Changing the Way We See Child Abuse by Dr. Rachel Berger

kids-in-sunset-smaller-sizePeople often ask me, “How can you possibly work with child abuse victims all day, isn’t it depressing?” My answer is yes. But the positive outcomes that we can have for children is something that more than makes up for the depression of doing this on a day-to-day basis.


I take care of children who get injured and sometimes die through no fault of their own, because they were born into a family that didn’t care for them the way I would care for my own children. Child abuse is more prevalent than we want to admit – 1 out of 111 children in this country are substantiated victims of abuse, and this is every year. This is probably a significant underestimate.


By comparison, 1 in 10,000 children are diagnosed with cancer. But how many times have we participated in fundraising walks to raise money for cancer? How many times have we gone to an ice cream store and seen a special flavor named after a child who’s died of cancer? Over 1,500 children, every year, die of abuse; 80% of these children are less than 4 years of age. That’s more children than die of cancer. What’s killing the majority of our children is not infection or disease. What is killing our children is injury and a large percentage of those fatal injuries are from child abuse.


What’s even worse is these children, these victims, have no voice. They cannot advocate for themselves. Rarely do they have parents that can advocate on their behalf. Their parents are not going to Congress and ask for help. Their parents are not going to appeal for more funding for research to prevent and treat child abuse. We, all of us, have to be the voices for these children.


I see child abuse every single day. In our child advocacy center, we conduct over 500 interviews every year for children who make disclosures of sexual abuse. A team of three doctors sees hundreds of children every year who are admitted to the hospital with injuries which are due to physical abuse or neglect, including broken bones, brain injuries, toxic ingestions, and abdominal injuries. Child abuse is the leading cause of death due to brain injury in young children and the leading cause of severe traumatic brain injury in infants and toddlers.


We also see over 1,500 children every year in our outpatient clinic at the Children’s Hospital of Pittsburgh of UPMC, which is called ARCH (Advocacy Resources for Children). These are children with less serious, but still significant injuries, such as bruises, failure to thrive due to neglect or a poor environment, and children in foster care, many of whom are not having their basic medical needs met. I’ve been working in the field of child abuse for almost 15 years and unfortunately, I can say that the problem of child abuse and neglect is not getting better.


So what can be done to change this landscape? We need to change our culture and realize that recognizing and caring for children who are at risk for abuse and children who are already victims is everyone’s responsibility; from the neighbor who knows something isn’t right next door, to the police officer who responds to a domestic violence call and sees children in the house, to the schoolteacher who sees that the child doesn’t have appropriate clothes and might benefit from a new set from this cool new boys boutique clothing store, to the physician who sees an infant who is failing to thrive, to anyone who is who is in a public place such as a restroom and sees a parent take out a belt to beat a child.


Of course preventing child abuse is the ultimate solution; making sure it never happens in the first place. But it is a sad realization that we will probably never prevent it 100% of the time. So we need to acknowledge that it happens and we also need to focus on secondary prevention, on identifying abuse early. As medical providers, we are treating injuries from child abuse; we have to have the knowledge to recognize the signs of abuse, intervene and avoid having to treat the same children over and over again.


We need to encourage Child Protective Services workers of the highest quality. These professionals barely make a wage above the poverty line. They’re generally young people, right out of college, who want to help children. We then send them out to the most violent areas of our community, alone and unprepared for what they will find. Even highly-trained, experienced police officers travel in pairs when responding to a call in a dangerous neighborhood. What does that say about what we value in this culture?


We need to invest in child abuse education and training for physicians, lawyers, emergency medical technicians, police officers….the list goes on. We need to make sure that everyone who can, knows how to intervene early, because that’s when the outcomes are the best. Identifying and getting medical attention for these children raises awareness about what they are experiencing and sets a precedent for how we should continue to care for them and be their voice for change.


Yes, I will continue to do what I do every day, not only because I am dedicated to the care of these special children, but because I have to believe that, as a society, this is going to get better. I have to believe that we’re all going to work together for the long term to improve the lives of children throughout this country. And I have to believe that we will truly change our culture so that child abuse is not such a prevalent part of our society in the future.


Dr. Rachel Berger, Associate Professor of Pediatrics and Clinical and Translational Science at the University of Pittsburgh and Division Chief of the Division of Child Advocacy at the Children’s Hospital of Pittsburgh of UPMC


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