Signs of abuse are dark side of pediatrics

The word pediatrician conjures up Norman Rockwell-like images of a doctor listening to the heart of a child's doll. We tend to be a happy crew: treating newborns with unlimited potential, struggling with teens as they figure out who they are. That's the good stuff.

But there's a darker side of pediatrics. It rears up when a child removes his shirt for an exam and has telltale bruises. Or when a child flinches each time a parent moves suddenly.

Recently, as I was preparing for patients, I noticed a consult report on an 8-year-old boy whom I have been caring for since birth. His visits were always a highlight because I knew that behind the exam-room door would be a smile and an infectious energy.

The ominous letterhead of the consult, which I have seen too many times, was from our Child Protection Team at St. Christopher's Hospital for Children. The five-page report was filled with words that would forever change my patient's life: Cousin, penetration, repeated multiple times, thoughts of death. As I walked into the exam room, he met me with a downward gaze and a shrug when I asked about his summer. I felt anger, grief, and sorrow for him and his family.

The 2013 welfare department's Annual Child Abuse Report is filled with chilling statistics and accounts.

In 2012, there were 26,664 reports of suspected child abuse in Pennsylvania, a rise of 2,286 over 2011. Of these, 13.4 percent were substantiated. Eight percent of those reports involved children who had been abused before. Almost 300 children are falling through the cracks of child protection.

The Philadelphia Urban Adverse Childhood Experience Study, which surveyed adults' experiences as children, found 35 percent of city adults were physically abused, and 16 percent sexually. A tsunami of trauma.

Tragically, 33 Pennsylvania children died from abuse in 2012, most of them less than 4 years old. Deaths were by blunt force, suffocation, drowning, and starvation. They were defenseless. Like Jaquinn Brewton, 3, who died by blunt force to the abdomen in a trash-strewn West Philadelphia apartment. His godmother and her boyfriend repeatedly beat the 31/2-foot, speech-delayed boy with belts, shoes, and metal brushes and burned him with boiling water and a cooking torch.

The costs in Pennsylvania from child abuse are $3.5 billion. The cost to each child can't be estimated.

We know the risk factors for abuse. Disabled kids and those with difficult temperaments are more often hurt.

Risk factors in the parent include substance abuse, mental illness, lower educational levels, impulsivity, and a history of maltreatment.

Risk factors in the family include domestic violence, poverty, single-parent households, having a non-related male in the home, multiple children, and food insecurity.

Risks for the community include social isolation and lack of community supports such as places of worship and playgrounds.

People who care for children in the state must report suspected abuse to ChildLine (1-800-932-0313). Callers need have only a reason to suspect abuse.

The population we serve in the First Congressional District has all of the ingredients to brew a large urban stew of children at risk. Our child poverty rate is the nation's third-highest at over 45 percent. The district ranks second in single-parent families (67 percent) and in food insecurity.

Programs such as Pennsylvania Family Support Alliance (www.pa-fsa.org), SCAN (www.scanpa.org), and Prevent Child Abuse (www.preventchildabusepa.org) use the best approaches to help families.

As I continue my day, talking to parents about safety, nutrition, and the joys of parenting, I start to relax. I am happy to slide back into the blissful world of newborns and toddlers with scraped knees.

But the memory of my 8-year-old patient never goes away. I remain prepared for the dark side of pediatrics.