Thank you Maurice. I work on the front lines in child abuse, as a social services professional. Further on in the continuum of child abuse and medicine, I can think of the following issues, if they are not actually dilemmas. Your points are excellent. Also, a few to mention are:

1. Medical confidentiality and adult patient care versus legal duty to report child abuse
2. Lack of training by emergency room staff or even family doctors, in signs or indicators of child abuse and what to do about it
3. Judgement or discrimination in why it occurs, such as delinquent teenagers, or "out of control" children "deserving" strong discipline
4. Cultural or religious acceptance or non acceptance of child abuse, or more specifically, its definition, rather than a standardized approach, including by medical professionals
5. Lack of coordination between medical staff, law enforcement, criminal justice, and social services
6. Conflict of interest in whether adults or children, especially when combined in a mother's womb, are primary or secondary in terms of treatment
7. Biggie where I live - harm reduction versus cessation in drug or alcohol use during pregnancy as well as first year of child's life, when attachment and bonding are vital for future development
8. Role of the state, provincial, or federal government, in enforcing child abuse standards and the medical profession and corollary fields such as social services

I would like to push the envelope a bit. In much of what you are saying, Maurice, it is the parents or even God, for reasons of irresponsibility, addictions, parental rights, or religion, that doctors have to contend with in assessing whether a situation is child abuse. But do doctors themselves play a role at times in condoning or turning a blind eye, or due to ignorance, in child abuse recognition and action to prevent or treat? I have alluded to some aspects of physician responsibility in my points, but am seeking some self reflection from physicians as well.