“He used to put a wrench, a stick, and a belt on the table, and just say, ’Choose.’ ”

What is good parenting?  What is child abuse?  If you grew up accustomed to a certain way of life, then repeating the things you know best seems normal, even if the world around you thinks you may be a monster.  I would not want to be Adrian Peterson this week for all the money or NFL records in the world.  I thought a switch was an electrical device, only to find out it is a tree branch used by some parents (described by many sports personalities and commentators as being black parents in the South) to teach discipline.  See the stories in Forbes, ESPN and Chicago Tribune.

New Hampshire’s Health and Human Services Division for Children, Youth and Families receives more than 15,000 reports annually concerning suspected child abuse and neglect.  The Bureau of Child Protection works to protect children from such physical, sexual or mental abuse and neglect while trying to keep the family unit intact, if possible.  The Federal Child Abuse Prevention and Treatment Act (CAPTA), which was amended in 2010, identifies a minimum set of acts or behaviors that define child abuse and neglect.

What defines child abuse and neglect in our medical universe, you may wonder?  The American Academy of Pediatrics has gone into great detail about physical, sexual and emotional/psychological abuse.  Physical abuse is defined as “any physical injury to a child that is not accidental and may involve, but is not limited to, hitting, slapping, beating, biting, burning, shaking, or strangulating.  As a result of these actions, a child may have bruises, broken bones, burns, or internal injuries that document the occurrence, as well as imprints of the specific object used to inflict the injury (e.g., belt buckle, hand, and knuckles).”  In 2006, the national rate of child maltreatment was 12.1 per 1,000 children under age 18, but sadly, the rate for African American children was the highest, at 24.7 per 1,000.  Definitions of child abuse vary between tribal, state and federal jurisdictions (an injury that goes beyond temporary redness, Tennessee?), but as physicians, we have a duty to report our suspicions of child abuse.  Understanding the physician’s relationship with the family, case-specific elements (pattern of injuries, delay of care), access to professional resources to discuss possible abuse concerns and any prior experience with Child Protective Services (CPS) will all likely increase reporting of abuse by a physician practice.  A 2008 study showed that only 6% of suspected child abuse injuries were reported by physicians to CPS.  We need to do better, no matter how uncomfortable it may appear at first.  See the articles in AMA’s Virtual Mentor, American Medical News and American Family Physician.

Growing up as a kid in Brooklyn in the 1960s and ‘70s, I was actually a Vikings fan, because they had Fran Tarkenton (the original Johnny Football) and the Purple People Eaters, went to the Super Bowl a lot and the New York Football Giants, my hometown team, were horrible.  I also got to eat soap if I cursed at my parents, and once got to pick which belt I was going to be hit with.  I suppose I turned out alright, but the rules were different back then.  We were just kids and believed it was our fault.


Stuart J. Glassman, MD

Please send your comments or questions to president@nhms.org or post a comment below.