated outcome) and the high heterogeneity in the analysis, which was not explained by subgroup analysis (Table 2).

Discussion

The signs pointing to physical violations that drive physicians to identify cases are successive injuries said to be accidental and an inexplicable delay between the “accident” and the search for medical attention. Signs also include multiple acute injuries, subdural hematomas, behavioral changes, and fractures in various stages of healing⁶⁸68 Berthold O, Frericks B, John T, Clemens V, Fegert JM, Moers AV. Abuse as a cause of childhood fractures. Dtsch Arztebl Int 2018; 115(46):769-775..

Dental surgeons are inclined to find signs of violence among their patients, as 65% of physical damage affects the oral and facial regions. The main injuries reported by pediatric dentists in cases of suspected violence are fractures, avulsion or tooth displacement, contusion, and mucosal laceration or burning mouth syndrome⁶⁹69 Machado HCP, Silva LJR, Souto LN, Araújo MVA. O cirurgião-dentista no diagnóstico de casos de abuso sexual infantil: revisão de literatura. Rev Odontol UNESP 2020; 49(Esp.):104..

Victims of violence have worse cognitive and motor functions and deficits in the expression and reception of language. Thus, speech therapists are more susceptible to identifying cases of violence because they work with language disorders⁷⁰70 Terra BB, Figueiredo EAd, Terra MPEdO, Andreoli CV, Ejnisman B. Maus-tratos infantis. Revisão da literatura. RBO (Online) 2013; 48(1):11-16.. In the case of psychologists, studies describe that psychologists often have difficulties in seeking other ways of intervening in addition to individual psychotherapy. Their clinical training focuses on treating traumas caused by violence and not on their identification⁷¹71 Esswein GC, Rovaris AF, Rocha GP, Levandowski DC. Actions for children's mental health on Unified Health System (SUS) Primary Health Care: an integrative review of Brazilian literature. Cien Saude Colet 2021; 26(Supl. 2):3765-3780..

Health professionals identify situations of child abuse in their clinical practice. However, the number of identified and/or suspected cases falls short of the number of effectively notified cases. In other words, professionals often identify violence but do not report it. It indicates the urgency of expanding knowledge on the subject in the curricula of undergraduate programs in the health area and systematizing permanent education as a transforming instrument so that there is an appropriation of the contents of policies capable of leading professionals to be more active against violence⁷¹71 Esswein GC, Rovaris AF, Rocha GP, Levandowski DC. Actions for children's mental health on Unified Health System (SUS) Primary Health Care: an integrative review of Brazilian literature. Cien Saude Colet 2021; 26(Supl. 2):3765-3780..

Underreporting cases of violence is caused by the health professional’s difficulties in dealing with the situation. These difficulties include the lack of information about signs and symptoms of violence, the social, economic, and emotional breakdown in handling situations of violence, and the lack of knowledge of legal aspects to be considered in the referral of victims, the fear of suffering retaliation by the aggressor and the lack of trust in government protection agencies⁷²72 Demarco GT, Silva-Júnior Id, 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.^,7373 Silva BPD, Camargo D. Professional practices in situations of child abuse: an integrative review. Cien Saude Colet 2023; 28(6):1703-1715..

When it comes to professionals from public institutions, identifying and reporting cases of violence is not a routine practice. It stems from the lack of knowledge, on the part of professionals, of the notification form in health units, which guarantees an increase in the chances of cases being underreported⁷⁴74 Albuquerque IFQ, Oliveira MVSM, Myllenne SA, Drumond CL, Oliveira MAC, Pires LPB. Percepção e abordagem dos cirurgiões-dentistas frente a maus-tratos infantis. Rev Saude Desenvolv 2022; 16(25):3-16.. Professionals in private spheres, who work in private offices or clinics, do not have institutional support to deal with cases of violence, which impairs the identification and notification process²⁹29 Noguchi MS, Assis SG, Malaquias JV. Occurrence of child abuse: knowledge and possibility of action of speech-language pathologists. Pro Fono 2006; 18(1): 41-48..

With the information collected through the qualitative synthesis, it was noted that health professionals with more than ten years of training are more likely to suspect, identify, and/or report situations of violence against children and adolescents, corroborating other studies72. However, most studies did not report the average time of formation of the evaluated sample, making it impossible to assess the influence of this variable on the observed prevalence through a meta-regression.

