I'm curious about the connection between COVID-19 and the number of cases of child abuse. In the United States, have the numbers gone up or down?

We know the numbers of reported cases have gone down, but what we've seen across the United States is an increase in the severity of physical abuse. What we think is happening is the children are isolated, not going to school, not going to daycare. So the reports aren't happening earlier where we can prevent more severe abuse, and it's not actually coming to our attention until it's severe enough where they have to present to the hospital into the emergency rooms for medical intervention.

In terms of child abuse, we think about physical abuse or sexual abuse, but there are other forms of child abuse. Can you go over the different types?

In the United States, the most common form of abuse is neglect. That can be anything from failing to provide food and shelter to not providing appropriate supervision. Children that may be too young and left home alone, not providing educational resources for them, or even not providing the necessary medical treatment they need. And that really accounts for three-fourths of child maltreatment in United States. Of course you have physical abuse and sexual abuse, but then there's also emotional abuse and that's probably the one that's most difficult to prove. This is some action by the caregiver that impacts the child's growth or development or psychological functioning. This can be extreme forms of punishment, not physical punishment, but emotional punishment, such as putting them in a dark closet, that's going to make the child very fearful, belittling the child, where they feel rejected and unloved. So those are all forms of emotional abuse as well. 

In terms of the protocol for reporting child abuse, what are the requirements?

It really is the responsibility of everyone who has access to children to intervene and report if needed. In Texas, everybody's a mandated reporter, especially people that are responsible for children, such as doctors and teachers and medical professionals. 

Does that mean that you're able to call in anonymously and confidentially? I'm sure some people might be afraid to speak up if you suspect something, but you're not quite sure.

The laws in my state (Texas) say if you have reasonable suspicion, you're a mandated reporter. There is an 800 number that we call. Child protective services cannot tell the parent who made the report. They can't tell the family, it is confidential. When you call in a report, you don't have to give your information, but obviously, it's very helpful for the investigators to know who made the report so they can talk to you about your concern. So we always encourage people to give their information.

During COVID-19, what can we do as a community to prevent these cases? We see some horrific cases, there was a recent case here in Korea that made the headlines. What do we need to do?

I think it's a matter of understanding that even if it's not your family, that child is still your business. That it is your responsibility to step in and help protect that child. And the only way we can do that is to report and hopefully report before it gets to the point of a child losing their life or having severe injuries. Of course, even better would be the preventive services for families to help keep them healthy. But it's everybody's business to stand up for children because they can't do it themselves. It's also better for us as a society because then we can intervene, hopefully provide services for that family to reunite them and keep that child in the home, but in a healthy home where that child is loved and nurtured. And then that child will then grow up to be a productive adult. We know when we don't intervene in these cases of abuse, there can be really severe longterm, physical and mental outcomes with these children that we all as a society pay.

Doctors at Cook Children’s believe the stresses from the COVID-19 pandemic are linked to nine cases of severe child abuse seen at the hospital since March 17, 2020. Three of those children have died. Typically, Cook Children’s sees this many such cases over the course of a month

All of the children admitted were 4 years old and under.

"We usually only average six deaths from abuse a year at Cook Children's and now we've had two children die on the same day," said Jamye Coffman, medical director of the Cook Children’s Center for Prevention and Child Abuse and Neglect and the CARE team​. "This is an issue related to stress. We are seeing it from all over from urban area to more rural counties."

For the providers who take care of these children, the news of this abuse didn’t come as a total surprise. During the recession in 2008/2009, Cook Children’s saw the leading cause of death from trauma change from motor vehicle crashes to abusive head trauma.

“We knew an increase in abuse was going to occur, but this happened faster than we ever imagined,” said Christi Thornhill, director of the Trauma Program, the CARE team and Fostering Health at Cook Children’s. “I mean this happened in a week and these are really bad abuse cases.”

Dr. Coffman believes these unprecedented times have simply become too much for some parents.

“People have so much increased stress right now,” Dr. Coffman said. “They’ve got financial stress. Some people lost their job or worried about keeping their current job. They lost their income. You’ve got stress from being overcrowded. Everyone’s cooped up together. They feel like they can’t get away from each other. These stressors can lead to abuse.”

Dr. Coffman said another factor is that people can’t get away from COVID-19 news. It’s on TV and social media constantly.

It’s more difficult to take your child to a grandparent or neighbor’s house right now. Kids aren’t going to school to give their parents some away time.

So what do you do now?

