D. was the mother of two children, the youngest in for his nine-month visit. I had known her for several years, and was aware she was struggling to raise her children by herself.
Knowing the importance of social connection, I asked D. whether there were other adults whom she could call on for help with the kids. She drew a blank, so we talked for a minute about where she might find support.
The conversation got nowhere. D. worked as a home-health aid and didn't have regular contact with peers at work. She didn't attend church. She didn't have family nearby and, feeling her neighborhood was unsafe, rarely mingled with neighbors.
A seed was planted that afternoon, though.
Walking through the waiting room an hour later, I saw D. having an animated conversation with another mom. D. introduced me to her friend – they had known each other in rehab and now had kids the same age. As time went on, they renewed their friendship and the two of them helped each other in the many ways – little and big – that can make the difference.
"Most cases of child abuse or neglect occur when the adults are stressed."
I share this story because too often we hear about cases of child abuse and neglect only after they've occurred, trying to analyze ways it might have been prevented. I'd rather talk about how our daily practice of pediatrics can help strengthen families and prevent neglect and abuse from ever happening.
Most cases of child abuse or neglect occur when the adults are stressed. Stressed parents have a hard time with the difficult--but normal--behavioral milestones of childhood: infant crying, toddler tantrums, school children dawdling and adolescents talking back.
The new fourth edition of
Bright Futures just came out, offering a new layer of understanding related to how we can support children and their families. Decades of research has shown that child abuse and neglect can be prevented by helping parents understand and anticipate normal, if sometimes challenging, phases of child development and behavior.
"For parents who feel that they can go it alone, a few inquiries ("Who helps you with your kids?") and gentle suggestions may help them feel more comfortable with offering and receiving help."
Pediatricians also can encourage parents to take care of their own mental and physical health, develop social connections, and find support for basic needs such as food and shelter. We can help families in need access food through federal programs such Supplemental Nutrition Assistance Program (food stamps), for example, and may be able to direct them to county or state resource centers for assistance with housing, fuel, or even education and job training. For parents who feel that they can go it alone, a few inquiries ("Who helps you with your kids?") and gentle suggestions may help them feel more comfortable with offering and receiving help.
As a child abuse pediatrician, confrontation is all too common and "thank-yous" are rare. We don't always get to follow-up with the families working to heal after abuse or neglect intervention.
A few years ago, though, I was asked to go to clinic on the Tuesday before Thanksgiving. There was a father there who needed to talk to me. I wasn't sure what to expect, but it turns out Dad had found the time to come over and offer his thanks. When his daughter, H., was born, both he and her mother were in treatment for opioid addiction. As required by law, my colleagues and I filed a report with the child welfare agency based on the infant's prenatal exposure and postnatal withdrawal symptoms.
Two years had since passed. The family was doing well, and with the help of our social worker, they now had a home of their own.
This is what prevention feels like – it is impossible to write a case series full of things that didn't happen. No one can ever know what might have happened with D. and her family, or H. and hers, without the support of our clinical practices. But we can be sure that the work we do with their families and others facing similar circumstances makes them stronger, reduces the confusion and chaos of child-raising, and protects children.
Robert Sege, MD, PhD, FAAP, nationally known for his research on effective health systems approaches to the prevention of violence and abuse, has served on the American Academy of Pediatrics Committee on Child Abuse and Neglect. He is currently Chief Medical Officer at Health Resources in Action, directing The Medical Foundation there. In addition, he serves as a Senior Fellow at the Center for the Study of Social Policy and a member of the boards of the Massachusetts Children's Trust and Prevent Child Abuse America.