Child Abuse Prevention Month stresses understanding (4/15/98)April is Child Abuse Prevention Month - time to alert the citizens of South Texas to the ramifications of child abuse, its symptoms and treatment - since one in three girls and one in seven boys now living in Bexar County will have an unwanted sexual encounter by the time they are 18 years of age. And for every known case of sexual abuse, an estimated three victims remain silent.
"Child abuse begins in the home," says Nancy Kellogg, MD, medical director of the Alamo Children's Advocacy Center and associate professor of pediatrics at The University of Texas Health Science Center at San Antonio. "Victims of physical and sexual abuse may never experience childhood.
"Many parents understand the ramifications of child abuse," says Dr. Kellogg, "but some, who must struggle with day-to-day living, do not."
Some children who disclose their abuse end up in foster homes; others receive no support and eventually retract their stories, sometimes forever, according to Dr. Kellogg. The Alamo Children's Advocacy Center represents the city of San Antonio and the Health Science Center's desire to work towards more humane treatment of these children.
During the '70s and '80s, Dr. Kellogg recalls, the public shunned discussions on sexual abuse, but when overwhelming numbers and evidence was found on its prevalence, people began to listen and to understand. Today, sexual abuse in children is more common than asthma, according to Dr. Kellogg.
"The biggest problem is what sexual abuse does to the mind of the child," says Dr. Kellogg. "Since the perpetrator is usually a person the child knows well and trusts, abuse means loss of faith in adults. The best way to keep an abused child silent is to instill guilt in that child. From this point onward, that guilt is crippling. Without counseling, the child will have lifelong problems in forming stable relationships.
"Some children who have been abused often feel guilty and responsible for getting the abuser into trouble. I try to explain the situation in a way the child hasn't considered," Dr. Kellogg explains. "I tell them that adults who abuse children are similar to people who are addicted to drugs. The adult has an illness and is unable to stop himself until he gets help. When a child tells, it is an opportunity for the abuser to take responsibility for his actions and get help.
"I point out to the child that yes, the abuser should take responsibility for what he has done, that his actions were wrong, and that yes, he should be punished," continues Dr. Kellogg. "but I also point out to the child that the abuser needs help."
Will the abused child heal? "This depends upon the child's family," says Dr. Kellogg, "and the support the child receives after abuse has taken place."
There isn't a lot of respect for kids these days, according to Dr. Kellogg. "To be seen and not heard is still a common approach of many parents, so children don't understand their rights.
How, as parents, we raise our children is so important. It's hard to understand, when we have a child and love that child, that losing control during discipline creates first a victim and later, a perpetrator. But in many dysfunctional families losing control is common.
"This is especially true when we are talking about physical abuse. I talk to children and I ask them how they usually get punished when they do something bad," she continues. "It is common for them to be hit with a belt, paddle, switch or some other object in a way that leaves bruises or marks. But the child does not see this as a violation of their rights; they see this as a common practice, or a parent's right. The child may even say, 'I broke this, or I lost that, so I deserved what I got.'
"Many children are not only hit by objects with a force that causes visible injury, but are also choked, kicked, slapped or punched with a fist," says Dr. Kellogg. "The child does not perceive this as abuse because this is the standard they know. If they do not perceive that their rights have been violated, then they won't tell anyone what happened to them. If they don't tell, they can't get help because most of the injuries of child abuse are hidden or obscure.
"When you hit your child in a way that leaves marks, you teach the child that violence is the way to resolve a conflict," says Dr. Kellogg. "The message your child receives is 'If you don't like something, strike out.' The violent programs on TV, even cartoons, often reinforce this idea, and the community we live in doesn't teach children otherwise. There begins to be a desensitization to violence, making impulsive and tragic episodes of violence - such as an 11-year-old boy killing his schoolmates - more likely to occur."
According to Dr. Kellogg, part of the problem is that we lack clear guidelines on behavior that is classified as physical abuse. "When children have to go to the hospital as a result of physical abuse, that's one thing," she says, "but what about those victims who don't end up in the hospital? What happens to them?
"We need to be very clear on the definition of physical abuse," she says. "There are laws governing parents' rights. At what point are the rights of the parents deemed reasonable? A parent is allowed to discipline the child, but the discipline is considered abuse when substantial harm is done to the child."
What can we, as parents, do to raise our children properly?
"Parenting requires both positive and negative reinforcement. Positive reinforcement is when you 'catch 'em being good' - you comment on the nice way they are playing, helping, working," says Dr. Kellogg. "As busy parents, we tend to give more negative reinforcement. 'Don't touch that; don't hit your brother; you need to hurry up or we'll be late.' Parents should keep track of each type of reinforcement, making sure that they have at least one more check mark in the positive column than in the negative column by the end of the day.
"I feel so privileged that the abused children I talk to are able to share a very hurtful and intimate part of their lives," the pediatrician continues. "When they are abused their trust is shattered, so when I talk with them and examine them, it is my responsibility to earn, not assume, their trust. I try to show them that some adults can learn to listen. Some parents don't listen, and it is critical in child-rearing to be able to communicate with your child."
Sexual abuse in children is frequently difficult to diagnose and health care professionals may need help from their peers for certain diagnoses, according to Dr. Kellogg. This has been a problem, especially in Texas, where there are many under-served rural areas. It has sometimes been difficult for physicians to make peer contact.
"There is an emerging telemedicine network that is going to offer a solution to this problem," says Dr. Kellogg. Called the Children's Justice Act Telemedicine Network, the project is attempting to establish a statewide collaboration.
"This is a new frontier in treating child abuse," says Dr. Kellogg. "This computer program will allow us to capture, transmit and store medical images. We can discuss cases with peers via teleconference, and all participants can give their opinion. This will be invaluable in the future."
Child abuse victims and their families may receive information or assistance by calling any of the following numbers:
Contact: Jan Elkins (210) 567-2570