I am a board-certified child abuse pediatrician who has practiced child abuse pediatrics in Maine for the past 30 years. I have evaluated many thousands of children for abuse and neglect. During that time, I have unfortunately also seen many children die from abuse. For every child who dies in Maine (an average of two to three per year), at least 50 sustain potentially life-threatening injuries and several hundred sustain some form of harm. According to the fourth National Incidence Study on Child Abuse and Neglect, by the time children reach age 18, well more than half will have experienced some form of abuse or neglect.
The deaths of 4-year-old Kendall Chick and 10-year-old Marissa Kennedy were unbearably tragic, but more than that, they were preventable. Although the details of these two deaths are not available, I can say with absolute certainty from my three decades as a child abuse pediatrician and member of the Maine Child Death and Serious Injury Review Panel that these and other children who die or who are seriously injured from abuse and neglect should not have died, should not have sustained life-threatening injuries and should be alive and well today.
Child abuse pediatrics, a subspecialty of pediatrics, was formally recognized by the American Board of Pediatrics in 2006. Approximately 200 of us became board certified in 2009, and there are close to 400 board-certified child abuse pediatricians in the United States today.
We are not only experts in the diagnosis of all forms of abuse but also routinely participate in prevention, education and advocacy. Many of us are researchers, and most are clinicians who evaluate children every day. As illustrated in my recent book “What Happened in the Woodshed: The Secret Lives of Battered Children and a New Profession to Protect Them,” child abuse pediatricians have emerged as a new and important force for child welfare in the United States.
I laud the work of the Office of Child and Family Services, the Legislature’s Government Oversight Committee and the Office of Program Evaluation and Governmental Accountability for reviewing these two deaths. I have always appreciated Gov. LePage’s passion for protecting abused children. However, child safety VERSUS family preservation is the wrong terminology. The right terminology should be child safety AND family preservation. We know that children do better, all other things being equal, in their parents’ care. But they do not do better if they are not safe. And even if they’re safe – whether with the family, in kinship care or in foster car – no child does well unless they and their caretakers receive appropriate supports.
The debate about criminalizing failure to report abuse may also miss the target. Mandatory reporters do not, for the most part, fail to report suspicion, but they do usually fail to even suspect abuse. Many missed cases of child abuse are missed because reporters fail to recognize suspicious injuries.
Ethan Henderson of Arundel died in 2012 at the age of 10 weeks because 15 individuals in five agencies failed to suspect abuse. If, at any point in his short life, one of those individuals had called us at Spurwink, we would have first told them to immediately report the injuries to child protective services, and then we would have hospitalized Ethan to assess him for further injury. We teach medical providers that if they are unsure whether to report, they should at least contact us for consultation and advice.
It perhaps needs repeating that the child welfare system in Maine is not just child protective services. It is all of us: medical providers, school personnel, law enforcement, day care providers, home visitors and, most important, neighbors and family members.
Child abuse is the greatest secret of all. It is a secret to family members, who may not see what’s going on, to mandatory reporters, who may not understand what’s going on, and to many others in our communities. Today in Maine we have an opportunity to work together to save the lives of children across our state as we seek to see and understand child abuse for all its complexity and tragedy.
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