This is our yearly reminder to redouble our efforts to identify children at risk of maltreatment and employ strategies to promote the physical, social and emotional well-being of children and families.  

• U.S. Data for 2010 indicated that approximately 9 per 1000 children had been documented for maltreatment, with neglect being cited in 78% of these cases. 

• Children under 8 years old are at highest risk for neglect or abuse, comprising 57% of the cases for children birth to 18 years 

• Those typically responsible for maltreatment were parents (81%). 

In their article, Children’s Exposure to Violence as a Public Health Issue, San Francisco clinician-researchers Alicia Lieberman and Esta Soler warn that, in addition, children under 5 years are more likely than older children to witness domestic violence in their homes. [AF Lieberman & E Soler (2013). Child exposure to violence as a public health emergency. Zero to Three Journal, 34(2), 4-10.] 

This high prevalence of exposure to interpersonal violence in infancy and early childhood has stark implications for children across the age range because early experiences are most influential in shaping the structure and functioning of the brain, the quality of attachments and other relationships, and the child’s readiness to explore and learn. The physical and mental health problems and learning difficulties of older children may have their roots in early victimization experiences that remain unidentified and unaddressed. – Page 5

Cycles of intergenerational violence within families have been well-documented, showing that parents who were abused as children may be at higher risk of abusing their own children or experiencing partner violence.  How and why does this happen?  Lieberman and Soler help us understand:

When traumatized parents feel helpless to protect their children and themselves from drive-by shootings, gang violence, and street crime, their heightened stress may find expression in harsh corporal punishment of their children in a misguided effort to instill good behavior or necessary survival skills.  In turn, traumatized children may engage in dysregulated and aggressive behavior that triggers parental punitiveness, creating attachment patterns characterized by anger and fear.  Children who are chronically afraid—both within the family and in their communities—are more likely to misperceive cues to danger and resort to aggression in an effort at self-protection.  Through these multiple overlapping patterns, violence becomes a social virus that generates contagion at all levels of the family and community….”- Page 5

Adverse Childhood Experiences Have Lifelong Consequences

The repercussions of early childhood traumatic experiences can last a lifetime and be passed to future generations.  Unfortunately, these experiences are common, as determined by the Adverse Childhood Experiences (ACES) Study.  It tracked the prevalence of childhood experiences (including domestic violence, abuse, and family dysfunction) in more than 17,000 primarily White middle class adults receiving routine health care inCalifornia.  Nearly two thirds of participants reported at least one adverse childhood experience, and greater than one fifth reported three or more ACEs.  These early adverse experiences were linked to chronic physical and mental health problems in adulthood.  A more recent ACE study has found similar results across a random sample representing multiple racial/ethnic and socioeconomic groups in five states. ACE studies show that the accumulation of adverse experiences increases the risk of developing major health issues as adults, such as heart disease, cancer, diabetes, alcoholism, drug abuse, depression, and attempted suicide.  The ACE research results point to the critical need to identify early signs of abuse, neglect, and other concerns about family functioning, that could hamper children’s long-term health or place them in harm’s way.  

Prevention: Identifying Families at Risk

Prevention is key to breaking the intergenerational cycle of trauma described above.  That means everyone involved with young children and families needs to be on alert.  Pediatricians and other health practitioners, for example, are in a prime position to detect families a risk.    For example, rather than focusing solely on the physical health of the child, pediatricians have the opportunity during routine visits to assess family strengths and challenges, and advise parents on the health and developmental impact of early experiences.  As trusted experts, healthcare practitioners can refer families to community resources that offer support, education or therapy when needed, and discuss which resources best fit each family’s needs.

In his article, Converging Trends in Family Research and Pediatrics, Donald Wertlieb discusses how children who have experienced adverse events may circumvent negative outcomes with the help of resilient families to develop into healthy adults.  He advocates for the

…need to consider family processes, such as conflict, anger, aggression, emotional neglect, and ineffective discipline, as elements in poor health outcomes for children. At least as important will be consideration of the association of successful family variables, such as good communication, social connectedness, positive parenting, and religious or spiritual orientation, as factors in health and illness. – Wertlieb, page 1574.

Assessing Parents at Risk

In our daily work with families we all need to pay attention to the parenting strengths that serve as protective factors contributing to the child’s resilience.  We also need to identify parenting concerns that may hinder child health and safety.  There are interventions proven to increase protective factors and reduce child maltreatment.  Early identification, coupled with intervention, can lead to maltreatment prevention.  By intervening early we can promote strong and rewarding parent-child interactions, which create a positive spiral of reinforcement.  Similarly, by intervening early we can prevent the downward spiral of negative parent-child interactions that can lead to abuse. An observational parenting assessment, such as KIPS, facilitates this process by offering an appraisal of current parenting strengths and identifies areas for improvement.  Thus, assessing parenting plays a critical role in preventing child maltreatment.  Since a bit of prevention can yield lifelong benefits, the effort is well worth the cost.