Nothing in medicine is harder to discuss than those situations where children are injured intentionally or by neglect. Nothing is harder for a physician to do than to call child protective services — or even the police — to report a clinical situation where a child was potentially harmed by abuse or by neglect. Once the legal process is initiated, not only is it about treating the patient, but about documenting injuries, mechanisms of injury, and social situations and exposures that led to the harm or injury.
Some clinical situations are “no brainers”: Intentional injuries that lead to broken bones, brain trauma, burns, starvation, pregnancy, coma, or death. Others become more suspect when the nature of the injury’s psychological, emotional, or has resulted from perceived neglect: A child is left unattended and drowns; a child is not supervised and eats candies which contain marijuana (THC) or prescribed medications (Opioids) and is found not breathing; a child is found wondering and lost after being exposed to illegal drugs or their manufacturing process; or the child is exposed to psychological neglect that leads to emotional or mental injury.
The legal definitions are very complex, but for those who are interested, the following website has much more information than this article can provide: https://www.childwelfare.gov/pubPDFs/define.pdf. The CDC also has an excellent resource: Preventing Child Abuse and Neglect: A Technical Package for Policy, Norm, and Programmatic Activities CDC-pdf. You can find it in Spanish, as well.
The nationally accepted definition of Child Abuse and Neglect declares that children under the age of 18 years may be exposed to abuse and neglect by a parent, caregiver, or another person in a custodial role (e.g., clergy, coach, teacher or any individual who shares permanent or temporary custody). The abuse can be physical, sexual, emotional or psychological, or can be entirely attributable to neglect.
Each state in the union has their own definitions and exemption clauses. Some definitions are routine and without question (intentional stabbings or gunshot wounds), but others are vigorously contested: “Corrective actions” not intended to harm but to discipline. Can you imagine how many Marine corps Drill Instructors would go to jail if their methods were applied on school grounds?
I remember being sent to the Principal’s Office while in elementary school for having “kissed” a girl named Leticia (factitious) — at least that’s what she said on the first day. I, of course, denied this and got three consecutive days of paddling (by the principal) for not admitting to it. Seeing me suffer, on the third day, she courageously admitted to her mother that all she had done “was share a bite of her sandwich.” Her mother had told Leticia she should “never” share of her sandwich — especially with boys — as this “would be the same as kissing.” Leticia must have thought I was very cute — or forgetful — when she offered a bite of her peanut butter jelly sandwich. Of course, being a gentleman, I took a big bite. It never occurred to me we might be kissing. The paddling stopped. I don’t remember an apology, but I never got paddled again — even when I deserved it. Hee-Haw!
It had to have been one of the best peanut butter jelly sandwiches of my life to still remember it…or maybe it was the spanking, who knows. One thing for sure, looking back on that experience, I would never argue that I was abused by my principal, or Leticia. On the contrary, it is one of the fondest childhood memories — just like Marine Corps Boot Camp. I would not trade either one of those experiences for the world.