Hendrick seminar examines Child Abuse

Abilene, TX  –  Knowing if a child’s injuries constitute abuse can be a difficult task, requiring medical personnel and others to step back and see if the facts fit, said Dr. Jamye Coffman, medical director of Cook Children’s Medical Center’s C.A.R.E. Team.

“Does the story they’re telling of the fall off the bed, the turning on the hot water accidentally, whatever it is, does that fit with what you’re seeing?”  Coffman said after her talk, “Recognition and Evaluation of Child Abuse,” at Hendrick Medical Center on Thursday.

Coffman spoke Thursday at “Kids Count…On Us: A Conference on the Prevention of Child Abuse.”

The idea for “Kids Count” grew from an “alarming increase in child abuse cases in our area,” according to information provided by Hendrick.

“We feel like this needs to be offered in our community and information needs to be given out to everyone, not just nurses but law enforcement, Child Protective Services, social workers, and people in our community that deal with these problems every day,” said Susie Striegler, sexual assault nurse examiner program coordinator.

This year’s conference included presentations on babies born addicted, recognition and evaluation of child abuse, interdiction for the protection of children and sex trafficking in Texas.

Those trying to ferret out the truth of an injury must know if a child’s injuries are consistent with the history of the case, consistent with the child’s developmental level, and whether or not the history is constant over time, Coffman said.

One must also consider any potential delay in seeking care, possible triggering events and overall timing, she said.

WITH NO HISTORY

A problem is that often, children come in with no additional or known history, she said, something that “really hamstrings the medical staff because they’re having to figure out what’s wrong with this child with no information,” Coffman said.

“We never know what we’ll see when we’re called in,” Striegler said.
Certain injuries, though, can provide clues – bruising patterns, for example.

“Accidents happen, but the child has to be old enough to get into the accident,” Coffman said after her talk.  “If you have a child that is non-mobile – they can’t crawl, they can’t walk, how are they going to get hurt?  And if they do get hurt, somebody knows.  They can’t get back up into the crib, somebody has to pick them up and put them back.”

There’s really no such thing as a person’s rank outstripping anyone else, she said, at least when it comes to this issue, she said.

“It doesn’t matter what anyone else thinks, if you have concerns, you have to make the report,” Coffman said, recalling times when nurses correctly expressed concerned about possible abuse when physicians didn’t.

“It takes that investigation to know if it is or isn’t (abuse),” she said, a process that begins with an individual following through on initial concerns.

EFFECTS DIFFER

Abuse can affect a child in a variety of ways, Coffman said.

We know that abuse is toxic stress,” she said.  “We know that it has the potential to have effects down to the cellular level”.

That includes brain structure – “how the brain grows or doesn’t grow, what neurons are created, what connections are created,” she said.

Abuse can create changes at the hormonal level because of the stress hormones, she said.

“It can create risk for chronic health conditions later in life,” Coffman said.

Abuse can even create change at the genetic level, she said.

“There are what is called epigenetic modifications, so it can even change gene expression, which can be generational,” she said.

Such considerations make intervention “extremely important from a public health standpoint – not only moral and ethical,” Coffman said.

“If you get the intervention, if you make the report, the child gets the help they need,” she said.

Without such help, “there’s no hope,” she said.

Appropriate intervention can also open positive doorways for parents, Coffman said.

“Parents of these kids, I think sometimes we have to look at their past, and instead of saying ‘what’s wrong?’ (ask) ‘what happened to you?’” she said  “That can open up the conversation.”

And that means those parents may be open to more help, including learning “different ways to parent,” Coffman said.

If they’re willing to do that, then “perhaps we can stop the cycle” of abuse, she said.