“Most of us know family members or neighbors we can reach out to when we know that maybe this is high stress situation,” Dr. Coffman said. “I think just maintaining some human connection is extremely important so people don’t feel isolated or people don’t feel as alone, which may reduce some of the anxiety and frustration. It may even be a phone call to somebody to say, ‘I’m having a hard time’ or even ‘my kids are driving me nuts.’”

Dr. Coffman emphasizes it’s normal to feel more frustrated because of the unknown and uncertain times, but when you feel frustrated, it’s Ok to ask for help or reach out and ask for advice.

"Stress is not an excuse for abusing your child, but rather we hope that caregivers can recognize their stress and ask for help rather than accelerate dangerous behaviors, and that others can recognize and intervene as well," Dr. Coffman added. 

Childhelp.org offers a resource for both parents and children alike during this time. For this article, we called this organization. We were told they are currently available to help and welcome any phone calls. The National Child Abuse Hotline is 1-800-4-A-Child or 1-800-422-4453.

Thornhill encourages people to get involved during this difficult time. The number one reporter of child abuse continues to be teachers, but kids aren’t seeing them right now.

“We worry about who will see abuse and report it right now,” Thornhill said. “That’s where we need neighbors and other family members to pay attention. If you hear the child next door screaming, call for help. All of us need to be involved. As much as most of us don’t want to, we all must make it our business.”

If you suspect a child is being abused or neglected, please contact the Texas Department of Family and Protective Services (TDFPS) toll free at 1-800-252-5400, 24 hours a day, 7 days a week. You may also file a report using the secure TDFPS website. Reports made through this website take up to 24 hours to process. The Texas Abuse Hotline is 1-800-252-5400.

For more resources:

• The Center for Prevention of Child Abuse and Neglect
• About The Center for Prevention of Child Abuse and Neglect
• Early Detection of Child Abuse and Neglect Training
• Predicting Child Abuse and Neglect
• childhelp.org
• Childhelp National Child Abuse Hotline

“It’s heartbreaking. We’ve seen a substantial increase in serious child abuse cases at Cook Children’s recently,” said Jamye Coffman, M.D., medical director of the Cook Children’s Center for Prevention of Child Abuse and Neglect and the CARE team​. “We can’t say for certain if the effects of COVID-19 are driving this increase. All we can do right now is sound the alarm about what we are seeing.

Since March 17, nine children, all 4 years old or younger, have been admitted to Cook Children’s Medical Center for injuries related to child abuse. Three of those children died.

So far in 2020, a total of four children have died as a result of injuries related to child abuse, with three of those deaths occurring within four weeks of each other.

To help put that number in perspective, Cook Children’s  saw a total of 4 deaths as a result of child abuse in all of 2017, 6 in 2018 and 6 in 2019. 

“It’s concerning to see this spike coincide with the pandemic, especially without knowing when it will come to an end or the ultimate toll it will take on our communities,” said Anu Partap, M.D. director for the Center for Prevention of Child Abuse and Neglect at Cook Children's. “With stay-at-home orders in effect, coupled with the loss of jobs, support systems and routines, the results can be disastrous.”

Cook Children’s isn’t the only hospital reporting an increase in severe child abuse. Healthcare workers at the Arnold Palmer Children’s Hospital in Orlando, Florida saw eight children with severe injuries in the past few weeks.

"These are children with, I'm talking multiple fractures, head injures that go to the operating room, severe burns. These are critical," Dr. Donald Plumley, medical director for pediatric trauma at Arnold Palmer hospital told News 6 Orlando.

In observance of Child Abuse Prevention Month in April, Cook Children’s staff planted 2,055 pinwheels outside of the medical center to represent each child abuse visit in 2019. With isolation and stresses mounting due to COVID-19, we could see even more pinwheels planted at the hospital next year.

“We know that families are under more stress, whether related to income or children being out of school. There’s a lot of pressure on parents and caregivers right now,” said Dr. Coffman. “What’s most concerning for us is that we saw a similar rise in child abuse during the recession. We don’t want to see that again”

Dr. Coffman says that in 2008, prior to the recession, the most common cause of death due to traumatic injuries in children was car accidents. During the recession, that changed to abusive head trauma.

“As North Texas heads into the peak of COVID-19, we have to take steps to support one another and rally, as we would during any natural disaster,” said Dr. Partap. “We can offer help, a listening ear or even just empathy for a parent who is struggling.”

Dr. Partap suggests reaching out to friends and family with children, either virtually or by phone, just to check in and offer support. If you are a parent who is struggling, know the best thing you can do is ask for help.

“In Tarrant County, 211 is a great resource for parents,” said Dr. Partap. “The Texas COVID-19 mental health hotline, the national Child Help Hotline, Texas youth crisis hotline and domestic violence hotlines are on stand-by with 24/7 staff.”

