4R's of Child Abuse

Agency Referrals

If Emergency Department personnel suspect a child presenting to the Emergency Department has been abused, Emergency Department personnel must make mandatory referrals and other referrals, as appropriate before the child is released.

Mandatory Referrals:
Department of Public Welfare 24/7 CHILDLINE (1-800-932-0313)

As a Pennsylvania professional working with children, you are legally required to call and report the suspected abuse. You may come to this suspicion based on the child’s statements or your physical examination of the child. You do not have to prove child abuse first. If the child makes an allegation of abuse or your examination suggests that it may be a possibility, you must report it.


Involving the authorities immediately can make a significant difference in protecting the child. If your area is served by multiple police departments and you know the address where the suspected abuse occurred, call the police department for that area. If the child was harmed by someone in a caretaker role, both child protection and the police should be aware of the case and have the opportunity to come to the hospital, as needed. If the person who harmed the child was not in a caretaker role, the police are the only authority allowed to investigate.

Local Office of Child Protection Services

If the child was harmed by someone in a caretaker role, the Local Office of Child Protection Services may send a caseworker to the Emergency Department to evaluate the situation before the child is released.

Other Referrals:


Refer the child for necessary medical follow-up.


Many counties have Children’s Advocacy Centers, Rape Crisis Centers, or other programs that will provide crisis counseling and ongoing support for the child. With the legal guardian’s permission, the hospital case worker can call and make the referral. If the center provides 24/7 hotline service, a counselor may be available immediately to assist with the case.

Victim Compensation funds

Your District Attorney’s Office and/or Rape Crisis Center can direct the family to the local organization that will assist them in completing an application for Victim Compensation Funds. If a crime has occurred and been reported to the police, this fund may cover some crime-related expenses, if insurance will not. For example, the fund may pay for a portion or all of the Emergency Department visit, follow-up care, and/or counseling.