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Book Details
Abstract
Pediatric primary care provides a unique opportunity to tackle child abuse and neglect. In the United States in particular, primary care is a well-established system, and most children have multiple visits, especially in the first few years. There is typically a very good relationship between parents and health professionals, who are respected experts on children. The interested pediatrician, thus, has a remarkable entrée into the workings of a family, its shortcomings, and its strengths. With some knowledge and skill, pediatricians can play a pivotal role, even in a few strategic minutes. We know, however, that some professionals feel very uncomfortable becoming involved in this unpleasant area and may be deterred from taking any action. Understandable as this may be, it can jeopardize a child’s health and safety. Hopefully, this issue of Pediatric Clinics of North America will help make this work a bit easier, albeit not easy. With training and support, pediatricians can equip themselves to be competent and more comfortable addressing child maltreatment. Aside from the possible forensic implications, the heart of this work is primarily about helping families take adequate or good care of their children. Indeed, helping address child abuse and neglect also helps promote children’s health, development, and safety, and it is central to the rich mandate of Pediatrics.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Child Maltreatment\r | i | ||
| Copyright\r | ii | ||
| Contributors | v | ||
| Contents | ix | ||
| Pediatric Clinics Of North America\r | xiv | ||
| Foreword\r | xv | ||
| Preface\r | xvii | ||
| The Pediatrician and Child Maltreatment | 865 | ||
| Key points | 865 | ||
| Importance of the first few years | 866 | ||
| Toxic stress | 866 | ||
| A broad view of maltreatment | 866 | ||
| Development of the field of pediatrics | 867 | ||
| Beyond the biomedical model | 867 | ||
| Protective factors | 867 | ||
| The potential of primary care | 868 | ||
| Practical pointers for practice | 868 | ||
| Summary | 870 | ||
| References | 870 | ||
| Prevention of Child Maltreatment | 873 | ||
| Key points | 873 | ||
| The role of pediatric health care providers in child maltreatment prevention | 874 | ||
| Screening for maltreatment risk factors and identification of families at risk | 874 | ||
| Prevention programs rooted in models of anticipatory guidance | 876 | ||
| Community-based prevention programs | 877 | ||
| Prevention of sexual abuse | 882 | ||
| Advocacy | 883 | ||
| References | 884 | ||
| Bringing Back the Social History | 889 | ||
| Key points | 889 | ||
| Why the social history matters | 889 | ||
| The ill effects of maltreatment can last a lifetime | 890 | ||
| Child maltreatment prevention begins with primary care | 890 | ||
| Goals of the social history | 890 | ||
| Key psychosocial risk factors that increase the risk of toxic stress and child maltreatment | 894 | ||
| Psychosocial risk factors | 894 | ||
| Negative Attributions and Unrealistic Expectations | 894 | ||
| Physical Discipline | 896 | ||
| Parental Mental Health | 897 | ||
| Substance and Alcohol Abuse | 897 | ||
| Prior Child Protective Services Involvement | 898 | ||
| Intimate Partner Violence | 898 | ||
| Summary | 899 | ||
| References | 899 | ||
| Appendix 1 Safe environment for every kid parent questionnaire | 905 | ||
| Engaging Families Through Motivational Interviewing | 907 | ||
| Key points | 907 | ||
| Introduction | 907 | ||
| Extent of the problem: health care provider–centered approach | 908 | ||
| Sequelae of the problem: increasing barriers to change | 909 | ||
| Preparing for MI | 910 | ||
| Effectiveness of MI | 911 | ||
| Substance Use | 912 | ||
| Partner Violence | 912 | ||
| Depression | 913 | ||
| Harsh Punishment | 913 | ||
| Managing Medical Health | 914 | ||
| Clinical assessment | 914 | ||
| Approach | 915 | ||
| Open-Ended Questions | 915 | ||
| Affirmations | 915 | ||
| Reflections | 916 | ||
| Summary Statements | 916 | ||
