About 1 in 4 children are exposed to caregiver intimate partner violence within their lifetime. This places them at risk of profound short- and long-term impacts on their physical and mental health and well-being. Pediatricians can offer education and attempt to intervene in a sensitive manner that validates the lived experiences of survivors and maximizes their safety.
The American Academy of Pediatrics (AAP) recommends ways that clinicians can evaluate, treat and support children exposed to intimate partner violence within an updated clinical report published in the July 2023
The report, "Intimate Partner Violence: Role of the Pediatrician," also provides guidance on advocating for survivors of intimate partner violence, as well as how to connect families with available local and national resources.
Exposure to intimate partner violence: effects on children
"Exposure to intimate partner violence in the home places a child at higher risk of suffering other forms of maltreatment, but also at increased risk of significant adverse physical, psychological, and psychosocial effects," said Jonathan Thackeray, MD, FAAP, a lead author of the report, written by the AAP Council on Child Abuse and Neglect and AAP Council on Violence, Injury, and Poison Prevention.
Witnessing intimate partner violence increases a child's risk of anxiety, depression and withdrawal, and may also result in outward behaviors, such as attention problems, aggression, and rule-breaking actions. About 30% of children exposed to intimate partner violence also grow up to perpetuate abusive behaviors toward others, according to the AAP report.
Creating safe, healing spaces
"Patients and families may be reluctant to share concerns about violence or other forms of abuse in the home, either out of fear, embarrassment or other reasons," Dr. Thackeray said. "We know that pediatricians can help by providing education upfront, supporting children and their caregivers, offering community resources and creating safe and healing spaces."
Intimate partner violence is defined as physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former intimate partner. It also includes other aspects of intimidation and control, including financial and immigration-related abuse.
The AAP recommends that pediatricians:
Endorse a "universal education" approach to addressing intimate partner violence. Pediatricians may routinely provide brief education and resources during office visits, rather than following a traditional screening model. Conversations about intimate partner violence are normalized and an environment is established in which a parent or caregiver has the opportunity to disclose violence only if he or she feels safe and comfortable doing so.
Discuss the unique barriers experienced by those who have both experienced intimate partner violence and oppression/inequity, including immigrants, people of color, individuals living in poverty, and survivors who identify as LGBTQ+. Consider policies and practices rooted in racism and fear that have significantly impacted patients' comfort in accessing resources, treatment, and interactions with the legal system.
Engage with culturally specific agencies and programs to maximize opportunities for impact.
Ensure that all children at risk or exposed to intimate partner violence undergo developmental screening, according to established guidelines.
Identify opportunities to improve intimate partner violence education for learners of all levels.
Intervene in a sensitive and skilled manner that validates the lived experiences of survivors and maximizes safety for the child and caregiver.
"Pediatricians are well positioned to provide vital resources to families experiencing intimate partner violence," said Nina Livingston, MD, FAAP, co-author of the report. "By connecting caregivers to community domestic violence advocacy services, addressing the needs of the child, and taking a strengths-based approach to supporting resilience, we can help these children thrive."