On Call With Dr. Gorski

April Showers Bring May Flowers

The advent of Child Abuse Prevention Month inspired me to consider what message I wish would endure beyond this brief annual period of public attention to the safety and well-being of children.  For while it is saddening to discover that the United States of America reports one of the highest rates of child abuse and neglect in the world, it is much harder to understand why so many parents endanger their dependent children. Statistics are numbing to the mind and either mobilize anger or paralyze hope. Children, on the other hand, should never go numb trying to wall off fear, or grow up feeling the rage and despair of maltreatment. We have learned that the brain and nervous system of children who suffer early and repeated trauma, whether physical or emotional, undergo changes in wiring that often leaves them, even as adults, likely to undermine their chances for healthy relationships, school success, career advancement, economic security and personal happiness. Then again, abuse and neglect know no geographic, economic or social borders. Hard as we try to identify individuals and groups more likely to victimize their children, we end up protecting too few and putting too many under the shadow of negative expectations. Furthermore, routing out perpetrators as a primary strategy runs two important risks:

1. Such efforts breed a basic mistrust of support systems by parents who may most need a helping hand.
2. Criminalization aims at punishment and, at best, the long, costly and difficult process of rehabilitation. It misses the chance to prevent the root causes of the damaging behavior in the first place. 

If we accept that prevention has the advantage of helping families before problems take root, we might recognize an additional opportunity. Instead of trying to predict who needs more help with rearing their children, we could recognize which supports all families deserve in order to give their children a secure, positive start to life. Looking for where to begin, I would suggest insuring that every family has the basic resources needed to offer their children the foundation for success: a sense of dignity, security, worth and purpose. Healthy, happy and hopeful children come from socially connected, financially secure families who pass on a spirit of optimism and ambition. We are still the only nation in the developed world that excludes large numbers of citizens from their human right to basic health care, education, housing and freedom from poverty. Every parent who ever had a bad day or a sleepless night knows how hard it is to control our emotions and reactions when our children cross the boundaries we set for their behavior. Imagine how much harder it would be if, between your child and your nerves, you had nobody’s shoulder to lean on, no one’s ear to talk to, no secure job to help pay the bills and no insurance to cover unanticipated illness, accident or misfortune. Let’s put ourselves all in the same boat since we all need and deserve the same tools to succeed in life. Such an approach to public policy, community services and personal behavior would include everyone, would make no assumptions and would treat all people fairly. 

But what about the matter of cost? Certainly, the right answer is that we cannot afford the cost of not preventing child maltreatment. Consider the economic consequences of just a few preventable conditions. Each prematurely born infant runs up tens to hundreds of thousands of dollars in hospital bills (premature babies and developmentally delayed children are also more likely to be victimized and, as adults, more likely to give birth to infants at risk for health and developmental problems). Every unemployed parent not only contributes little to the public treasury, he or she cannot adequately feed, clothe, shelter or transport children or inspire them with hope for their future. And every child who enters school weakened by the disgrace of hunger, anxiety, depression or shame is condemned to under-perform, is more likely to drop out before graduating, is less likely to earn a livable wage and is more likely to end up with an unwanted pregnancy, a prison record or a chronic and debilitating health problem. Already, the rising demand for foster care, special education, juvenile prison, medical and psychiatric day and residential treatment programs, drug rehabilitation and treatment of intentional and unintentional injuries exceeds the capacity to administer and pay for these services. In the current era of receding public revenues and resultant service reductions, we need policies and resources that promote child well-being and positive child outcomes.

Health, happiness and success in life start with loving families, caring neighbors and healthy communities. In turn, safe and prosperous communities need secure, capable and motivated citizens. It’s time to break out some common sense before we break the public bank. Re-growing the economy begins by nurturing our children. And investing in families, all families, is the rightful way to leave no child behind. 

Peter A. Gorski, M.D., M.P.A. is the Director of Research and Innovation at the Children’s Board of Hillsborough County and Professor of Pediatrics, Public Health, and Psychiatry at the University of South Florida. If you'd like to e-mail Dr. Gorski directly, please click here.