University of Texas Health Sciences study: Children born with cleft lip or palate and spina bifida are at an increased risk for abuse

11 Dec

The American Psychological Association lists the reasons children are abused in Why Do Adults Hurt Children?

It takes a lot to care for a child. A child needs food, clothing and shelter as well as love and attention. Parents and caregivers want to provide all those things, but they have other pressures, too. Sometimes adults just can’t provide everything their children need.

Adults may not intend to hurt the children they care for. But sometimes adults lose control, and sometimes they hurt children.

Adults may hurt children because they:

  • Lose their tempers when they think about their own problems.

  • Don’t know how to discipline a child.

  • Expect behavior that is unrealistic for a child’s age or ability.

  • Have been abused by a parent or a partner.

  • Have financial problems.

  • Lose control when they use alcohol or other drugs….                                                                       http://www.apa.org/pi/families/resources/abuse.aspx

A University of Texas Health Sciences study concludes that children born with cleft lip or palate and spina bifida are at an increased risk for abuse.

The Centers for Disease Control and Prevention describes what a cleft lip or palate are:

What is Cleft Lip?

The lip forms between the fourth and seventh weeks of pregnancy. As a baby develops during pregnancy, body tissue and special cells from each side of the head grow toward the center of the face and join together to make the face. This joining of tissue forms the facial features, like the lips and mouth. A cleft lip happens if the tissue that makes up the lip does not join completely before birth. This results in an opening in the upper lip. The opening in the lip can be a small slit or it can be a large opening that goes through the lip into the nose. A cleft lip can be on one or both sides of the lip or in the middle of the lip, which occurs very rarely. Children with a cleft lip also can have a cleft palate.

What is Cleft Palate?

The roof of the mouth (palate) is formed between the sixth and ninth weeks of pregnancy. A cleft palate happens if the tissue that makes up the roof of the mouth does not join together completely during pregnancy. For some babies, both the front and back parts of the palate are open. For other babies, only part of the palate is open.

Other Problems

Children with a cleft lip with or without a cleft palate or a cleft palate alone often have problems with feeding and speaking clearly and can have ear infections. They also might have hearing problems and problems with their teeth….                                                                                                   http://www.cdc.gov/ncbddd/birthdefects/CleftLip.html

Another group of children at high risk of abuse are those with spina bifida. The Mayo Clinic describes spina bifida:

Spina bifida is part of a group of birth defects called neural tube defects. The neural tube is the embryonic structure that eventually develops into the baby’s brain and spinal cord and the tissues that enclose them.

Normally, the neural tube forms early in the pregnancy and closes by the 28th day after conception. In babies with spina bifida, a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord and in the bones of the spine.

Spina bifida occurs in various forms of severity. When treatment for spina bifida is necessary, it’s done surgically, although such treatment doesn’t always completely resolve the problem….                   http://www.mayoclinic.org/diseases-conditions/spina-bifida/basics/definition/CON-20035356

Children with a medical condition are vulnerable to abuse.

Alyson Sulaski Wyckoff , Associate Editor of AAP wrote in Maltreatment of child under 2 more likely if certain birth defects present:

Children younger than 2 years were more likely to be maltreated if they had spina bifida or cleft lip/palate than if they had Down syndrome, according to a population-based study of 3 million children born in Texas from 2002-’09.

Birth defects occur in one in 33 U.S. births, and children with disabilities face an increased risk for maltreatment and out-of-home placement. It is not known how the risk might vary by type of birth defect.

The study was conducted to assess whether the risks and predictors of maltreatment vary by three types of birth defects: Down syndrome (intellectual impairment), cleft lip with or without cleft palate (facial malformation and speech impairment) and spina bifida (physical disability). Children with these disabilities were compared to an unaffected group.

The risk of any type of maltreatment was significantly higher for children with spina bifida and cleft lip/palate, an increase of 58% and 40%, respectively, even after adjusting for child-, family-, and neighborhood-level factors. Children with Down syndrome, however, were not at increased risk of maltreatment before age 2.

The study also found that children with birth defects are at risk for different types of maltreatment than other children. The risk of medical neglect was three to six times higher in the three birth defects groups compared with the unaffected group, which may be related to the medical complexity of the children’s conditions.

Maltreated children tended to be males and those born prematurely. Parents were the most frequent perpetrators, especially those living in poverty.

The risk of maltreatment was elevated for children whose mothers were young, white non-Hispanic, unmarried and who did not indicated paternity information on birth certificates. They were more likely to have a high school education or less, to have given birth previously and to have had the birth covered by Medicaid.

Future studies could inform policies and services aimed at improving outcomes of at-risk families by targeting populations with the highest risk for maltreatment, the authors noted.

Children with developmental delays, including those with the birth defects examined in this study, qualify for early childhood intervention services (Part C) under the Individuals With Disabilities Education Act, but many qualifying children do not receive these services, the study points out….                                                                                                                                                   http://www.aappublications.org/news/2015/12/01/Maltreatment120115

Citation:

Children with specific birth defects at increased risk for abuse

Date:           December 10, 2015

Source:       University of Texas Health Science Center at Houston

Summary:

Children born with cleft lip or palate and spina bifida are at an increased risk for abuse before the age of two, according to researchers. The researchers found that compared to children without birth defects the risk of maltreatment in children with cleft lip and/or palate was increased by 40 percent and for children with spina bifida, the risk was increased by 58 percent.

