Most of us don’t like to think about children being neglected or abused. Unfortunately, not thinking about a problem does not make it go away, and this particular problem happens far too often.
April is Child Abuse Prevention Month, so let’s take a moment to familiarize ourselves with the most recent child abuse statistics.
In 2011, there were 676,569 cases of child abuse reported in the United States – or about 9.1 per 1,000 children. Among these cases, the highest rate of victimization occurred among the youngest children – 21.2 cases per 1,000 children from birth to age 12 months. Other 2011 statistics on the topic reveal:
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- Both boys and girls are at equal risk for becoming a victim.
- More than 75% of maltreated children were also neglected
- About 15% were physically abused
- Approximately 10% were sexually abused
- A total of 1,545 children died, 80% of whom were aged younger than 4 years
- Parents perpetrated 78% of fatalities
- Among children who died 40% were white, 28.2% were black and 17.8% were Hispanic
How can we as clinicians do our part to stop our patients from becoming another child abuse statistic?
Several years ago when I was faculty in a pediatric resident’s primary care clinic, I had a resident report a case to me that prompted us both to suspect child maltreatment.
The 15-month-old child in question was a young mother’s only child. The mother said her paternal grandmother looked after the child when she worked a part-time job.
The mother said she noticed the child occasionally had circular lesions with raw centers on her arms and legs after leaving the grandmother’s apartment. When confronted about the child’s lesions, the grandmother reassured the girl’s mom the marks were bug bites the child had scratched a lot.
During the office visit the child had three of these marks in various stages of healing. Upon examination the lesions looked like cigarette burns to us. The resident was conflicted about what to do next, as she did not want to upset the mother with accusations she was not sure were true.
However, patient welfare is the healthcare provider’s top priority. Mandatory reporting laws mean that clinicians are required to report suspicion of child maltreatment or neglect, whether it is confirmed or not. It is then the job of the investigator from Child Protective Services to substantiate or dismiss the claim.
We informed the mother of our concerns and disclosed our intent to report the case to Child Protective Services. Predictably, she was unhappy with us.
The resident felt she would likely never see this family again, but at the next scheduled well visit, they returned. The mother reported that the investigation was closed, because it could not be substantiated. She said she found alternative childcare, and her daughter no longer experiences the lesions.
Many providers worry they will lose a family as patients if they report suspected child abuse. Certainly that does happen, but not always.
What always will happen, if you choose to ignore suspected child maltreatment, is the possibility that the abuse will continue. The opportunity to stage an early intervention for families in need of help will possibly be lost lost. Do not let this happen. If you see something suspicious report it. Our children depend on you.
Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.
