WEDNESDAY, Nov. 9 (HealthDay News) -- Many cases of child abuse are not reported by primary health care providers, a new study suggests.

Primary care providers (PCPs) are usually doctors but can also be physician assistants and nurse practitioners.

In this study, researchers interviewed PCPs about 111 cases involving injured children, six weeks and six months after they treated the children. The cases were also reviewed by five child abuse experts.

The PCPs and child abuse experts agreed about the suspicion of abuse in 81 percent of the cases, but PCPs did not report 21 percent of injuries that the experts said they would have reported to child protective services (CPS).

The findings suggest that PCPs require better training in the diagnosis and management of child abuse, according to the researchers from Boston University School of Medicine and Boston Medical Center.

"To become more certain of their suspicions, PCPs need better education about the recognition of injuries that are suspicious for child abuse, particularly bruises and fractures, and the role of state CPS agencies in investigating the child's circumstances," lead author Dr. Robert Sege, a professor of pediatrics at BUSM, and director of ambulatory pediatrics at BMC, said in a medical center news release.

The study appears in the November-December issue of the journal Academic Pediatrics.

It can be difficult to determine whether a child's injury was caused by abuse because there may be no witnesses and the child may be too young or afraid to describe the abuse, the researchers noted.

More information

The American Academy of Pediatrics has more about child abuse.