Female professionals showed a higher prevalence in identifying situations of violence, and the same data was observed in other studies⁷²72 Demarco GT, Silva-Júnior Id, 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.^,7474 Albuquerque IFQ, Oliveira MVSM, Myllenne SA, Drumond CL, Oliveira MAC, Pires LPB. Percepção e abordagem dos cirurgiões-dentistas frente a maus-tratos infantis. Rev Saude Desenvolv 2022; 16(25):3-16.. On the other hand, male professionals observed more signs of violence⁷⁵75 Al Hajeri H, Al Halabi M, Kowash M, Khamis AH, Welbury R, Hussein I. Assessment of the knowledge of United Arab Emirates dentists of Child Maltreatment, protection and safeguarding. Eur J Paediatr Dent 2018; 19(2):105-118.. The type of violence most encountered by health professionals was physical. Research indicates that this violence is the easiest to recognize precisely because it has the potential to leave visible marks⁷⁶76 Araújo RFM, Valença FFEC, Alves MR. Rede de proteção a crianças e adolescentes em situação de violência na visão dos profissionais. Rev Baiana Enferm 2021; 35: e42099.^,7777 Antognolli SRDB, Oliveira GF, Cunha BRR, Alves PMR, Silva LRDS, Giorgiani M, Batista JRR, Souza AC, Souza ACF, Marcene HC, Oliveira S. Perfil epidemiológico da violência contra crianças e adolescentes no estado de Minas Gerais, Brasil. Ensaios Cienc 2021; 25(1):95-101.. Sexual violence is the most silent type since, for each reported case, ten to twenty are not reported. Therefore, according to some studies, sexual violence is the most frequent⁷⁸78 Silva FG, Fonseca PCSB, Dantas JSOM, Silva CC, Carvalho CTC. Violência infantil no Brasil: panorama das notificações e indicadores desse fenômeno. Conjecturas 2021; 21(5):146-165.^,7979 Santos LF, Silva MdVFB, Santos NSS, Pacheco LR, Silva JB, Mutti CF. Perfil da violência contra crianças em uma capital brasileira. DRIUFT 2020; 7(1):36-43.. On the other hand, psychological violence does not produce visible marks, causing many victims to experience this aggravation without it being identified and notified⁷⁸78 Silva FG, Fonseca PCSB, Dantas JSOM, Silva CC, Carvalho CTC. Violência infantil no Brasil: panorama das notificações e indicadores desse fenômeno. Conjecturas 2021; 21(5):146-165..

In line with other published studies, females were more prevalent among the victims⁷⁷77 Antognolli SRDB, Oliveira GF, Cunha BRR, Alves PMR, Silva LRDS, Giorgiani M, Batista JRR, Souza AC, Souza ACF, Marcene HC, Oliveira S. Perfil epidemiológico da violência contra crianças e adolescentes no estado de Minas Gerais, Brasil. Ensaios Cienc 2021; 25(1):95-101.^,7979 Santos LF, Silva MdVFB, Santos NSS, Pacheco LR, Silva JB, Mutti CF. Perfil da violência contra crianças em uma capital brasileira. DRIUFT 2020; 7(1):36-43.^,8080 Salazar López ME, Linch G, Paz AA, Valenzuela LV, Levandowski DC, Barros HMT.. Violence against boys exists, but it is underreported, as male victims take longer to talk about what happened⁸¹81 Machado HCP, Silva LJR, Souto LN, Araújo MVA. O cirurgião-dentista no diagnóstico de casos de abuso sexual infantil: revisão de literatura. Rev Odontol UNESP 2020; 49:104.. In addition, there is a trend towards greater protection of girls and, on the other hand, a culture of greater tolerance for male aggression⁸⁰80 Salazar López ME, Linch G, Paz AA, Valenzuela LV, Levandowski DC, Barros HMT..

