Child abuse and neglect, also known as maltreatment, can stem from family stress, economic pressure, substance use or a variety of other factors. But like other health risks, it can be prevented, according to the American Academy of Pediatrics.
The AAP has updated a clinical report outlining ways pediatricians can reduce child maltreatment. Efforts to reduce child maltreatment include offering anticipatory guidance to families and caregivers, identifying family stressors, and providing evidence-based interventions to reduce child maltreatment.
Resilience fueled by positive social relationships
"Resilient families typically have positive social relationships," said John Stirling, MD, FAAP, lead author of the clinical report. "They have access to housing, food and vital services, which lessens stress and makes daily life more manageable.
"When families have this strong foundation, they are in a better position to foster safe, stable and nurturing relationships with their children. These strong connections help children learn to regulate their own emotions, maintain relationships and deal with adversity," Dr. Stirling said.
Types of child maltreatment
Child maltreatment includes child abuse, child neglect, sexual abuse and psychological abuse. Each type is discussed in the clinical report, written by the AAP Council on Child Abuse and Neglect. The report also addresses what pediatricians can do if maltreatment has already occurred, offering interventions to prevent further victimization and alleviate long-term damage after childhood trauma.
Public health research shows that child maltreatment is often associated with economic or environmental stress, and that a child's resilience is compromised by a lack of healthy relationships.
The power of positive experiences
Positive experiences count, too. "Even more important than knowing what is going wrong in a family is knowing what is going strong," said Amy Gavril, MD, MSCI, FAAP, a co-author of the report. "Pediatricians can most effectively work with families when they see positive relationships or strengths to build on. Perhaps there's a teacher or family mentor who offers to provide a child with some extra time and care, for instance."
The AAP recommends that pediatricians:
Obtain the social history of the child and family members initially and over time. History taking, observation, and surveillance can identify family stressors, including characteristics particular to the child that are challenging for a parent. Normal variations in infant crying, feeding difficulties, toilet training, and defiant behavior have all been triggering events for physical or emotional abuse.
Acknowledge and address parents' concerns while reinforcing effective parenting.
Guide parents in providing effective, nonphysical discipline.
When caring for children with disabilities or chronic illness, heed their increased vulnerability. Be alert to indicators of parental intimate partner violence, unhealthy substance use and depression, and know how to respond if a caregiver reports such problems.
Learn about community resources and offer referrals when appropriate.
Prepare the physician-led team to accommodate the complex presentations of families undergoing stress.
Offer practical guidance to caregivers on supporting the child or adolescent who has been victimized to prevent further maltreatment.
Monitor frequently for signs and symptoms of toxic stress and continued maltreatment, and recommend therapeutic interventions and mental health services.
The AAP discusses other resources, such as parenting programs, home visitation and early childhood education that have been shown to promote safe, stable, nurturing relationships and help prevent child maltreatment. The clinical report includes information on preventing sexual abuse by helping families raise their children around healthy, respectful sexual relationships, enhancing a child's self-esteem and communication skills, and providing age-appropriate education on sexual development to children and parents.
"By paying attention to healthy family relationships and helping caregivers deal with risky situations, pediatricians can take a giant step towards reducing child maltreatment before it occurs," Dr. Stirling said. "We have the skills and a unique opportunity to help."
Clinical reports created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.
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