| When to use MI | 917 | ||
| Summary | 919 | ||
| References | 919 | ||
| Sentinel Injuries | 923 | ||
| Key points | 923 | ||
| Introduction/characterize the issue/problem | 923 | ||
| Extent of the problem | 924 | ||
| Causes/contributory or risk factors | 926 | ||
| Sequelae of the problem | 929 | ||
| Clinical assessment | 930 | ||
| Approach/management | 931 | ||
| References | 933 | ||
| Neglect: Failure to Thrive and Obesity | 937 | ||
| Key points | 937 | ||
| Introduction | 937 | ||
| Defining age-appropriate growth | 938 | ||
| Prevalence | 938 | ||
| Etiology | 939 | ||
| Food Insecurity | 940 | ||
| Assessment of Growth and Nutrition | 941 | ||
| Sequelae | 941 | ||
| Clinical assessment and approach | 943 | ||
| The role of neglect | 949 | ||
| Prevention | 950 | ||
| References | 951 | ||
| More than Words | 959 | ||
| Key points | 959 | ||
| Introduction | 959 | ||
| What is emotional maltreatment? | 960 | ||
| How emotional maltreatment affects children | 961 | ||
| The lingering effects of emotional maltreatment | 962 | ||
| Prevalence | 962 | ||
| Risk factors | 964 | ||
| Domestic Violence | 964 | ||
| Mental Health of Caregiver | 965 | ||
| Identification/intervention | 965 | ||
| Prevention | 966 | ||
| Summary | 967 | ||
| References | 967 | ||
| Corporal Punishment | 971 | ||
| Key points | 971 | ||
| Introduction | 971 | ||
| Extent of CP | 972 | ||
| Sequelae of spanking and hitting | 972 | ||
| Clinical assessment | 973 | ||
| Addressing corporal punishment | 974 | ||
| Approaches to Corporal Punishment | 974 | ||
| Summary | 977 | ||
| References | 977 | ||
| The Conversation | 979 | ||
| Key points | 979 | ||
| Introduction | 979 | ||
| Taking the history from parents and caregivers when abuse is suspected | 980 | ||
| The art of asking | 980 | ||
| One Recommended Sequence for Conducting the Interview | 981 | ||
| First Principles of Interviewing | 981 | ||
| Listen before talking | 981 | ||
| Don’t answer your own questions | 982 | ||
| Wait for an answer | 982 | ||
| Retain (benign) neutrality | 983 | ||
| Talking to children: special considerations | 983 | ||
| Setting the Stage | 983 | ||
| Know with Whom You Are Speaking | 984 | ||
| Keep It Simple | 984 | ||
| Suggestibility? | 984 | ||
| Medical History Versus Evidence | 985 | ||
| Three pitfalls | 985 | ||
| Cognitive Errors | 997 | ||
| Key points | 997 | ||
| Cognitive processes: an overview | 998 | ||
| Cognitive errors and child maltreatment | 999 | ||
| Implicit Stereotypes | 999 | ||
| Anchoring | 1001 | ||
| Triage Cueing | 1002 | ||
| Countering errors in thinking | 1003 | ||
| Summary | 1004 | ||
| References | 1004 | ||
| Cultural Considerations and Child Maltreatment | 1007 | ||
| Key points | 1007 | ||
| Background: culture and cultural competency | 1008 | ||
| Defining Culture | 1008 | ||
| Cultural Competence | 1009 | ||
| Culture’s influences | 1009 | ||
| Cultural Influences on Child Rearing | 1009 | ||
| Factors influencing parenting practices and parental intent | 1009 | ||
| Culture and parental discipline | 1011 | ||
| Cultural Influences on Health Behaviors | 1011 | ||
| Cultural Influences on Manifestations of Abuse | 1012 | ||
| Global variability | 1013 | ||
| Global Variability in the Determination of Child Abuse | 1013 | ||
| Variability in Child Protection Policies and Their Implementation | 1013 | ||
| Universal principles in child maltreatment | 1014 | ||
| A Child Rights Approach | 1014 | ||
| A stepwise approach for the primary care provider | 1015 | ||
| Establishing a Culturally Competent Practice | 1015 | ||
| Characterizing Caregivers’ Acts and Determining Harm to the Child | 1015 | ||
| Understanding Applicable Laws and Moral Principles | 1016 | ||
| Culture and protective factors against child maltreatment | 1017 | ||
| Summary | 1018 | ||
| References | 1018 | ||
| Has This Child Been Abused? | 1023 | ||
| Key points | 1023 | ||
| Introduction | 1023 | ||
| Defining uncertainty | 1024 | ||
| Technical Uncertainty | 1024 | ||
| Personal Uncertainty | 1025 | ||
| Conceptual Uncertainty | 1025 | ||
