As usual, my wife is mostly right.
Child abuse pediatrics is a valid sub specialty now, and a board exam will be offered starting in 2012 I think. In fact I currently work with one of the major researchers and question writers in the field. There are currently tons of positions opening up in child abuse. They need medical directors to run and organize child advocacy centers, and there aren't many who have formally trained.
Much of the job is investigational. Examining bruises or burns and being able to tell what could or could not have caused them. Getting a story from parents, and determining whether the history is consistent with the actual injuries. Can a kid fall from a bed and get a skull fracture? Probably. Can he end up with retinal hemorrhages from it? No. Your main role is saying 'this is abuse,' 'this is not abuse,' or 'I can't tell if this is abuse, but it's suspicious.'
How much time you spend in court depends on the area, the laws and on you. Due to testifying laws here, we have a little more court time than average. Outside of court we see a lot of different kinds of patients. We have an in patient consulting service that sees kids who have suspicious histories or injuries both on the wards and in the unit.
We also have an outpatient clinic where people are referred for follow up or investigation if the injuries don't bring them to the hospital. A typical case may be a child who tells mom that her uncle touched her and you then have to get a detailed history as to what the child said. It's a fair amount of 'well child' checks, but you have a lot more than just 15 minutes to do everything.
You have to get comfortable performing genital exams, most of which are normal (even in the case of sexual trauma/abuse exams can be normal). There are special forensic interviewer who interview the child about what happened, so that's not your job. You work closely with child protective services who may go to a parents house to investigate the living situation. You advise prosecuting attorneys and detectives and write up reports as to the cause of injury. Sometimes you work with defense attorneys as well.
You do not perform autopsies, that's for the pathologists, but you will often have to comment in court about the findings of the autopsy. In a similar fasion, you have to be able to comment on radiologic findings like fractures, subdural hematomas, things like that. They'll often ask you about medical diseases like osteogenesis imperfecta or metabolic diseases that the injuries could be attributed to, so part of your investigation is ruling out those kinds of things.
You also don't have psychological sessions with the abused children to help them heal. There are specialists for that, and you work with them.
Most research involves biomechanics or just statistical examination. How much force does it take to break a femur? How often do kids fall and injure themselves, and how far do they have to fall in order to be seriously injured? Things like that. Most child abuse pediatricians are involved with research like that, and most advocacy centers depend on grants for that kind of research to stay in the black. All are tied to a university for funding.
That's all I can think of. Does it help?
