With very few exceptions, no one has ever had a child with the intention of abusing them. And yet 1 in 7 people experience child abuse. It’s a massive problem with tragic outcomes. Every day in the U.S., 4-5 children die from abuse and neglect. Despite the number of children affected, pediatricians who specialize in child abuse are rare. In Virginia, there are 3.
Jennifer Andrews, DO, is 1 of those 3. Child abuse pediatricians look for signs of abuse in forensic exams, consult with doctors who want a second opinion, and also help advocate for ways to prevent child abuse. In addition to working at UVA Health Children’s, she also works for the Foothills Child Advocacy Center.
April is Child Abuse Prevention Month, and prevention, not simply awareness, is the goal. The symbol for the month, pinwheels, is meant to represent the whimsy and simple pleasures of childhood, which everyone deserves. But what people deserve and what they get are often miles apart. So, I asked Andrews what could be done to help secure this idyllic childhood for more kids.
After talking to her, I realized how much prevention is on all of us. Some job positions have additional opportunities to spot abuse. These jobs include:
- Pediatricians
- Teachers
- Child caregivers
But for true prevention, the entire community needs to be involved.
For most of us, it won’t be a full-time career (though for Andrews and other child advocacy workers it definitely is). But we all can help prevent child abuse. And when it’s prevented, we all benefit.
Understanding Child Abuse
Child abuse is a hard problem to wrap your head around. The scale is massive. But we often don’t see it. Sometimes medical professionals pick up on abuse. But child abuse doesn’t always leave physical marks and many cases go unnoticed. Andrews says she wishes people understood how common child abuse is. And how long it stays with people.
Long-Term Effects of Adverse Childhood Experiences
Adverse childhood experiences (ACEs) are traumatic events that happen during childhood. They include things like the death of a loved one, seeing violence, or an important need going unmet. People with more ACEs are at increased risk of:
- Depression
- Mental illness
- Substance abuse
- Cancer
- Heart disease
- Obesity
- Diabetes
According to the CDC, if we ended childhood abuse, we could potentially prevent over 21 million cases of depression.
“You can’t completely prevent adverse events or traumatic ones,” Andrew says. “And some can actually be beneficial by helping a child develop resilience and character.”
So, what’s the difference between a traumatic childhood experience that contributes to (or leads to) diabetes and one that develops character? Having a support network and resources to help children process these events safely.
When a child loses a beloved pet, sadness and trauma are unavoidable. But having support through a natural and healthy grieving process can help prevent long-term harm.
How Do We Prevent Child Abuse?
Preventing child abuse is obviously the ideal solution. Treating it after the fact is possible but can’t erase the hurt.
Fortunately, there’s no shortage of ways that each of us can help prevent child abuse in our community.
Be Kind & Supportive — To Everyone
This advice from Andrews takes me by surprise because it almost seems too simple. “Just be kind,” she says. “Try to be a nice person to those around you. Be supportive to people with young kids.” While everyone needs support, often people with young children are experiencing additional stressors.
Abuse often occurs when stress factors outweigh support and internal resources. There are two sides to this equation, and you can help with both.
Don’t add to someone’s stress pile. From cutting in line to acting overly frustrated about minor inconveniences, it’s easy to add to someone else’s stress pile. Remembering that the people in your community are doing their best can be hard. But choosing kindness can ease instead of create stress for others.
Offer support to the people around you. Especially those with children. That can look like offering to help cut the grass, or just being a person to talk to.
Normalize Childhood Milestones
One of the things that adds stress for parents is unrealistic expectations for their child’s behavior. Parents start to feel as though they’re not pushing their child hard enough. Or think that the behavior they’re seeing is a result of something they’re doing wrong. So, they do the opposite. If you think your permissive parenting is what’s causing your 9-month-old to throw food on the floor, you might lean too far into discipline.
When you know all 9-month-olds throw their food, you might accept it.
When you realize a 9-month-old throwing food is really them discovering gravity (what a concept!) and having fun, you might get excited about it.
Milestone Check-Ins
At well baby visits, your pediatrician will talk to you about milestones. This is a great time to talk about concerns. They can also help you look ahead to prepare for what’s next.
Help Children Feel in Control of Their Bodies
Most abuse is most likely to be committed by a child’s parents. But sexual abuse is usually committed by someone else. It’s usually someone the victim and parents know and trust.
Teaching children that they’re in charge of their bodies can help safeguard them from sexual abuse. Foothills Advocacy Center offers resources for talking to children about their bodies. Pediatric psychologists are also able to offer valuable insight on sexual assault prevention.
“I also tell people to keep it under consideration until they can rule it out,” Andrews says. Symptoms of sexual abuse can be as nonspecific as struggling in school. But many people dismiss sexual abuse too early as a potential cause. This can delay identifying and fixing the problem.
Don’t Be Afraid to Report
Reporting abuse can save a child’s life. When a mom left her toddler home alone for 10 days, neighbors heard the child’s cries. And just like her mom, her community failed her. A single phone call may have made the difference between life and death for Jailyn. It never came.
People can be afraid to report to their community's child protective services (CPS) for many reasons. They may fear putting the family through a stressful and frustrating investigation. “Calling CPS is certainly not a benign action,” Andrews agrees.
In some cases, CPS can offer a family assessment instead of an investigation. Instead of deciding “founded vs unfounded,” a family assessment looks at risk factors and how to mitigate them.
What if abuse is happening and CPS doesn’t catch it? Most CPS investigations end up being “unfounded.” Which means they can’t say for sure whether abuse happened. Still, for some families, it’s the wakeup call they needed. CPS can help arrange support to keep the family together, safely.
Know the Signs
How can you tell abuse might be happening? Look out for “sentinel” injuries, Andrews says. These injuries are so minor they could easily be ignored. But shouldn’t be. Bruising on a child under 4 months is one example. At this age, isn't able to move around. So it's unlikely they hurt themselves. A bruise of any kind means the child might be being abused, or could point to a serious medical condition. Here’s a list of sentinel injuries.
Offer Parents a Gameplan for Stressful Times
Giving parents a gameplan for when things get frustrating gives them a tool they can keep in their back pocket. Whether it’s “call a babysitter and step away” or “talk about your frustration with your partner.” Even reminding parents that if a baby is clean, fed, and still crying, it's okay to set them down safely and walk away can be a preventative measure.
The timing of first-time abuse is relatively predictable. Babies’ crying peaks right around 6 weeks, when some can cry for up to 5 hours. Toddlers have ups and downs during potty training that can be maddening. And teenagers are well-known for pushing boundaries and terrifying behavior.
These things can trigger extreme stress and even fear in parents. When you think your teenager is jeopardizing their future, it’s easy to justify extreme acts of discipline. Easy….and very wrong. Having a gameplan in advance helps avoid that kneejerk mistake.
Support Your Child Advocates
When they’re working well, it can be easy to forget that your local child advocacy center exists. Child advocacy centers offer help to children (and their non-offending family) during crisis. They conduct forensic exams to find physical signs of abuse and provide trauma-informed care. And they also offer education and resources to others in the community who would like to help prevent child abuse.
This April, Foothills Child Advocacy Center is organizing several events throughout Charlottesville to raise awareness and funds to help expand their advocacy.
Check out their Facebook page for more event details.
