by Michael Jordan, MD
Whenever we hear of another child seriously injured from the child abuse the common reaction is a collective anger toward the perpetrator and often some creative suggestions of delivering justice. While that is an understandable reaction the social factors leading to abusive injury are complex. Child abuse is often caused by caregivers who were also victims of abuse as children. In this “world of abnormal rearing” the family’s that suffer abuse are often isolated, under significant stress and have minimal family and social supports. Nonetheless, there is good data that indicate preventative steps can and do work to reduce child abuse.
We have all heard to the food pyramid concept of good nutrition. This pyramid idea is also helpful in planning other community health initiatives like child abuse prevention. Imagine the steps to prevent abuse as a pyramid of interventions. At the base level are interventions aimed at the underlying problems which lead to dysfunctional rearing and abuse. We can approach the social situations that breed “abnormal rearing” patterns and which expose vulnerable children to care-giver violence. Some examples base level prevention include decreasing teen pregnancy, promoting two parent families, extended family support, and advocating a reduction in poverty with lowering unemployment. The next step up on the pyramid of prevention would be primary understanding of childhood development and teaching examples of age appropriate – timely discipline as a loving essential in child rearing. Perpetrators of child abuse often have unrealistic expectations about the developmental abilities of the young child so at this step we would address those groups at risk such as new stressed out parents. Childbirth education classes and post-partum teaching on maternity floors can inform new mothers on child safety. Prevention education includes alternative response training for dealing with that new infant who will normally cry as much is 5 or 6 hours a day in the first months of life. Abuse can also be prevented by promoting breast feeding and encouraging active participation in child rearing by fathers and other partners.
Farther up the pyramid should be efforts at secondary prevention. This would include training teachers, social workers, bus drivers and nurses in abuse recognition and referral and teaching children abusive recognition and the appropriate steps to safe reporting. Finally at the top of this prevention pyramid would be our efforts to minimize the tremendous long term emotional damage already done by abuse. This could include training and advice for foster parents and legal guardians on the long term psychosocial effects of physical and sexual abuse and its effect on the future development.
Our results with shaken baby syndrome prevention efforts are a good example of how a community can reduce child abuse.
Shaken baby syndrome occurs when an adult shakes an infant causing permanent brain damage, blindness, and severe learning problems. Nearly 25 % of all shaken babies will die of internal injuries. Just a few seconds of shaking can result in lifelong injury or death. Most adults responsible for causing shaken baby syndrome do not mean to hurt the child – usually they’re just frustrated because the baby will not stop crying.
The most important prevention step is teaching that every person who cares for the child must know to never, ever shake a baby. Other instruction includes training new parents caring for a crying baby to first check to make sure he is not hungry or sick and that his diaper does not need to be changed. If they feel overwhelmed, it is okay to place the child in a safe place (like a crib) while you take a break for 5 or 10 minutes. Once relaxed, they can try again to calm the baby.
All new parents are taught Shaken Baby Syndrome child abuse prevention at the Newark Wayne Woman’s Care unit before discharge with their newborn; in fact New York State law requires that all hospital maternity wards offer new parents the opportunity to view a video on shaken baby syndrome. This initiative has reduced SBS injuries by 47% in Western New York alone.
Understanding the causes of abuse, supporting new families and education on the dangers of shaking crying infants does make a difference. If you think a child has been shaken, seek proper medical care immediately and report the incident to the New York Statewide Central Register of Child Abuse and Maltreatment (Child Abuse Hotline) at 1-800-342-3720. It can save a child’s life.