Overreliance on One CAP Opinion

The Hidden Danger of One Opinion: Why Sole Reliance on a Child Abuse Pediatrician Is Risky for Children and Families

When the opinion of a single Child Abuse Pediatrician (CAP) can determine whether a family stays together, the stakes couldn’t be higher.
But what happens when that opinion is wrong—or incomplete?

This is the reality in many states: a single CAP diagnosis often becomes the sole basis for child removals, criminal charges, and dependency petitions. There are no mandatory requirements for second opinions, interdisciplinary review, or family access to independent evaluations.

The result? Families are torn apart, innocent parents are accused, and children endure unnecessary trauma—all because of one unchecked opinion.

Why Relying on Just One CAP Opinion Is Dangerous

1. No Standard for Plausibility

CAPs frequently label explanations as “implausible” without documenting why or engaging specialists in related fields (orthopedics, neurology, dermatology, or infectious disease). Typically reasons are not provided. The first time families hear the reasons may be in court. Reasons are often related to claims that "our research shows this is highly unlikely" versus any actual investigation.
These subjective judgments can be—and often are—wrong.

2. Lack of Oversight

Unlike criminal investigators, CAPs face little scrutiny. Their reports are often treated as authoritative, and their conclusions are given extraordinary weight in court—even when contradictory evidence exists.

3. Misuse of Research

Many CAP opinions rely on outdated or poorly designed studies (e.g., “Those Who Don’t Cruise Rarely Bruise” and "Sentinel Injuries") without acknowledging their limitations and study author caveats. These maxims are often presented as absolutes rather than hypotheses.

4. Exclusion of Alternative Explanations

In many cases, CAPs do not review full medical histories, family-provided evidence, or specialist input. Conditions like clotting disorders, birth trauma, or viral illnesses (which can cause bruising and hemorrhages) are dismissed or ignored.

5. Trauma to Children

False abuse diagnoses don’t just hurt parents—they traumatize children. Children may be forcibly removed, placed in foster care, or subjected to invasive testing—all unnecessarily.

Real-World Consequences

  • Wrongful Family Separation: Families often lose custody of their children for months or years before courts acknowledge diagnostic errors.

  • Criminal Prosecution: Innocent parents face felony charges based solely on one CAP report.

  • Loss of Trust in Medical Care: Families who experience false allegations often avoid hospitals and well-child visits, undermining true child safety.

What Needs to Change

We are not against Child Abuse Pediatricians.
We are against a system that gives unchecked power to one doctor—without requiring collaboration, transparency, or accountability.

Proposed Reforms:

  • Non-accidental Trauma Diagnoses Reporting Standards by AAP.
    Far too little effort is put in by CAP before they issue a diagnosis, putting them in a position where they are unwilling to go back on their original diagnosis. This should included a detailed list of evidence the CAP considered, persons personally interviewed by the CAP, Report format to included specifics of when and why explanations were ruled out progression of injuries (CAPS often do not examine patients or review materials the same day as concerns arise. Progression and photo of injuries with a measuring device, from different angles, must be provided. 

  • Mandatory Interdisciplinary Reviews for all high-stakes abuse diagnoses.

  • Right to Second Opinions before children are removed or criminal charges are filed.

  • Documentation Requirements: CAPs must explicitly state when, how and why alternative explanations were ruled out and document the time and reason provided to the family. If an explanation was not witnessed by parents, but acknowledged by another party, that party must be interviewed.

  • Recorded Family Interviews to ensure accuracy and protect against misrepresentation.

Why It Matters

Child abuse is real. It destroys lives. But so do false accusations.
When the voice of one doctor can carry more weight than all other evidence, the system stops protecting children and starts harming them.

Families deserve more than one opinion. Children deserve better than a rushed, unchecked diagnosis.

[Join the Movement] – Sign our petition for mandatory second opinions in child abuse cases.

[Learn More] – Read research on diagnostic errors in Child Abuse Pediatrics.