Many doctors and nurses who see a child they suspect has been physically abused do not report it to the appropriate authorities, a survey has indicated.
Many doctors are fearful of reporting suspected abuse
Worry about getting it wrong, the repercussions for the child and family and possible legal action were reasons given for not reporting their concerns.
Of the 419 medical staff polled, 60% had seen a child with signs of abuse, but less than half reported it.
The Belfast-based study is published in the Journal of Advanced Nursing.
About three-quarters of the healthcare professionals questioned said they were aware of how to report child physical abuse, but more than eight out of 10 said they would like further information.
Community nurses showed the highest level of awareness, followed by doctors and dentists.
Virtually all of the respondents said there should be more training for staff on how to recognise and report child physical abuse.
More than a fifth of the respondents were worried about getting it wrong, and many were also concerned about confronting the family involved.
The staff said they would want to remain anonymous if they did report a case and feared hostility and damage to their relationships with the families.
GPs were particularly concerned that reporting might trigger a formal complaint, a disciplinary hearing or even litigation.
High profile court cases such as that of Professor Sir Roy Meadow, the paediatrician who was struck off after giving flawed evidence at Sally Clark's 1999 trial for the murder of her sons, may have added to medics' anxieties, say the study authors.
Other barriers to reporting included workload pressures, red tape and hierarchy, reporting procedures and lack of sensitivity and support from social services and colleagues.
Lead researcher Dr Anne Lazenbatt, from the School of Nursing and Midwifery at Queen's University Belfast, said medical staff faced a tough challenge and needed support when making such hard decisions.
"Although the consequences of failing to identify child physical abuse can be catastrophic, it is also essential that professionals are educated to recognise conditions that might inadvertently be mistaken as abuse so that unnecessary distress can be avoided.
"Healthcare professionals can play an essential role in recognising and reporting abuse, but only if they receive the education and support they need to make informed decisions."
Maureen Scott of the Royal College of Nursing said: "The report validates what we have been saying for some time - that nurses and other health care professionals require much better training and education about child abuse as they play such an essential role in recognising and reporting incidents."
Chris Cloke of the NSPCC said: "Parents need to have the confidence that their children are in safe hands.
"Reporting concerns is a vital part of child protection work and everyone whose work involves contact with children should at least have a basic level of child protection awareness."