"Stress is not an excuse for abusing your child, but rather we hope that caregivers can recognize their stress and ask for help rather than accelerate dangerous behaviors, and that others can recognize and intervene as well," Dr. Coffman added.

Social distancing doesn’t mean you’re alone.

• Stay in regular contact with family, friends and neighbors by phone, social media or other technology. Even a few minutes of conversation a day is important.

• Take part in healthy activities that relieve stress. Go outside, take a walk, read or tell stories. Find ways to find joy and make connections.

Reduce the pressures of parenting

• You may feel like you have a lot more on your to-do list, especially with kids at home.
• Feel good about what is going well and celebrate the small things! Pat yourself on the back for a decent meal, a funny joke or just quiet moments.
• Build a new routine at home. Remember to include breaks for everyone to take care of themselves with downtime, playtime and exercise.
• Speak up when you need help and offer support to others when you can.

Reach out for help

Sometimes the pressure can be too much. Reaching out for help is important for you and your family. Following are 24-hour, free help lines for different needs.

• For confidential support when you need help with the stresses of parenting, contact Child Help: - Call or text 1-800-4-A-Child (1-800-422-4453) or live chat at childhelp.org
• For help with teen-specific concerns: - Call Texas Youth Helpline: 800-989-6884 or text 512-872-5777
• For help with parenting tips, local resources and to learn about family fun: - Visit helpandhope.org
• For mental health support and crisis care, contact iCARE: - Call or text iCARE at 817-335-3022
• For access to services through a social service hotline: - Dial 2-1-1 or 877-541-7905 or visit 211texas.org

(A printable flyer is available for download at the top right-hand corner of this page.)

About the Center for Prevention of Child Abuse and Neglect

Find ways to cope with COVID-19 social distancing guidelines

There are more people staying home and you may have lost your usual activities due to the new restrictions. Social distancing doesn’t mean you’re alone.

• Stay in regular contact with family, friends and neighbors by phone, social media or other technology! Even a few minutes of conversation a day is important.
• Take part in healthy activities that relieve stress. Take walks, go outside, read or tell stories. Find ways to cultivate joy and connection.

Reduce the pressures of parenting

You may feel like you have a lot more on your to-do list, especially with kids at home.

• Feel good about what is going well and celebrate the small things! Pat yourself on the back for a decent meal, a funny joke or just quiet moments.
• Build a new routine at home. Remember to include breaks for everyone to take care of themselves with downtime, playtime and exercise.
• Speak up when you need help and offer support when you can.

Reach out for help

Sometimes the pressure can be too much. Reaching out for help is important for you and your family. The following are 24-hour free help lines for different needs.

• For confidential support when you need help with the stresses of parenting, call Child Help:
  • Call or text 1-800-4-A-Child (1-800-422-4453) or live chat at childhelp.org
• For help with teen specific concerns:
  • Call Texas Youth Helpline: 800-989-6884 or text 512-872-5777
• For help with parenting tips, local resources and to learn about family fun:
  • www.helpandhope.org
• For mental health support and crisis care, call iCARE:
  • Call or text iCARE at 817-335-3022
• For access to services through a social service hotline:
  • Dial 2-1-1 or 877-541-7905 or go to 211texas.org

For all other questions/updates on COVID-19, visit cdc.gov.

If you suspect a child is being abused or neglected, please contact the Texas Department of Family and Protective Services (TDFPS) toll free at 1-800-252-5400, 24 hours a day, 7 days a week. You may also file a report using the secure TDFPS website. Reports made through this website take up to 24 hours to process. The Texas Abuse Hotline is 1-800-252-5400.

For more resources:

• The Center for Prevention of Child Abuse and Neglect
• About The Center for Prevention of Child Abuse and Neglect
• Early Detection of Child Abuse and Neglect Training
• Predicting Child Abuse and Neglect
• childhelp.org
• Childhelp National Child Abuse Hotline

About The Center for Prevention of Child Abuse and Neglect

The Center for Prevention of Child Abuse and Neglect is focused on innovative ways to address this important concern in our community.

Through the 2007 Community-wide Children's Health Assessment & Planning Survey, child abuse/maltreatment was identified as one of the top seven health issues affecting the children of North Texas.

Child abuse and neglect includes the issue of child abuse but is also a more all-encompassing term that describes a wide range of behaviors and related risk factors that are unacceptable and must be addressed. These include:

• Sexual abuse
• Physical abuse
• Psychological abuse
• Neglect
• Neglectful supervision
• Medical neglect
• Threat of gang violence
• Bullying
• Cyber bullying
• Related trauma
• Trafficking

Learn more about our program here. 

