For the first time in more than a decade, pediatricians are getting new guidance on how to identify and address maltreatment of children with disabilities.

In a clinical report out this week, the American Academy of Pediatrics said that kids with disabilities are at least three times more likely than other children to experience abuse and neglect. And, cases of such mistreatment are likely underreported since many of these kids have communication difficulties and are unable to report problems.

The guidance notes that several factors could account for this increased risk. Families may be overwhelmed by the complex nature of their children’s needs, the added financial demands or a lack of respite care. Parents may also overestimate their child’s capabilities and resort to physical punishment to address what they view as stubbornness, the report indicates.

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Notably, the pediatrics group said research suggests that children with milder disabilities are actually more at risk of abuse and neglect than those with more significant disabilities.

“Parenting a child with disabilities is often challenging,” said Larry W. Desch, a pediatrician at the Chicago Medical School and an author of the clinical report. “Some children with disabilities respond differently to the usual ways we think about discipline and reinforcing good behavior. This can become very frustrating and add to the caregiver’s stress.”

Pediatricians should play an active role in assessing family wellbeing at each medical visit and discussing appropriate discipline, the pediatrics group said. Families ought to be given reasonable expectations for their child, offered concrete ideas for how to respond to developmental challenges a child is facing and provided referrals to local resources and agencies for support.

In addition, physicians should recognize signs of maltreatment and report concerns to authorities, as appropriate. But, the guidance points out that pediatricians also have a responsibility to document self-injurious behaviors and other factors that may be key in distinguishing whether or not injuries are likely the result of abuse.

“As pediatricians, we see families every day who are trying to do their best for their children but may lack the coping skills and resources to help manage stress or difficult circumstances,” said Lori A. Legano of New York University, the lead author of the clinical report. “Pediatricians can offer a nonjudgmental perspective, help families focus on their child’s strengths and guide them through challenging times.”