|
 The guidelines from the American Academy of Pediatrics build on
previous advice for doctors to be on the lookout for signs of past
maltreatment. Since the last guidelines came out in 2008, new
evidence has documented the connection between mistreatment early in
childhood and subsequent health problems, and studies have provided
fresh insight into the lasting effects of chronic stress.
“Child maltreatment is seriously under-reported,” said lead author
of the guidelines, Dr. Robert Sege of Tufts University and Health
Resources in Action in Boston.
“As a result, pediatricians who are treating a child for complex
behavioral problems, especially when these problems seem difficult
to treat, might do well to consider that the symptoms may have
arisen due to prior abuse or neglect,” Sege said by email.
Although some children recover from adversity, traumatic experiences
can result in significant disruption of normal development,
researchers note in Pediatrics.
Children, like adults, can develop post-traumatic stress disorder (PTSD)
that may be accompanied by depression, anxiety or disruptive or
defiant behaviors, for example.
Child abuse early in life is also a risk factor for attention
deficit/hyperactivity disorder (ADHD).
When children have experienced neglect or abuse, they may respond to
certain sights, sounds, smells or actions in ways that appear overly
dramatic or inappropriately emotional, the guidelines note.
This may happen because when children are exposed to reminders of
past maltreatment, their brain experiences a fight-or-flight
response similar to what occurred during the initial abuse or
trauma.
Kids may also have behavioral responses to teachers or caregivers
that are shaped by past mistreatment. For example, stern warnings
can become louder and brusquer and discipline can seem harsher.
Early brain development can also be impacted by what’s known as
toxic stress, or chronic exposure to severe stress over a long
period of time. This can also alter kids’ hormonal development and
influence how soon they enter puberty.
[to top of second column] |
Pediatricians can ask about exposure to stress, abuse or neglect as
part of taking down a child’s medical history, the guidelines note.
Doctors can also help parents and caregivers understand that
children with a history of maltreatment may not feel psychologically
safe and may need different types of support or discipline than
other kids.
“The good news is that once in the safe care of non-maltreating
adults, there are a set of parenting skills that can be learned that
are very helpful in responding to child behavior that may be the
result of traumatic response,” said Melissa Jonson-Reid, a
researcher at Washington University in St. Louis who wasn’t involved
in the guidelines.
“The other important take-home message is that children are not
responding in ways meant to disrupt the family,” Jonson-Reid said by
email. “Parents can help their own stress level by realizing that
these are just adaptations to past events not a reflection of the
current feelings or negative thoughts the child may have of them as
parents.”
Parents and pediatricians should be alert to potential signs of
abuse or mistreatment such as a lack of interest in usual
activities, sleep disturbance or changes in appetite, said Dr.
Charles Nemeroff, a researcher at the University of Miami in Florida
who wasn’t involved in the guidelines.
“Isolation, drop in grades, and reluctance to take part in certain
activities are all warning signs of possible abuse,” Nemeroff said
by email.
“Parents need to be vigilant about the safety of their children and
educate their children about appropriate and inappropriate
behavior,” Nemeroff added. “Perpetrators often seek positions with
access to children including coaching, gardening, repairmen, clergy,
and often perpetrators are family members.”
SOURCE: http://bit.ly/2n6Uj60 Pediatrics, online March 20, 2017.
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