The ACEs Task Force, chaired by Cook Children’s, aims to reduce adversities for children starting before they are even born. Their work is based on a study conducted between 1995 and 1997 by Kaiser Permanente and the CDC. The study, which involves 10 questions about what a person experienced before the age of 18, shows ACEs are associated with high risk behaviors, chronic disease and reduced quality of life in adulthood. The task force is focusing their efforts on the signs of stress or difficulties that show up in early childhood.

In The Media

At 2 p.m. CST on Tuesday, Jan. 8, 2019, Jamye Coffman, M.D., will be a featured expert on Munchausen Syndrome by Proxy on 'The Dr. Oz Show.' The episode will explore the case of Gypsy Rose Blanchard, whose mother (Dee Dee Blanchard) claimed she was terminally ill and wheelchair-bound since childhood. Blanchard pleaded guilty to second-degree murder in the death of Dee Dee and is serving a 10-year prison sentence.

Anyone who has ever heard of Munchausen syndrome by proxy has probably asked themselves the same questions:

Why in the world would a mother want to hurt her own child?

And how does a child end up receiving unnecessary medical procedures? Don’t doctors know when a patient is really sick?

The answers are complicated. But each year, experts in Tarrant County get a little better at understanding how to spot these abusers and bring them to justice.

What is medical child abuse?

You may have heard about the HBO documentary ‘Mommy Dead and Dearest’ about the 2015 murder of Dee Dee Blancharge. Her daughter, Gypsy Rose, pleaded guilty to second-degree murder and is serving a 10-year sentence for her death. The trial uncovered a number of unknowns about the relationship between Dee Dee and Gypsy.

To everyone who knew Gypsy, she was believed to have been wheelchair bound and have a myriad of medical problems. It turns out those issues were largely fictitious and now, at 25 years old, Gypsy is arguably one of the most notorious victims of medical child abuse.

Medical child abuse is the diagnosis given to a child whose parent or guardian is suspected of lying about their medical history, leading to unnecessary treatments and procedures. This condition was formerly known as Munchausen syndrome by proxy. The abuser has what’s known as factitious disorder imposed on another.

“Anyone who has worked in pediatrics for very long has run across these kids. The question is whether or not you recognize it because it is so difficult to diagnose,” said Jamye Coffman, M.D., medical director of the Child Advocacy Resources and Evaluation (CARE) team at Cook Children’s. “We call it medical child abuse because in all of the other names, abuse is nowhere in it. But it’s abuse. And it’s medical, because we are the weapon.”

Few people may realize just how experienced experts in Tarrant County have become with this disturbing crime.

Since January 2009, the Tarrant County District Attorney’s office has investigated 19 reports of medical child abuse. Of the eight prosecutable cases, five were reported to Child Protective Services (CPS) by attending physicians at Cook Children’s. In each case, the abuser was the child’s mother.

“Tarrant County is pretty good at identifying and handling these cases,” said Michael Weber, a Tarrant County investigator who specializes in medical child abuse. “We have a system in place that is better than most counties in America.”

That system heavily relies on information provided by the medical community.

They’re using us to harm their child

In the medical field, the Hippocratic Oath is sacred. At the beginning of a physician’s career, they make a promise to ‘do no harm.’ But when a parent gives a doctor false information, they may unintentionally end up breaking the oath by providing procedures the child did not really need.

“The most common unnecessary surgery is placement of a feeding tube, or G-tube,” said Dr. Coffman. “That’s because there are very few tests that tell us if a child needs a G-tube. We are dependent on a history showing a failure to gain weight.”

The inability to gain weight is one of the top symptoms in medical child abuse cases. The abuser may withhold food and water from the child to make it seem as though there is a medical issue preventing weight gain. Besides inducing symptoms, abusers may also exaggerate and even fabricate symptoms.

“The parent may say their child threw up seven times in 12 hours, but they really threw up once. Or, if they are fabricating symptoms, they may say a child threw up seven times but there was never any vomiting at all,” said Dr. Coffman.

The severity of these cases can vary, and some symptom fabrications that seem mild may actually end up being life threatening.

For instance, a parent may tell a physician their child has been diagnosed with sleep apnea. Due to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), physicians cannot access another hospital’s records unless they have written permission from a parent or guardian. Without approval to access information protected by HIPAA, the physician has no way of knowing if the parent is being truthful about the apnea diagnosis. Once admitted to the hospital, the parent may actually suffocate their child in order to set off alarms, thus inducing symptoms.