Regarding the supremacy of Brazilian studies found, it is worth noting that, in 2017, Brazil was named the fifth nation with the highest rates of violence against children and adolescents, according to a report by the United Nations Children’s Fund⁸²82 United Nations Children's Fund (UNICEF). Report on regular resources 2017 - results for every child [Internet]. 2017. [cited 2023 jun 11]. Available from: https://www.unicef.org/reports/report-regular-resources-2017
https://www.unicef.org/reports/report-re... . Brazil is also one of the countries with a high increase in violence in recent decades. Brazilians are the most fearful of violence in the world, with 83% of the country’s population highly concerned⁸³83 Institute for Economics & Peace. Global Peace Index 2020: Measuring Peace in a Complex World [Internet]. 2020. [cited 2023 maio 8]. Available from: http://visionofhumanity.org/reports
http://visionofhumanity.org/reports... .

The limitations of this review should be considered, as 12 studies included in the meta-analysis were at high risk of bias. This event is mainly due to the poor methodological description of these works. Only one study⁴³43 James J, Womack WM, Stauss F. Physician reporting of sexual abuse of children. JAMA 1978; 240(11):1145-1146. was based on a random sample. The others were developed from convenience samples. In addition, the inclusion criteria of the participants were not clearly defined, nor were validated instruments used, confounders were not controlled, and the results were not measured reliably. The evaluation carried out by the GRADE tool showed that the evidence generated was very low. The factors that led to this decrease were related to the risk of bias and the high heterogeneity in the analysis, which was not explained by the subgroup analysis.

There is a limitation of instruments that assess health professionals’ knowledge, prevalence, and attitudes toward violence against children. Among the instruments developed for this purpose, most have methodological problems regarding their reproducibility and/or validity⁸⁴84 Silva-Oliveira F, Ferreira EF, Mattos FF, Ribeiro MT, Cota LO, Vale MP, Zarzar PM. Cross-cultural adaptation and reproducibility of a questionnaire to assess the knowledge and attitude of health professionals in cases of child physical abuse. Cien Saude Colet 2014; 19(3):917-929.. According to research, the instruments used in studies of knowledge, perception, and attitude of health professionals in cases of child abuse, in many cases, bring uncertainty in the applied methodology caused by the use of the measurement instruments employed, which often do not pass by validation methods²⁶26 Luna GL, Ferreira RC, Vieira LJ. Mandatory reporting of child abuse by professionals of Family Health Teams. Cien Saude Colet 2010; 15(2):481-491.^,3838 Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, Torriani DD. Child maltreatment: a survey of dentists in southern Brazil. Braz Oral Res 2012; 26(1):5-11..

However, the study allowed us to glimpse what has been published in the literature on the subject. Publications indicate that, on the world stage, many children and adolescents suffer from violence, and health professionals have the potential to identify these cases. Thus, this research highlights the need to invest in the training of health professionals for the adequate identification and notification of cases of violence, contributing to reducing this problem.

Prevalence studies are considered initial among public attitudes to know the scenario in which a certain factor appears. Thus, they have subsidies to evaluate and plan programs and attitudes⁷³73 Silva BPD, Camargo D. Professional practices in situations of child abuse: an integrative review. Cien Saude Colet 2023; 28(6):1703-1715.. In this sense, the results presented here revealed a high underreporting rate. The notification of violence by the health professional is an essential information instrument for elaborating public policies. It allows an epidemiological dimension of the problem, providing the health authorities with data that allow the determination of the causes and the planning of possible solutions and strategies for coping with and reducing the social problem presented⁸⁴84 Silva-Oliveira F, Ferreira EF, Mattos FF, Ribeiro MT, Cota LO, Vale MP, Zarzar PM. Cross-cultural adaptation and reproducibility of a questionnaire to assess the knowledge and attitude of health professionals in cases of child physical abuse. Cien Saude Colet 2014; 19(3):917-929..

Another implication provided by this review’s results is the need to validate instruments to assess the knowledge, prevalence, and attitudes of health professionals toward cases of child violence. Then, presenting reliable instruments so that reliable public attitudes are taken, starting from safe subsidies⁸⁴84 Silva-Oliveira F, Ferreira EF, Mattos FF, Ribeiro MT, Cota LO, Vale MP, Zarzar PM. Cross-cultural adaptation and reproducibility of a questionnaire to assess the knowledge and attitude of health professionals in cases of child physical abuse. Cien Saude Colet 2014; 19(3):917-929..

Conclusion

Approximately one in two health professionals face situations of violence against children and adolescents in their clinical practice (41%), and about one in three health professionals report the cases (30%). However, the generated evidence regarding this outcome is still uncertain.

References

Publication Dates

History