~ by Linda M. Girgis, MD
There is nothing sadder than the death of a child, except maybe a death that was preventable. In the US, an average 5 children die every day as victims of child abuse. While the US leads the world in innovation and technology, it lags behind many other countries in the protection of its children. If you watch the media, people are outraged by a child allowed to play alone in the park, yet no one raises a voice for the children that are abused to death.
Why is it important to talk about child abuse on a medical blog?
The medical community is one layer of defense protecting these children. Yet, doctors, nurses and healthcare workers often fail to identify these kids. Teachers are not finding these children at risk. Society is not seeing the abuse happening.
Preventable deaths aside, why should doctors need to pinpoint these cases? Perhaps, most importantly, one third of abused children go on to become abusers themselves. It is imperative that we break this cycle of violence. Approximately, 14% of men and 36% of women in prison were abused as children. This is double what is observed in the general population. Children who have been abused are 9 times more likely to become involved in criminal activities. They are also 25% more likely to become pregnant as a teenager and engage in more high risk sexual behaviors. Additionally, almost 75% of those receiving treatment for drug abuse report a history of abuse or neglect.
Survivors of child abuse have complications lasting into adulthood. These adults tend to suffer from higher rates of mental health disorders. These include, but are not limited to, depression, personality disorders, anxiety disorders, PTSD, eating disorders, increased risk of suicide, dissociation and sexual difficulties. It has been estimated by at least one source that 50% of those abused as children have 3 or more psychiatric disorders. Many survivors’ lives are defined by frequent crises leading to job dissatisfaction, failed relationships, frequent relocations, and financial setbacks. Many of these adults live in “crisis mode” and this can be quite disheartening and exhausting.
Similarly, these adults face more physical complications than those who were not abused as children. These range through a whole gamut of diseases including diabetes, GI problems, heart disease, certain neurologic disease, etc. The mechanism of why it occurs has several factors. The obvious is that some physical problems begin in childhood as a direct result of the abuse. It has also been postulated that the stress caused by the early abuse alters the immune system and these changes play a role in the later development of these diseases. There have also been studies suggesting that childhood abuse affects the brain structure and the way neurons connect with each other. While the exact etiology is unclear, many studies clearly support that a history of child abuse clearly leads to increased chronic medical problems as adults.
Knowing the devastating consequences of child abuse and neglect, why does society allow it to continue?
For one, it is often very well hidden. The perpetrators are careful to hide their crimes so it is not so easy to detect. It is also something that is so horrible that many people can’t believe this evil exists. It is easier to ignore the signs. But, we can no longer afford to that. Children suffer and die as we stand by. And they suffer into adulthood. We, especially the healthcare workers among us, need to take greater measures to find these kids and save them, not only from the abuse, but the future risks of mental and physical diseases.
Child abuse is not so easily discoverable but any unexplained injuries or bruises should always be questioned. And ask yourself, does the injury match the mechanism of injury? Also, be on the lookout for bruises or burns that match the shape of an object. Conflicting reports from the child and adults should be a red flag. Changes in a child’s behavior are also a clue. Be concerned if you see a child suddenly become anxious, withdrawn or aggressive. Some children even return to earlier behaviors like thumb sucking and bed wetting. Many of these children are afraid to go home and reluctant to leave school. They may appear frightened to go with the abuser. Changes in eating habits or weight can be seen. Sleep problems, such as nightmares, can frequently be observed. These kids may appear unusually tired or fatigued. Lack of personal hygiene is often seen as well. Some of these kids engage in high risk behaviors or inappropriate sexual behaviors. It always better to err on the side of protecting a child than overlooking a case of abuse. If you have the least suspicion, contact CPS and let them investigate.
While the statistics are truly scary, there is nothing more frightening than to be a child living through the abuse. No can imagine what it is like to hide for fear of your life under your bed or learn to tolerate the taste of your own blood in your mouth. I know because I lived that life. Don’t kids deserve to be treated better and kept safe from harm?
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Bio
Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter’s University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University, UMDNJ, and other institutions. Dr. Girgis earned her medical degree from St. George’s University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University. She has appeared in US News and on NBC Nightly News.
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