Disrupted Caregiving and its Role in Child Abuse
When I was about 10 years old, my stepdad threw my mom against the wall so hard that her tailbone broke, and so did the wall. Another time, there were yells and screams as I hid under the bed while the police came. A broken lamp lay on the floor. My mom didn’t press charges.
My stepdad used to call her all sorts of names. When I got into my teen years, he would turn to me and say, “You are just like your mother.” When I was 16, my mom got out, taking me with her.
We were lucky. My mom was alive; I was physically unharmed. She joined Codependents Anonymous with me in tow. We both got a lot of therapy, she later married a wonderful man, and I thought I was okay. I went to medical school and eventually became a pediatrician. After all, I wasn’t afraid of the dark anymore. Maybe I could help kids and families like the ones who helped us? Besides, the kids I help are a lot worse off than I was…right?
But when I picked up “The Body Keeps the Score” by Bessel van der Kolk, a book about how trauma lives on in our bodies unless we truly face it, I physically felt like vomiting. It took me six years to pick that book back up and finish it. I realized then how much more work I still had to do.
Each person walks into parenthood with their own emotional, cognitive, environmental, and mental bandwidth. Disrupted caregiving occurs when caregivers are unable to provide consistent, attuned, and responsive care. This can happen when a parent carries their own stress, trauma, or resource limitations--past or present--and is struggling to cope themselves. These challenges may stem from mental health conditions, domestic violence, substance use, financial strain and food insecurity, social isolation, or intergenerational parenting patterns.
Children can evoke intense emotions, triggering memories and patterns locking into a parent’s psyche and subconscious, and a parent who does not know how to self-regulate may become reactive, or, at times, overly permissive out of fear of that reactivity. Cycles of dysregulation between parent and child can reinforce a child’s sense of unsafety, increasing the risk of ongoing and intergenerational trauma.
There are many forces in our current world that contribute to disrupted caregiving. In the United States, tens of millions of families are navigating significant stressors: approximately 44 million people experience food insecurity; 1 in 4 women and 1 in 7 men experience domestic violence; up to half of adults report at least one adverse childhood experience; over 650,000 people experience homelessness; millions face unemployment; and nearly 1 in 4 adults live with a mental health condition. At the same time, over 120 million Americans live in designated Mental Health Professional Shortage Areas.
I could continue to write about disrupted caregiving academically, but I also understand it viscerally. What I know from both literature and my life is that, in most cases, these moments do not arise from a lack of love or a lack of desire to do one’s best. They arise from a lack of support, a lack of skills, a lack of capacity, and from feeling utterly alone--sometimes even ashamed to ask for help.
What I also know is that children do not need perfect parents. They need parents who love them and are willing to grow. I learned this from my mother. She is the strongest woman I know, not only because she got us out, but because she never stopped asking herself what led her there in the first place. She never stopped growing. She never stopped loving me, others, and ultimately, herself.
She taught me that to love ourselves and that we must be willing to face our own shadows. We must be brave enough to sit with the parts of ourselves that feel broken, crooked, or cracked, the parts that break our own hearts. When the reflection in the mirror hurts or the memory stings, we take a breath, we feel, and then we begin to accept, and, eventually, to let go. And boy, those things are hard to do. But we can do hard things.
And yet, none of that growth happens in isolation. The wisdom my mother and I gained over the years was made possible by the friends who helped us get out, counselors who offered therapy, wise ones who helped us transcend, and others who provided the scaffolding for a different life. Community did not just support us; it saved us.
As pediatricians, we have the opportunity to be part of that scaffolding. We can walk alongside parents in their most vulnerable moments, offering spaces of compassion, nonjudgment, and hope. When we shift from asking “What’s wrong with this parent?” to “What is this parent carrying, and how can I help lighten it?”, we become part of the pathway forward.
There is no shortcut. The only way out is through, but no one should have to go through it alone. The AAP National Center for Relational Health and Trauma-Informed Care empowers pediatricians and pediatric health care professionals to promote safe, stable and nurturing relationships, recognize and treat trauma, and provide guidance and support to help children and families thrive. The Center’s resources include education about disrupted caregiving along with resources to support children.
The author of this blog works as pediatrician and is a member of the American Academy of Pediatrics. We have chosen to publish this blog anonymously owing to the sensitive nature of the content.
*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.