An Important Conversation About Child Abuse and Neglect

Child abuse is a difficult subject to think about, much less discuss with your family and friends. But it also can’t be ignored.

Jamye Coffman, M.D., medical director of the Child Advocacy Resource and Evaluation (CARE) Team at Cook Children’s, says if we don’t talk about the issue, change won’t ever occur.

“Children are dependent on adults so it’s up to us to make sure they are protected and taken care of, regardless if they are our children or not,” Dr. Coffman said.

Today, we discussed abuse and neglect with Dr. Coffman to learn more about the types of abuse our children face and what we can do about it.

What are the types of services the CARE team provides?

The CARE team is made up of board-certified pediatricians and advanced practice nurses trained in the treatment of child abuse. Our team is involved in providing assessments, education and medical evaluations of the child.

What are the different types of abuse seen at Cook Children’s?

I think when people hear  the word "abuse" they think of sexual or physical abuse. But we also see kids for neglect.

Would you mind explaining neglect a little more to us?

The most common form of child maltreatment is neglect. We see different types of neglect, which is defined as a failure to provide adequate food, clothing and shelter. Children who are neglected are often underweight and/or unkempt. They may beg for food or eat out of a trashcan at school, or they may be dirty, have dirty clothes and have a bad odor. For infants, underweight or malnourished, unbathed and dirty or severe diaper rash can all be signs of neglect.

What is the impact that neglect can have on a child?

Neglect, especially in children under the age of 3, can cause the same long-term chronic health problems as being physically or sexually abused.

Primarily for younger children, babies, we see a lot of failure to thrive cases. Usually, these are kids under 2 or 3 years of age, who can’t get food for themselves. It may be because the parents are impaired with substances and are not paying attention to the needs of a child most of us take for granted like feeding the child or changing his or her diapers.

When the child gets older, we see school-aged kids who appear to be malnourished. The only meals they are getting are at school and they get breakfast and lunch. But during the weekends or summer when school is out, these kids are looking in the trash outside for food.

Another form of neglect is parents simply not watching their kids. That’s where we see bathtub drownings or a child left alone in a car.

Sometimes it’s about knowledge and awareness. It doesn’t always mean a criminal act. Sometimes the parents need to be educated and learn they can’t leave their child alone in the tub or in a car for even a short period of time.

What can the public watch for when it comes to child abuse and neglect?

For neglect, people should watch for a child who is extremely underweight or malnourished. They may beg for food or always have dirty clothes or a bad odor.

Any bruise on an infant is concerning because they are not mobile enough to bruise themselves, so if a bruise occurs it’s more than likely that someone else had to have had a part in it. Any unexplained injury of a young child. Infants under 6 months of age should not have bruises.

For older children, the concerning bruises are ear bruises, bruises on the padded parts of the body or the cheeks, and anything from the hips to the shoulders, on any side of the body (excluding the hip bone). If the child has bruises on the bony prominences such as forearms, shins, elbows, knees, forehead, nose or chin, those could all come from normal play that the child engages in and are not as concerning.

Other things to be looking for are pattern bruises anywhere on the body, which means anything that looks like an object such as a belt, switch or spoon. Similar to this are burns. If there is an emersion type burn on a child as if they had put a whole body part into hot water, that is also concerning. This is different from an accidental burn. Those types of burns, such as pulling a pot of hot water off the stove, would have a splash pattern from all the places the water went, whereas an emersion burn has a distinct pattern that usually looks like a glove or sock pattern. This means that their body was placed into hot water and was forced to stay there long enough for severe burns to form.

Sexual abuse can be difficult to detect because it doesn’t have many specific symptoms or behaviors. Some physical signs of sexual abuse, however, could include trauma or damage to the genital or anal areas, sexually transmitted diseases, or pregnancy.

Children may act out with sexual or inappropriate behavior that is beyond their expected developmental knowledge. This may indicate the child has witnessed or experienced the sexual behavior.

If someone does suspect a child is abused or neglected, how should they go about reporting the situation?

You should call the Texas Department of Family and Protective Services at 1-800-252-5400. If the child is in immediate danger, call 911.

I know it’s difficult to be involved. But these children are at increased risk of long-term poor health and early death. It’s our moral responsibility to act now and put our children first and get involved.

It’s also important to do what you can before things escalate. We have to watch out for one another. If you know someone, whether it’s a family member or close friend, offer to be a resource for them.

Step in and offer to babysit if you see a parent is struggling.

That doesn’t mean you don’t call if you see abuse though.

We all have to work together to do better and care enough to work together to improve the future of our children.