| Uncertainty Beyond the Medical Diagnosis | 1026 | ||
| Reporting to Child Protective Services | 1026 | ||
| Approach to uncertainty in physical abuse cases | 1026 | ||
| Timing of Injury | 1026 | ||
| Uncertain Diagnosis of Abuse | 1028 | ||
| Uncertainty arising from the possibility of accidental injury | 1028 | ||
| Uncertainty arising from the possibility of a medical condition | 1028 | ||
| Approach to uncertainty in sexual abuse cases | 1029 | ||
| Examination | 1030 | ||
| The impact of uncertainty on safety | 1030 | ||
| Safety Determination | 1030 | ||
| Safety Planning in Physical Abuse | 1032 | ||
| Safety Planning in Sexual Abuse | 1033 | ||
| Summary | 1034 | ||
| References | 1034 | ||
| Working with Child Protective Services and Law Enforcement | 1037 | ||
| Key points | 1037 | ||
| Introduction | 1037 | ||
| What happens when you report child abuse | 1038 | ||
| Reporting Laws | 1038 | ||
| When Does Sexual Contact Equate to Sexual Abuse? | 1038 | ||
| Child Protective Services Responses | 1038 | ||
| Law Enforcement Responses | 1039 | ||
| Legal Responses | 1039 | ||
| Problems physicians face when child abuse is suspected | 1040 | ||
| What Is the Threshold for Reporting? | 1040 | ||
| Obstacles to Reporting Suspected Abuse | 1041 | ||
| Impact of Education on Reporting | 1042 | ||
| Impact of Prior Experience with Reporting | 1042 | ||
| Challenges to working with community resources | 1042 | ||
| Lack of Understanding Regarding What CPS Does | 1042 | ||
| Lack of Understanding What CPS and Law Enforcement Need from the Physician | 1043 | ||
| Lack of Understanding of How to Utilize a Child Abuse Specialist | 1043 | ||
| Suggested approaches to working with community resources | 1043 | ||
| Seek Opportunities to Update Knowledge | 1043 | ||
| Consider Using a Screening Tool | 1045 | ||
| Identify a Child Abuse Expert or Resource | 1045 | ||
| Cooperate, Collaborate, and Communicate with Investigators | 1045 | ||
| Summary | 1046 | ||
| References | 1046 | ||
| Legal Issues in Child Maltreatment | 1049 | ||
| Key points | 1049 | ||
| Introduction | 1049 | ||
| Mandated reporting | 1049 | ||
| Expert witness testimony | 1051 | ||
| Informed consent in child maltreatment | 1052 | ||
| Liability | 1054 | ||
| Summary | 1056 | ||
| References | 1056 | ||
| Foster Care and Healing from Complex Childhood Trauma | 1059 | ||
| Key points | 1059 | ||
| Introduction: Foster care and trauma | 1059 | ||
| Extent of the problem: Overview of foster care | 1060 | ||
| Etiology: Toxic stress and complex trauma | 1061 | ||
| Sequelae of the problem: How trauma impacts the health of children in foster care | 1062 | ||
| Physical Health | 1062 | ||
| Mental Health | 1062 | ||
| Cognitive Development and Educational Success | 1063 | ||
| Clinical assessment: Pediatric care of the traumatized child in foster care | 1063 | ||
| A Physical Health Screen | 1064 | ||
| Mental Health and Trauma Screening | 1065 | ||
| Developmental and Educational Assessments | 1066 | ||
| Approach/management: Trauma-informed care | 1066 | ||
| Caregiver and Caseworker Education and Support | 1066 | ||
| Referral to Community Resources | 1067 | ||
| Outcomes: Resilience and stability | 1068 | ||
| Summary | 1068 | ||
| References | 1068 | ||
| Advocacy Opportunities for Pediatricians Caring for Maltreated Children | 1073 | ||
| Key points | 1073 | ||
| Introduction | 1073 | ||
| Scope of the problem and why advocacy by pediatricians remains essential | 1074 | ||
| Advocacy within a medical setting | 1074 | ||
| Physical abuse | 1075 | ||
| Sexual abuse | 1076 | ||
| Neglect | 1077 | ||
| Reporting cases of suspected child maltreatment | 1078 | ||
| Working collaboratively with nonmedical professionals | 1078 | ||
| Courtroom testimony | 1079 | ||
| Education | 1079 | ||
| Advocating for youth in foster care | 1080 | ||
| Advocacy opportunities related to the development of policy and legislation | 1080 | ||
| Vicarious trauma and the development of resiliency | 1080 | ||
| Summary | 1081 | ||
| References | 1081 | ||
| Index | 1085 |