Intimate Partner Violence: Effects on Children Why Do We Need to Screen?

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Intimate Partner Violence Effects on Children
Why Do We Need to Screen?

• Heidi M. Sallee, MD
• University Pediatrics
• Saint Louis University
• Saint Louis, Missouri

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Summary of AAP Policy Statement

• A parent who is being abused may not seek care
  for their injuries from a pediatrician (or anyone
  else).The pediatrician may note
• Facial bruising,or other injuries.
• Depression, anxiety, and failure to keep
  appointments.
• Reluctance to answer questions about discipline,
  or frequent visits for complaints.

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Summary of AAP Policy Statement

• Women may reveal the abuse to the pediatrician if
  they are questioned in a
• Sympathetic and sensitive manner.
• In a confidential setting, away from the abuser.
• Provided some assurance of safety.

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Summary of AAP Policy Statement

• Questions about family violence should be a part
  of anticipatory guidance.
• Pediatricians must understand the dynamics of
  Intimate Partner Violence (IPV).
• Pediatricians must be knowledgeable about the
  guidelines and resources for managing situations
  of abuse.

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AAP Recommendations

• Residency training programs and CME program
  leaders incorporate education on family and IPV
  and its implications for child health into the
  curricula of pediatricians and pediatric
  emergency department physicians.
• Pediatricians should attempt to recognize
  evidence of family or IPV in the office setting.
• Pediatricians should support local and national
  multidisciplinary efforts to recognize, treat,
  and prevent family IPV (American Academy of
  Pediatrics, 1998).

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Other Reasons to Screen

• Only 23 of woman injured shortly after pregnancy
  received Tx for their injuries, but almost all of
  these women used care for their infants.

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Other Reasons to Screen

• Children 5 and under are disproportionately
  represented in households in which there is IPV.
• The child may be identified as the cause of the
  dispute.
• The child may be caught in the crossfire.
• The child may be directly physically abused.
• The child may be the one to call for help.
• 40 of 160 mothers surveyed in an urban
  outpatient pediatric clinic had filed a
  restraining order against a boyfriend or husband.

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Health Effects on Children Prenatal

• 6 of pregnant women, (240,000) annually are
  battered by men in their lives.
• Complications of pregnancy such as low birth wt.
  gain, anemia, infection, and bleeding are higher
  for abused women.
• Increased rates of depression, suicide attempts,
  tobacco, ETOH, and illicit drug use are higher
  among abused women.

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Health Effects on Children

• Depression, anxiety, symptoms of PTSD
• Violence towards peers
• Increased learning difficulties
• Poor concentration, increased distractibility

• Hyper-vigilance
• Sleep difficulties
• Somatic complaints
• More likely to attempt suicide, abuse drugs
  ETOH, run-away-from-home,engage in teenage
  prostitution, commit assault crimes

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Health Effects on Children

• 50 of men who frequently assault their wives
  frequently assault their children.
• In 30-60 of families that are affected by IPV,
  children are also directly abused.
• IPV may be the single major precursor to child
  abuse and neglect fatalities in the U.S.

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Health Effects on Adolescents

• Women ages 16-24 have the highest per capita of
  IPV
• Teens are at higher risk during pregnancy(21.7
  pregnant teens experience IPV as opposed to 15.9
  of pregnant adults).
• Teens who are victims of Of IPV have increased
  somatic complaints.

• May have sub-optimal management of chronic
  illness.
• 32 of teen victims report binging and purging.
• 2xs likely to report ETOH, illicit drugs, and
  smoking.
• Increased school drop-out, poor grades.

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Effects on Parenting

• The effects on the victims ability to parent do
  not mean that the victims are inherently abusive
  of neglect.
• The victim may be less attuned to the childrens
  need, less emotionally available.
• Parents who are the perpetrators are generally
  less involved in parenting.
• These parents are more likely to use physical
  punishment.
• These parents are less able to distinguish or
  recognize the childs needs as separate from the
  parents needs.

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Assessing for Childrens Safety

• Do the children usually get involved when
  violence occurs?
• What do they do when violence erupts?
• Do you talk with them? What do you say?
• Children should be taught their job is to stay
  safe, not to protect parents or stop the
  fighting.

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Assessing for Childrens Safety

• They should be taught how to call 911 when
  appropriate.
• Help the victim think about her options and their
  implications
• Ask about the possibility of referring a child
• or victim to appropriate services (e.g.
  counseling, mental health)

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Recommendations for Children Who Have Witnessed
IPV

• If the child has witnessed severe violence
  resulting in injury or hospitalization of either
  a child, sibling or parent
• If the childs symptoms have persisted more than
  3 months.

• If there has been a change in behavior or an
  increase in aggression or depression.
• If the caretaker is unable to be emotionally
  responsive.
• If the violence has resulted in the death of a
  parent.

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Reporting Requirements for Child Abuse and IPV

• Know your states reporting laws.
• Before asking about IPV you may want to disclose
  limits of confidentiality.
• If the child has been injured, or if your state
  requires mandated reporting in all cases of IPV
  you must follow the states protocol for
  reporting.

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Reporting Requirements for Child Abuse and IPV

• Missouris State Requirements
• Reasonable cause to suspect.
• Report if the child has been or maybe
• subjected to abuse, neglect or is being
• subjected to conditions that would
• reasonably result in abuse or neglect.
• Report the abuse to the Dept. Of Public Health
  and Human Services.