A total of 1083 e-forms were collected. Participants (respondents) belonged to 22 European countries (Albania, Armenia, Austria, Belgium, Bosnia and Herzegovina, Croatia, France, Germany, Hungary, Ireland, Israel, Italy, Kazakhstan, Lithuania, Poland, Portugal, Romania, Russia, Slovakia, Spain, Turkey, and Slovenia), thus providing a balanced geographic distribution throughout the continent, also representative of different socio-economic local realities [24, 25]. Of those who declared their gender, more women (n = 716, 66.1%) than men (n = 368, 33.98%) contributed to the study. Greater group of respondents belong to age group 51–60 (31,3%), followed by age groups > 61 (25,7%), 41–50 (21,9%) and < 40 (21.1%). The majority of respondents were family care paediatricians working in community or primary care settings (51,6%), while hospital paediatricians working in secondary and tertiary care were 34,3%, paediatricians working in university centres 10,1% and private care paediatricians 4,0%.
Awareness and attitude about CAN
Most of the times (49,4%), child abuse, neglect and in general violence against children, were identified by paediatricians as occasional finding during routine checks and in about one out of four cases (23,1%) during visits directly related to the matter. In 17,4% of the cases maltreatments were unreported and could be identified during emergency visits, while 10,1% of paediatricians recognized cases of child abuse and neglect in different circumstances.
In the majority of cases in which CAN was identified by respondents, paediatricians were requested to visit children by one of the parents (41,7%) or by a different family member (21,6%). While the intervention of a paediatrician to recognize possible cases of child maltreatment was solicited by teachers or school officers in 7,9% of the cases and by family friends in 4,2%. In about one fourth of the cases (24,6%), the suspect of CAN was raised by other unspecified types of figures. Eighty per cent of respondents have encountered at least a case of emotional or psychological child abuse in their practice and 76.3% have faced at least a case of physical or sexual child abuse (Fig. 1). In the majority of these cases, paediatricians’ respondents have activated legal procedures in order to protect the victims (Fig. 2).
Education and competence about CAN
One fourth (25,9%) of respondents rated their knowledge and competence about CAN to be good although improvable, and 2,6% to be excellent, while the majority of participants assessed their education on CAN as adequate (42,1%) and a minority not adequate (2,6%). During the three years preceding the study, about half of the respondents (47,8%) did not attend any continuing education course on CAN, versus 40,2% who attended educational programs addressing CAN, which in 39,2% of the cases were specialized courses held in person and 1.0% on line, while 12,0% attended generic in presence courses on domestic violence.
Knowledge about CAN provided in Europe by medical school curricula and paediatric residency programs was rated to be largely unsatisfactory, particularly due to the insufficient number of training hours dedicated to CAN (Fig. 3a and b). To this regard, the majority of paediatricians participants to the study indicated that educational programs on CAN should be made mandatory and included in the curricula of medical schools and residency courses in paediatrics, rating this option as useful (33.1) and necessary (65,5%), while only 1,4% consider that unnecessary.
Practice and formal procedures about CAN
Local child protective services, including social services, were the first institutional point of reference in case of CAN for 64,1% of participants in the study, while for 22,4% of them local judicial authorities were their first choice to report a maltreatment. Contacting specialized hospital centers was the first option for 8,0% of respondents, 2,9% of them reported episodes of CAN to different institutions and 2,6% did not make any report.
83,6% of the paediatricians reported the existence of specific laws protecting victims of CAN in their countries, and two third (66,1%) confirmed the presence of standardized formal procedures that can be activated if cases of CAN are detected by doctors. However, 15,5% stated the absence of any formal procedure for the contrast of child maltreatment, while 18,5% of respondents were unaware of any form of procedure that could be activated in cases of CAN in their country. Although the large majority of respondents reported the existence of laws for the contrast of CAN in their countries (83,6%), only 52% rated these laws as adequate.
The most important obstacles to an effective protection of CAN victims recognized by the paediatricians enrolled in the study are reported in Fig. 4. Finally, the large majority of respondents (88,0%) endorsed the statement that only a join action by child healthcare professionals at multi-national level, would provide an important lever to stimulate legislators to issue more effective laws and procedures to protect the victims of CAN.