Children with disabilities are three times more likely to become victims of abuse and neglect than their non-disabled peers, a disturbing statistic that is likely underreported because many children can't communicate the maltreatment.
Yet the pediatrician, as a trusted child advocate and role model, is well equipped to help prevent abuse by asking families about the pressures they face and offering assistance.
The American Academy of Pediatrics, in an updated clinical report released during National Child Abuse Prevention Month, expands on the understanding and incidence of abuse of children with disabilities for the first time since 2007. The report, "Maltreatment of Children With Disabilities," is published in the May 2021
Pediatrics. It brings new research to light that finds some disabling conditions place children at higher risk of maltreatment.
Coping skills & support
"As pediatricians, we see families every day who are trying to do their best for their children but may lack the coping skills and resources to help manage stress or difficult circumstances," said Lori A. Legano, MD, FAAP, lead author of the report, written by the AAP Council on Child Abuse and Neglect and AAP Council on Children With Disabilities.
"By asking questions and listening to caregiver concerns, we can help families improve parenting skills, set appropriate expectations for their children and help identify community resources that offer assistance."
For the purposes of this report, "disability" is described as a full spectrum of significant impairment in any area of motor, sensory, social, communicative, cognitive, and emotional functioning among children and adolescents. According to research, children with milder forms of disability are at higher risk of abuse and neglect than more profoundly affected children – possibly because parents overestimate their capabilities.
"Parenting a child with disabilities is often challenging," said Larry W. Desch, MD, FAAP, an author of the report. "Some children with disabilities respond differently to the usual ways we think about discipline and reinforcing good behavior. This can become very frustrating and add to the caregiver's stress."
Families may also be overwhelmed by the complex needs of children with disabilities, in both special health care and educational needs. Often children will need to receive essential medications, therapies, and appropriate educational placement, which can add to financial stress.
The U.S. Children's Bureau reported that an estimated 678 000 children were determined to be victims of abuse or neglect in 2018, with about 61% of those cases described as neglect. According to national data from 2015, child victims with a disability accounted for about 14% of all victims of abuse and neglect.
How pediatricians can help
AAP recommends that pediatricians can help by:
Recognizing signs and symptoms of child maltreatment in all children and adolescents, including those with disabilities, and understanding mandatory, state-specific reporting requirements for child and adult protective services.
Using each medical visit as an opportunity to assess family well-being.
Providing reasonable expectations for parents regarding their children with disabilities, offering concrete suggestions about how to respond to common developmentally based challenges for the child.
Referring families of children with disabilities to available community resources and agencies that provide services designed to aid families.
Structuring discussions about appropriate
discipline within well-child visits for the child with a disability.
Advocating on the local and state level for policies that support at-risk children.
"We encourage parents and caregivers to ask for help," Dr. Legano said. "Pediatricians can offer a nonjudgmental perspective, help families focus on their child's strengths and guide them through challenging times."