“We’ve seen kids in wheelchairs who said they could not walk, even though there was no problem with their ability to walk. We’ve had parents tamper with lab tests and falsify records. Abusers have even gone as far as injecting feces into a feeding tube or IV line to make a patient septic,” said Dr. Coffman.

“In most cases, the abuse has been going on for many, many years. It’s psychological manipulation, physical manipulation and total control of the child by the parent,” said Weber.

It may seem baffling that children, who would be perfectly healthy otherwise, end up in these situations.

“You have to remember that ninety-nine point nine percent of our parents are good parents giving us accurate information,” said Dr. Coffman. “But if all an abuser has to do is say their child is vomiting and they’re secretly withholding food from them, how are we supposed to know that? We are depending on parents to tell the truth.”

Hiding in the spotlight

Identifying medical child abuse cases can be difficult for a number of reasons. The medical team is usually being lied to by the abuser, patients may be too young to speak for themselves or they may have been conditioned to lie as well.

Also challenging is the fact that the person harming the child is often the last person anyone would suspect.

“You may have a mother who seems like the best parent ever. The medical staff loves them, they are extremely concerned about their child, and they have a lot of medical savvy,” said Dr. Coffman. “We used to think these people had a medical background, but now with the internet, that’s not necessarily the case.”

According to Weber, Google and social media are key to the investigation.

“When we are building a case, we take all of the child’s medical records and dump it into a spreadsheet with social media posts and internet search history. When arranged by date, we can see the abuse pattern, and the lies,” said Weber.

He says in one case, a mother falsely told a doctor that she took her child to an emergency room the night before. Then later, she made posts on her Facebook page about her child being admitted to the hospital, though that never happened.

“She had numerous Facebook posts that were all lies,” said Weber. “Social media is a huge part of these cases.”

When the hero is the villain

One of the biggest mysteries surrounding medical child abuse cases is ‘why.’

For Dr. Coffman, that’s not something she spends time worrying about.

“We don’t have to know the reason why. Just like I don’t understand why a pedophile is sexually attracted to a child, I don’t have to understand why a parent is doing this.”

Instead, she says she needs to know if a parent is exaggerating, fabricating or lying about a child’s symptoms. Then, a report can be made to CPS.

“I do believe it’s a compulsive behavior that creates some sort of internal gain for them. They like to be the hero,” Dr. Coffman said.

That doesn’t mean they can’t control their actions, she said.

“They know what they are doing, and they know it’s wrong. It’s premeditated.”

Both Dr. Coffman and Weber say anyone who suspects a child is being subjected to unnecessary medical care should report their concerns to CPS.

“If you suspect it, report it,” says Weber. “It’s no different from physical or sexual abuse.”

On Wednesday, Oct. 17, experts from Cook Children’s gathered at the Regional Child Health Summit to look at 2018 data and trends from more than 8,000 parents who participated in a survey. People from Tarrant, Denton, Parker, Johnson, Hood and Wise Counties participated in the latest Community-wide Children’s Health & Assessment Planning Survey (CCHAPS).

The purpose of the summit was to look at key children’s health priorities in the region and discuss potential area for community action to improve children’s health with the experts in the room.

During the course of the day, several important topics were discussed. Here are some of the highlights.

1. Play time with other children

• 82 percent of the children in our region play with other children every other day or every day, but there is a decrease in daily play from 2015 (from 71 percent to 63 percent.

2. School safety

• 92 percent across the region report children are safe at school. This is lower than the national rate (98%) and the state rate (97%).

3. Children and health care.

• Children in our region are more likely to have a primary physician than children statewide or nationally – even our homeless children. Between 85 – 98 percent of children in this region have a primary care doctor; compared to 65 percent statewide and 73 percent nationwide.
• 10 percent of children in our region, were without health care at some time in the last 12 months. That’s lower that the state average (15%), but slightly higher than nationwide (8%)

4. School Days Missed

• Children in our region are more likely to miss school than the state and national rates reflect and they are more likely to miss more days annually than statewide and national rates reflect.
• 65 percent of our children miss between 1 and 6 days of school per year due to illness or health problems.

5. Mental Health Disorders

• The most common mental health disorder among children in the area is sleep problems, followed by self-esteem, overeating or undereating, traumatic events, wetting the bed and negative or obsessive thoughts.

6. Bullying

• The number of children in our region bullied or teased at school decreased in 2018 from 17percent to 13 percent. Still the number of kids impacted is large with an estimated 93,655 children.

7. Abuse and Neglect

• Except for Denton, the rate all of the CCHAPS region counties is higher than the statewide rate for all three years. The Denton County rate of confirmed child abuse and neglect victims is half of the statewide rate (4.3 percent vs. 8.5). The Hood County rate is more than two and a half times the statewide rate (23.2 vs. 8.5) [Source: Texas Department of Family and Protective Services Data Book. (2016).]

