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An opinion on child abuse and the negative impact on the growing child

Every effort should be made to make foster care a positive experience and a healing process for the child. Threats to a child's development from abuse and neglect should be understood by all participants in the child welfare system. Pediatricians have an important role in assessing the child's needs, providing comprehensive services, and advocating on the child's behalf. The developmental issues important for young children in foster care are reviewed, including: Additional topics addressed relate to parental roles and kinship care, parent-child contact, permanency decision-making, and the components of comprehensive assessment and treatment of a child's development and mental health needs.

More than 500 000 children are in foster care in the United States. Such experiences are critical in the short- and long-term development of a child's brain and the ability to subsequently participate fully in society. Legal responsibility for establishing where foster children live and which adults have custody rests jointly with the child welfare and judiciary systems.

Decisions about assessment, care, and planning should be made with sufficient information about the particular strengths and challenges of each child. Pediatricians have an important role in helping to develop an accurate, comprehensive profile of the child.

Developmental Issues for Young Children in Foster Care

To create a useful assessment, it is imperative that complete health and developmental histories are available to the pediatrician at the time of these evaluations. Pediatricians and other professionals with expertise in child development should be proactive advisors to child protection workers and judges regarding the child's needs and best interests, particularly regarding issues of placement, permanency planning, and medical, developmental, and mental health treatment plans.

For example, maintaining contact between children and their birth families is generally in the best interest of the child, and such efforts require adequate support services to improve the integrity of distressed families. However, when keeping a family together may not be in the best interest of the child, alternative placement should be based on social, medical, psychological, and developmental assessments of each child and the capabilities of the caregivers to meet those needs.

Health care systems, social services systems, and judicial systems are frequently overwhelmed by their responsibilities and caseloads. Pediatricians can serve as advocates to ensure each child's conditions and needs are evaluated and treated properly and to improve the overall operation of these systems. Availability and full utilization of resources ensure comprehensive assessment, planning, and provision of health care. Adequate knowledge about each child's development supports better placement, custody, and treatment decisions.

Improved programs for all children enhance the therapeutic effects of government-sponsored protective services eg, foster care, family maintenance.

The following issues should be considered when social agencies intervene and when physicians participate in caring for children in protective services. Basic stimulation techniques and stable, predictable nurturance are necessary during these periods to enable optimal cognitive, language, and personal socialization skills.

Because these children have suffered significant emotional stress during critical periods of early brain development and personality formation, the support they require is reparative as well as preventive.

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The pediatrician, with knowledge of the child's medical and family history, may assist the social service and judicial systems in determining the best setting to help the child feel safe and heal. Attachment is an active process—it can be secure or insecure, maladapative or productive. Attachment to a primary caregiver is essential to the development of emotional security and social conscience. Successful parenting is based on a healthy, respectful, and long-lasting relationship with the child.

The psychosocial context and the quality of the relationship from which a child is removed, as well as the quality of alternative care that is being offered during the separation, must be carefully evaluated. This information should be used to decide which placement is in the child's best interest. The longer a child and parent have had to form a strong attachment with each other ie, the older the child the less crucial the physical proximity will be to maintain that relationship.

Separation during the first year of life—especially during the first 6 months—if followed by good quality of care thereafter, may not have a deleterious effect on social or emotional functioning.

Separations occurring between 6 months and about 3 years of age, especially if prompted by family discord and disruption, are more likely to result in subsequent emotional disturbances. This partly results from the typical anxiety a child this age has around strangers and the normal limitations of language abilities at this age. Children older than 3 or 4 years placed for the first time with a new family are more likely to be able to use language to help them cope with loss and adjust to change.

These preschool-aged children are able to develop strong attachments and, depending on the circumstances from which they are removed, may benefit psychologically from the new setting.

The emotional consequences of multiple placements or disruptions are likely to be harmful at any age, and the premature return of a child to the biologic parents often results in return to foster care or ongoing emotional trauma to the child. Any time spent by a child in temporary care should be therapeutic but may be harmful to the child's growth, development, and well-being.

Interruptions in the continuity of a child's caregiver are often detrimental.

