As a pediatrician who specializes in evaluating maltreated children in Central Pennsylvania, I have evaluated more than 5,000 cases. Throughout my career in this field, I am often asked how can I do this work. My answer is, “How can I not?”
In the middle of the last century, after decades of dedicated health care delivery to children, pediatricians began documenting alarming cases of children who were physically, sexually and emotionally victimized by those charged with their care. Since then an elaborate system of identification and legally mandated professional reporting of child abuse has been put into place that identifies more than 700,000 abused and neglected American children each year. As a pediatrician who has dedicated most of my professional life to the care of these children in Central Pennsylvania, I can speak to an unrelenting stream of cases of this preventable condition that affects so many children, stealing their childhood, and paving the way for abuse of their own children and a lifetime of comorbid physical ills as well as dysfunctional behaviors.
The Center for Disease Control and Prevention (CDC) has released data to show that the total lifetime cost of only one year of confirmed cases of child abuse and neglect is $124 billion. The report goes on to document that every year 3.6 million referrals are made to child protection agencies involving more than 6.6 million children — about six complaints per minute, every day. These data complement many other critically important studies, notably the ongoing adverse childhood experiences (ACE) studies that relate childhood exposure to abuse of household dysfunction to several leading causes of death among adults. The ACE studies’ data continues to be analyzed and reveals staggering proof of the health, social and economic costs that result from childhood trauma. The experiences and opportunities we each go through in our early years, both positive and negative, have a long-term impact on our health and development and create a substantial imprint on the adults that we one day become.
As a child abuse pediatrician I have never doubted this concept: that as I help to protect the health of my young patients, particularly those who have been abused or neglected, it will impact them across their entire lifespan. I have worked through the last 40 years with social workers, law enforcement and judicial professionals to identify, prevent and treat child abuse and neglect. The numbers belie our efforts to treat the problem systemically. In addition to nearly 700,000 new substantiated cases of child maltreatment each year there continues to be 1,700 deaths per year due to abuse and/or neglect.
Never in modern history has there been a greater need to care for our children. In this age of instant information we see devastating evidence not only worldwide, but here at home of children subjected to relentless violence, physical abuse, sexual assault, hunger, preventable diseases and inadequate or no educational opportunities. Healthy futures for these children are by no means certain. It is estimated that if your future productivity as an adult is decreased just by 5 percent because of childhood abuse, then we are dealing with a $90 billion problem per year in the U.S.
There are many examples of research-based effective preventive programs that help families create a healthy environment for themselves and their children (Nurse Family Partnership and Parents as Teachers for example). We must enhance these services, develop new ones and make the investment to keep our children safe. An upstream approach is necessary. We need to recognize families that are at risk and help to intervene as soon as possible even before the child is born. Prevention is possible. This is a complex problem that requires a series of thoughtful solutions — there is not one easy answer to how we as a nation can best protect our children. Federal and state leaders must support vulnerable families (raise the minimum wage, early childhood education for all, screening for ACES, earned income tax credits, SNAP), fund child abuse prevention and build a strong, multidisciplinary child welfare system. As we look to the future and what is at stake for these children, I hope that state and federal legislators will have the same resounding answer to the question of how they can do this work: “How can we not?”
Pat Bruno is a pediatrician for Geisinger. He lives in Selinsgrove.