To learn more about the CCHAPS survey and findings, click here.

They just didn’t know exactly how or for how long.

Inside the hospital, nurses and security guards were on high alert. The 2-month-old boy the Shiras were on their way to pick up was under a security watch. He had a broken femur and doctors were certain his injury was no accident. The longest and strongest bone in his body had been snapped in half. On top of that, he was suffering withdrawals from methamphetamine. Child Protective Services (CPS) acted quickly by taking the baby into their custody and beginning the search for a foster family.

“We got a call saying they were ready to discharge this baby and we decided to drive to Fort Worth to pick him up. We didn’t know much, but were told to find a specific nurse and give her a code,” said Katie Shira. “When we first arrived, the staff was very guarded. They weren’t going to let us see him until they figured out we were the foster parents. I was really impressed because they were doing everything to protect him.”

The baby, now known as Jett, was in a Pavlik harness. The full-body contraption kept both of his legs from moving. Katie and Chas listened as nurses explained how they should care for Jett. They had to handle him with extreme caution as the slightest adjustment could cause the baby pain.

When they left the hospital that night, the Shiras had no idea what life had in store. While they both wanted to provide love and support to a child in need, they never imagined the child would be in such a severe state.

“Sometimes I didn’t know if he was crying because his leg was broken or if he was withdrawing from meth,” said Katie. “It was so hard. He would shake and have tremors. His jaw would quiver. It was scary to watch and very sad.”

It took about six months for Jett’s addiction to subside. Slowly, his withdraws faded away and at the same time his leg was healing fast. He was soon able to ditch the harness and begin walking on his own. In many ways, things were looking up, but there was still a tough road ahead.

Jett’s biological family was fighting to get him back. They denied allegations of abusing the little boy and wanted full custody.

After 18 months of Jett living in the Shira’s home, the case finally went to trial. Katie describes the months leading up to that point as some of the most difficult she’s experienced.

“It’s a very odd feeling to have your life in the hands of 12 strangers,” she said. “I was struggling emotionally for two to three months before trial. I couldn’t sleep. I couldn’t eat. The anticipation of what was about to happen was so daunting.”

Katie and Chas both feared that Jett would be taken away from them. Even worse, they were scared he would be placed back into the care of the people who hurt him.

“When the trial began, the attorneys for the biological parents were arguing that his broken leg was an accident,” said Katie. “It got pretty ugly. Dr. Jamye Coffman was on the stand for 3 or 4 hours. She testified that there was no way this was an accident and his injury could have only been the result of abuse.”

Jamye Coffman, M.D. is a child abuse pediatrician and the medical director of the Child Advocacy Resources and Evaluation (CARE) team at Cook Children’s. She saw Jett soon after he arrived at Cook Children’s and followed his journey back to health and into a new home. It would be great to say that Jett’s case was one of the few Dr. Coffman became involved in that year, but the truth is her office saw 1,520 child abuse visits in 2015.

For the Shira family, having Dr. Coffman and the CARE team on their side was a game-changer. After seven days in court and two hours of deliberation, the jury came back with a decision. The Shiras were granted full custody of Jett.

“It’s funny because I feel like she has no idea what she has done for us. She changed the entire dynamic of the trial,” said Katie with audible emotion in her voice. “I get teary thinking about her because I believe she is an angel walking among us.”

For Dr. Coffman, knowing the outcome of cases like Jett’s help her stay motivated.

“Sometimes we don’t know if what we’re doing is really making a difference in a particular child’s life,” Dr. Coffman said. “Knowing that we helped a child is what keeps us going.”

Jett is now 2 years old and was officially adopted by the Shiras in January. Katie says there are days when she still can’t believe he’s theirs.

“It’s still kind of surreal that we don’t have to worry about his safety and well-being. He can just live with us forever,” she said.

In addition to becoming an official Shira, Jett is about to take on a new role. Katie and Chas are expecting their first child in May meaning Jett is about to become a big brother.

“We always wanted to have our own children, but we really wanted to adopt first,” Katie said. “We realized there are kids out there who don’t have the convenience of waiting until we have our perfect family. There are kids at the CPS office right now who just need someone to say yes.”

Adopting Jett Video

About the CARE Team

Led by pediatricians who are board-certified in child abuse medicine, the Cook Children's Child Advocacy Resources and Evaluation (CARE) team provides medical evaluations, psychosocial assessments and preventive education. Most CARE team examinations are conducted following a referral from Child Protective Services, a law enforcement agency or a medical provider.