  • Often parents believe that they have shielded their children from intimate partner violence, but research indicates that children see or hear many of the incidents;
  • What is Child Abuse?
  • Improved programs for all children enhance the therapeutic effects of government-sponsored protective services eg, foster care, family maintenance;
  • To create a useful assessment, it is imperative that complete health and developmental histories are available to the pediatrician at the time of these evaluations;
  • Mental illness—Experiencing childhood sexual abuse does not mean that you will develop a mental illness, but it is one of many risk factors.

Repeated moves from home to home compound the adverse consequences that stress and inadequate parenting have on the child's development and ability to cope. Adults cope with impermanence by building on an accrued sense of self-reliance and by anticipating and planning for a time of greater constancy.

Children, however, especially when young, have limited life experience on which to establish their sense of self. For young children, periods of weeks or months are not comprehensible. Disruption in either place or with a caregiver for even 1 day may be stressful.

  1. What is Child Abuse?
  2. Availability and full utilization of resources ensure comprehensive assessment, planning, and provision of health care. Separations occurring between 6 months and about 3 years of age, especially if prompted by family discord and disruption, are more likely to result in subsequent emotional disturbances.
  3. Physical abuse is the deliberate use of force against a child which results, or may result, in bodily harm.

The younger the child and the more extended the period of uncertainty or separation, the more detrimental it will be to the child's well-being. Pediatricians should advocate that evaluation, planning, placement, and treatment decisions be made as quickly as possible, especially for very young children. Physical and mental abuse during the first few years of life tends to fix the brain in an acute stress response mode that makes the child respond in a hypervigilant, fearful manner. When an infant is under chronic stress, the response may be apathy, poor feeding, withdrawal, and failure to thrive.

Some abused and neglected children learn to react to alarm or stresses in their environment reflexively with immediate cessation of motor activity freeze response. Older children who have been repeatedly traumatized often suffer from posttraumatic stress disorder and automatically freeze when they feel anxious, and therefore are considered oppositional or defiant by those who interact with them.

The same areas of the brain that are involved in the acute stress response also mediate motor behavior and such functions as state regulation and anxiety control. Comprehensive pediatric assessments can complement programs that prevent abuse and neglect, decrease the likelihood of placement in foster care, identify whether a child's current needs are being met, and allow placements to be customized to meet each child's needs.

Appropriate in breadth and depth, assessing physical, behavioral, emotional, cognitive, relational, and environmental domains.

  • Treatment for adult survivors may help you;
  • Successful parenting is based on a healthy, respectful, and long-lasting relationship with the child;
  • Connecting with others who care about and support you as early as possible can help protect you from the negative impact of childhood sexual abuse and help you heal;
  • The crisis lines linked in through 310-6789 have received advanced training in mental health issues and services by members of the BC Partners for Mental Health and Addictions Information;
  • Comprehensive pediatric assessments can complement programs that prevent abuse and neglect, decrease the likelihood of placement in foster care, identify whether a child's current needs are being met, and allow placements to be customized to meet each child's needs;
  • Children who live in situations of family violence can suffer immediate and permanent physical harm, even death.

Address the effect any 1 domain of function has on another domain of function eg, impact of motor deficits on speech. Age-appropriate using validated instruments that are sensitive to changes in development over time.

Anticipatory, focusing on early identification and interventions. Based on data collected over time to determine problems, each child's abilities, and future course. Able to synthesize and compile results for the purpose of prioritization.

Childhood Sexual Abuse: A Mental Health Issue

Sensitive to different values, meanings, and perceptions of importance. Conducted in settings and in a manner that protects the child's comfort and that controls and limits the stress of the evaluation. Sensitive, specific, valid, and reliable.

  • A New Zealand training programme;
  • In many substantiated abuse cases, the alleged perpetrators are family members or other relatives;
  • It can involve a single act or a pattern of incidents;
  • More than 500 000 children are in foster care in the United States.

Consistent with norms, standards, and goals of child welfare. Compact, efficient, and able to be completed in a reasonable amount of time.

At a minimum, the following areas should be assessed: