Navigating Emotional Labor and Role Strain in Child Abuse Pediatrics: The Buffering Role of Social Support

Background and Purpose:

Child Abuse Pediatrics (CAP) fellows experience intense psychological and structural demands when handling child maltreatment cases. They often experience secondary traumatic stress, moral distress, and heavy emotional labor while working within complex legal and medical systems. Yet, there is a noticeable dearth of research on their fellowship experiences and coping strategies. As frontline specialists at the intersection of healthcare, law, and child welfare, CAP fellows must balance their caring role as pediatricians with investigative and legal responsibilities, contributing to internal role conflicts. Guided by Role Strain Theory and Social Support Theory, this study explores how conflicting role expectations generate identity tension and how fellows seek support to cope with these pressures. Emotional labor in this context is also collaborative, as effective care relies on interprofessional teamwork. We emphasize the relational dimension of pediatric care, especially the integration of social work support, positing that such collaboration buffers stress and facilitates adaptive coping for CAP fellows.

Methods:

We conducted semi-structured interviews with 13 CAP fellows from multiple pediatric U.S. hospitals to capture their experiences and coping strategies. Using a combined Framework method and reflexive thematic analysis (Braun & Clarke, 2022), interview transcripts were systematically coded to identify key themes. To enhance rigor, two primary coders independently analyzed all transcripts, a third researcher served as a consensus reviewer, and a fourth conducted an audit of the coding process and theme development. This approach facilitated both structured cross-case comparison and reflexive, in-depth analysis of fellows’ narratives. Participants were recruited using purposive sampling to ensure a diverse representation from both urban and rural settings. An iterative coding process, complemented by regular team reflexivity sessions, further refined the analytic framework and enhanced reliability.

Results:

Three salient themes emerged. First, fellows negotiated their identity within systems of surveillance and skepticism, contending with societal stigma and encountering moral distress under intense scrutiny. Working under conditions of high stakes and uncertainty, they strove to reconcile their identity as compassionate caregivers with the investigatory demands of child protection. Second, participants found meaning and built emotional resilience through clinical advocacy; many described a reinforced sense of purpose and even vicarious growth, transforming trauma exposure into professional maturation. Third, support systems—both formal and informal—proved critical: trauma-informed social workers and cohesive interprofessional teams offered essential buffers against burnout. Through debriefings, peer consultation, and mentorship, these supports helped fellows process their emotional burdens and navigate the uncertainty inherent in these cases.

Conclusions and Implications:

Collaboration with social work and team-based reflection emerged as key to mitigating burnout among CAP fellows. Regular interdisciplinary debriefings with trauma-informed social workers strengthened ethical clarity and provided emotional validation, thereby reinforcing resilience. We recommend embedding trauma-informed debriefings, structured mentorship, and integrated wellness strategies into CAP fellowship training, as these measures can normalize support-seeking and reflective practice. Broadly, these insights are relevant to other child-serving healthcare settings: fostering strong interprofessional support and intentional wellness practices can improve retention and psychological sustainability among professionals in child welfare and pediatric care.