The team provides medical evaluations for:

• Sexual abuse
• Physical abuse
• Other forms of child maltreatment
• Neglect
• Drug exposure
• Medical child abuse

Find more information by clicking here.

Watch the live interview with Dr. Coffman here.

To see the full story, click here.

Recent studies show that the use of prescription opioids doubled for adolescents, 15 to 19 years of age, between 1994 and 2007. The Centers for Disease Control and Prevention (CDC) reports that nearly 2 million Americans 12 years of age or older either abused or were dependent on opioid painkillers in 2013.

In one study of illicit drug use among teens, opioids accounted for 100 percent of the deaths.

“These are kids that were prescribed opioids for some reason, most of the time for some pain-related condition by dentists, emergency room doctors or primary care physicians,” Dr. Gandhi says. “These kids are going back and taking these medications at a later time. They are using these left overs for non-medical use. We now know that the risk of death from overdose has increased. We also know that the use of opioid prescriptions leads to a higher incidence of anxiety and depression. Interestingly enough, even those kids that are given opioids for a legitimate reason will tend to misuse and abuse drugs.”

The CDC, the U.S. Surgeon General, and President Obama have all taken strong stances on addressing the epidemic of opioid misuse and related deaths.

However, most programs and position statements refer to adults and do not address the issues our children are combatting.

The Pain Management Program at Cook Children’s treats kids with pain ranging from fibromyalgia to migraine headaches to end-of-life patients to kids with life- limiting conditions such as neuromuscular disorders, and pain related diseases such as arthritis, cerebral palsy, etc.

The specially trained physicians at Cook Children’s create a treatment plan that is focused on each particular child and opioids aren’t often the first or only pain medicine used to treat children.

“The danger comes when physicians think the only way they can treat pain is through a narcotic and that’s not the case,” Dr. Gandhi says. We need to know what type of pain the patient is having and take into account the child’s experience of pain. We are all individuals and no two people react the same way."

Dr. Gandhi says that between 15 to 20 percent of the kids seen at her clinic are on chronic opioids, but they are kids that have life-limiting medical conditions or end- of-life conditions.

The other 80 percent of the pain management patients work with physical and occupational therapists and receive therapies such as massage, biofeedback, cognitive behavioral therapy and acupuncture. Music, art and animal assisted therapies are also available for children. They look at all factors that contribute to the pain experience such as diet, nutrition, sleep habits, stress management and coping mechanisms. They create an environment of integrative health where practitioners and patients work together.

“We need to be much more vigilant on how we treat kids’ pain and how we create centers that address that pain,” Dr. Gandhi says. “If you look in Fort Worth or Tarrant County, there are probably 60 adult pain centers in this area, but for kids there are 35 in the entire country. That’s a huge difference. That perspective is crazy.”

About the source

Artee Gandhi, M.D., is a pediatric pain management specialist and anesthesiologist. She has trained across the country including residency at the University of Missouri and fellowship at Stanford Univeristy. Cook Children's Pain Management program cares for infants, children and adolescents with chronic and acute pain. C​ook Children's is one of a few children's hospitals in the U.S. providing a comprehensive pediatric pain management program.

Obesity? That's one.

Car accidents? That's a big risk too.

But would you guess the number one issue is asthma?

In Tarrant County, 19.5 percent of children suffer from asthma, according to data gathered in a survey sent to parents by The Center for Children's Health led by Cook Children's. The Community-wide Children's Health Assessment and Planning Survey (CCHAPS) was completed by more than 8,600 parents in Tarrant, Denton, Hood, Wise, Parker and Johnson counties.

"We questioned parents on everything from how often their child is buckled in properly to how many grocery stores in their neighborhood sell fresh fruits and vegetables," said Larry Tubb, senior vice president of the Center for Children’s Health. "The information we are gathering is extremely valuable when it comes to measuring the overall health of children in our region."

Overwhelmingly, parents in Tarrant County (and all of the surveyed counties) reported their children are dealing with asthma. In fact, children in this area ages 6-9 are three times more likely to have asthma than children living in other parts of Texas. While we don't know why the numbers are so high, we do know people with asthma have varying triggers, and what affects one person will not necessarily affect another. Those triggers include, but are not limited to, cigarette smoke, indoor and outdoor mold, pet dander, air pollution, dust mites, cockroaches, pollen, smoke and strong odors.

The second biggest health issue on parents minds is obesity, with 17.8 percent reporting concerns about their child's weight, activity level and access to healthy foods.

