By: Gina Lombardo, Healthcare Policy, 2024
Pediatric emergency departments across the globe play a vital role in detecting cases of child neglect and abuse. Each year, approximately 1 in 7 children in the United States experience some form of neglect or abuse at the hands of someone they know [1]. However, thousands of children suffer in silence as countless cases go unreported each year. Child abuse encompasses various forms of maltreatment, including physical, sexual, and emotional abuse, often accompanied by instances of neglect. It can have profound and long-lasting effects on children's physical and emotional well-being, making early detection crucial to mitigate harm. Pediatric emergency medicine practitioners are uniquely positioned to recognize signs of abuse and intervene effectively to ensure the safety and well-being of their patients.
Pediatric emergency departments are often the first point of care a child victim comes into contact with when entering the healthcare system. For this reason, nurses and doctors are trained to recognize signs of child abuse and neglect to flag down high-risk patients before it's too late. One of the largest and nationally ranked pediatric acute care hospitals, Nationwide Children’s in Columbus, OH, says that there are both subtle and overt signs to look out for when evaluating each child for neglect or abuse [2]. Oftentimes, child victims have trouble maintaining eye contact with their providers during visits, in addition to displaying extreme emotional behaviors or a complete lack thereof. Sudden changes in behavior are also telling, as children will become more tense or fearful with their parents than without. On a physical level, they may appear malnourished and have noticeable bruising or untreated prior injuries — both of which can later stunt growth and development. Often, victims continue to suffer even after they escape their abusers, as children who experience neglect or abuse have statistically lower outcomes as well [3].
According to the American Society of Positive Care for Children, 30% of abused and neglected children will later abuse their own children, failing to break the horrific cycle. In addition to this, they are more likely to engage in sexual risk-taking behaviors, which results in 25% of abused children becoming parents when they are just teens [4]. Overall, the outcomes for children who survive neglect and abuse are daunting, but they shed light on the importance of healthcare providers who double as protectors. Not only do they physically care for their patients, but they play a huge role in mitigating any future harm by catching cases early and often, leading to better outcomes overall.
However, with great responsibility comes great pressure. Doctors admittedly struggle having to watch out for signs of abuse but recognize how important it is to detect them as early as possible. Nkeiruka Orajiaka, a board-certified pediatric emergency medicine doctor, details that this [observing for signs of abuse] is the hardest, yet most rewarding aspect of her career. Her expertise in pediatric medicine, and other specialists alike, allow her to conduct thorough medical evaluations to differentiate between accidental injuries and those caused by abuse. Dr. Orajiaka asserts that “dealing with children who have been sexually or physically abused before they can even read or write makes her wish she could erase her memory”, but bringing them justice is what keeps her going. However, she highlights how prevalent cases of neglect and abuse have become, especially since the COVID-19 pandemic. “Evaluating 3 to 4 cases of neglect or abuse per day has become the norm” stated Dr. Orajiaka, which is a major public health concern for children across the country. She urges that there is a continued need to train pediatric healthcare professionals in screening for neglect and abuse as the issue continues to persist [5].
Pediatric emergency medicine providers play a critical role in recognizing signs of child abuse and advocating for the welfare of vulnerable children. Their training, compassion, and commitment to child wellbeing are essential in addressing the complex needs of victims to set them on a path of recovery and healing. Pediatric EDs act as the eyes and ears of children in danger, which gives them a voice to receive the care and protection they deserve.
References
World Health Organization. (n.d.). Violence against children. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/violence-against-children
Recognizing signs of child abuse and neglect. Nationwide Children’s Hospital. (n.d.). https://www.nationwidechildrens.org/family-resources-education/700childrens/2017/04/recognizing-signs-of-child-abuse-and-neglect
Hyden, P. W., & Gallagher, T. A. (1992). Child abuse intervention in the emergency room. Pediatric clinics of North America, 39(5), 1053–1081. https://doi.org/10.1016/s0031-3955(16)38407-3
Child maltreatment & neglect statistics. American SPCC. (2024, January 29). https://americanspcc.org/child-maltreatment-statistics/
Nkeiruka Orajiaka, M. D. (2021c, July 12). I’m an ER pediatrician. the hardest part of my job is what happens in “room 65.” HuffPost. https://www.huffpost.com/entry/emergency-room-pediatrician-sexual-assault-children_n_60e5e7a5e4b0e01982e93c55
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