Accidental injuries rings in third. In Tarrant County, 11.9 percent of parents reported their children had been injured and required medical care. Those injuries range from car and ATV-related incidents to drowning, bicycle falls and crashes.

The fourth issue on the list is a lack of dental care for children. Parents reported 9.7 percent of children either didn't see a dentist regularly, didn't brush their teeth enough or some even reported their child didn't have their own toothbrush.

Finally, mental illness is the fifth biggest issue concerning parents in Tarrant County. Behavioral and emotional development is on the minds of 8.5 percent of respondents. Many reported their children have suffered sleep problems, self-esteem issues or have tried to harm themselves.

The survey used to gather this data is part of a Cook Children's initiative to improve the health and well-being of every child in our six-county region by 2020. This initiative launched in 2009 with the very first survey of its kind sent to parents. Since then, the surveys have been sent out every three years.

"The information provided by parents in our community is available on-line and being used by a host of organizations, including Cook Children’s, to build programs and services. There isn’t one perfect answer, but, together we are making solid progress in improving the health of the children in our community by putting the child and family at the center of our planning," said Tubb.

About The Center for Children's Health

The Center for Children's Health, led by Cook Children's, is home to the Community-wide Children's Health Assessment & Planning Survey (CCHAPS), Community Health Outreach and Community Health Research. The center's goal is to create aligned collaborations that will allow us to make our North Texas region one of the healthiest places to raise a child.

The school nurse has long offered an escape from the classroom… and as many Band-Aids as a kid could need. But the responsibilities of a school nurse stretch far beyond their tiny office walls. They are the keepers of care for hundreds, if not thousands, of students. Their duties range from administering CPR to managing insulin pumps and blood sugar levels. In between all of that, there is another heavy responsibility they are tasked with: recognizing and reporting suspected abuse and neglect.

“We want our nurses to have the updated knowledge, skills and resources they need to keep our kids safe and to do their job effectively,” said Cindy Parsons, Director of Health Services at Keller ISD. “The school nurse has an important role in education about child abuse. Teachers and other school staff members may not be as familiar with subtle signs of neglect, and the school nurse is often the person who helps to educate them.”

Irving Police said the boy admitted to choking to death his ex-girlfriend, but his unsolicited confession came before he had his rights read to him.

Although the story is sad and shocking to us, it’s all too common.

When it comes to relationships, teens are the most common age group to experience dating violence, and dating inexperience is often to blame.

“Many teens in danger don’t realize their relationships are unhealthy or that certain behaviors are inappropriate,” said Jamye Coffman, M.D., medical director of the Cook Children’s CARE (Child Advocacy Resource and Evaluation) team. “Abuse doesn’t always involve physical assault, and many inexperienced teens and young adults view threats jealousy and controlling behaviors as signs of love.”

An estimated one in three teenagers is in an abusive relationship.

Because abuse is common in teenage relationships, it’s important for parents to talk with their children about the signs of abuse and the components of a healthy relationship before teens start dating. Parents should also model respectful behaviors in their own relationships.

“Explain that partners should respect and support one another and maintain safe boundaries,” Coffman said. “If you are worried, you can say, ‘I’m concerned about our current relationship, and I want to make sure this is a healthy one for you.’ By maintaining a healthy, respectful relationship with your teenager, you can keep communication open.”

Unfortunately, many of these relationships by teens are carried over into adulthood.

If teenagers are in an abusive relationship and want to break up, support from family and friend is essential. According to Dr. Coffman, teenagers should always carry a cell phone so they can call for help if necessary. They should also never end an abusive relationship when they are alone.

If teens attend school with their significant other, the school needs to be aware of the situation to prevent retaliation from occurring during the school day.

“The break-up period is the most dangerous time for abuse to occur or escalate,” Dr. Coffman said. “Parents need to help their children develop a plan, which should include ways to maintain safety. It’s also important for parents to recognize that girls are not the only ones at risk for abuse, and abuse doesn’t only happen in heterosexual relationships.”

Identifying Abuse

The following signs indicate teenagers may be in unhealthy relationships:

• Checking their significant other’s email, text messages or voicemail without permission.
• Jealousy.
• Mood swings.
• Offhand comments intended to degrade or put down, which are often written off as joking or teasing.
• Withdrawal from friends, family and favorite activities.
• Unexplained bruises or physical injuries.

The best thing a friend can do is help a woman suffering from domestic violence to connect with people who can get her out of her situation so she can develop a safe plan to reclaim her life. If you are in the Fort Worth area, contact One Safe Place to learn more about domestic violence, support victims, or to receive help. Nationally, call the National Domestic Violence hotline at 1-800-SAFE (7233).