Journal Reference:

  1. B. S. Van Horne, K. B. Moffitt, M. A. Canfield, A. P. Case, C. S. Greeley, R. Morgan, L. E. Mitchell. Maltreatment of Children Under Age 2 With Specific Birth Defects: A Population-Based Study. PEDIATRICS, 2015; 136 (6): e1504 DOI: 10.1542/peds.2015-1274                                  http://www.sciencedaily.com/releases/2015/12/151210140510.htm

Here is the press release from UT Health Sciences:

Public Release: 10-Dec-2015

UTHeath study: Children with specific birth defects at increased risk for abuse

University of Texas Health Science Center at Houston

HOUSTON – (Dec. 10, 2015) – Children born with cleft lip or palate and spina bifida are at an increased risk for abuse before the age of 2, according to researchers from The University of Texas Health Science Center at Houston (UTHealth).The results were published in the December issue of the journal Pediatrics.

In the study, researchers found that compared to children without birth defects the risk of maltreatment in children with cleft lip and/or palate was increased by 40 percent and for children with spina bifida, the risk was increased by 58 percent. These rates were especially high during the first year of life. However, children with Down syndrome were not at an increased risk compared to children with no birth defects.

“A baby with Down syndrome develops just like any other baby unless they have another congenital defect. When they start missing developmental milestones is when the intellectual impairments associated with Down syndrome become more apparent. Additionally, they typically do not have the same level of medical complexity as babies with cleft lip with or without cleft palate and spina bifida, who likely have a lot of medical needs and complications. If you’ve just given birth and have to deal with a lot more complexity and care, it’s hard,” said Bethanie Van Horne, Dr.P.H., assistant director of state initiatives at UTHealth’s Children’s Learning Institute. Van Horne conducted the study as part of her dissertation at UTHealth School of Public Health.

Cleft lip and cleft palate are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy. A baby can have a cleft lip, a cleft palate, or both a cleft lip and cleft palate. Spina bifida is a neural tube defect that affects the spine and is usually apparent at birth. Children with spina bifida have physical impairments ranging from mild to severe depending where on the spine the opening is located.

The researchers drew data from several sources from 2002 to 2011: birth and death records from the Texas Department of State Health Services Vital Statistics Unit, surveillance of children born with birth defects from the Texas Birth Defects Registry and child maltreatment information from the Texas Department of Family and Protective Services.

In Texas, maltreatment is defined as neglectful supervision, physical abuse, physical neglect, medical neglect, sexual abuse, abandonment, emotional abuse or refusal to assume parental responsibility.

Among children with substantiated abuse, the risk of medical neglect was three to six times higher among all three birth defect groups than in the unaffected group. The complexity of their medical conditions may be a contributing factor for the increased risk of medical neglect versus other forms of neglect, according to Van Horne.

Researchers also studied how family factors affected risk of abuse. Children were more likely to be abused or neglected if their mothers had less than a high school education, had more children and used Medicaid. This was true even if a child did not have a birth defect. Van Horne said that poverty was likely the main factor in this finding.

“Physicians and medical personnel have to understand that the risk for abuse varies by specific disability. In general, when children are born with medical complexities like a birth defect, we need to be really supportive of those families. If we can identify them early and start services, we can help them understand what’s to come. A lot of providers do this, but we can do more,” said Van Horne.

###

Karen B. Moffitt, M.P.H., Mark A. Canfield, Ph.D., and Amy P. Case, Ph.D., from the Birth Defects Epidemiology and Surveillance Branch of the Texas Department of State Health Services were study co-authors, as was Christopher Greeley, M.D., a former faculty member at UTHealth, who is now with Texas Children’s Hospital. Co-authors from the School of Public Health included Robert Morgan, Ph.D., and Laura E. Mitchell, Ph.D.

The study, titled ‘Maltreatment of Children under Age 2 with Specific Birth Defects: A Population-Based Study,’ was funded through a cooperative agreement (#5U01DD000494-04) between the Centers for Disease Control and Prevention and the Texas Department of State Health Services, as well as through funding from the Title V Block Grant at the Texas Department of State Health Services.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.                   http://www.eurekalert.org/pub_releases/2015-12/uoth-usc121015.php

Stepparents and Abuse

It is difficult to find statistics on abuse by step-parents, but one study out of Sweden, Step-parents abuse children to death more often provide some food for thought.

258 children under the age of 16 were killed by their parents between 1965 and 1999. 23 of the children (9%) were abused to death. Stepchildren are more often killed by abuse than children who are killed by their biological parents, according to new research from the University of Stockholm. More than half of the 258 children were killed in connection with a conflict between the parents e.g. divorce or custody battle. Most of these children died in connection with the extended suicide where the perpetrator took or tried to take his own life. The men who murdered their children also often took the life of their partner. On the other hand, no woman tried to kill their partner when she murdered the children, writes senior lecturer Hans Temrin and PhD student Johanna Nordlund at The University of Stockholm.

The Department of Justice (DOJ) has statistics about infanticide but it is difficult to determine specific abuse by step-parents because of the reporting.

Note: Parents includes stepparents.

Of all children under age 5 murdered from 1976-2005 —

  • 31% were killed by fathers

  • 29% were killed by mothers

  • 23% were killed by male acquaintances

  • 7% were killed by other relatives

  • 3% were killed by strangers

Of those children killed by someone other than their parent, 81% were killed by males.

How to Spot Signs of Abuse

Child Information Welfare Gateway has an excellent guide for how to spot child abuse and neglect The full list of symptoms is at the site, but some key indicators are:

                         The Child:

Shows sudden changes in behavior or school performance

Has not received help for physical or medical problems brought to the parents’ attention

Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes

Is always watchful, as though preparing for something bad to happen

Lacks adult supervision

Is overly compliant, passive, or withdrawn

Comes to school or other activities early, stays late, and does not want to go home

The Parent:

Shows little concern for the child

Denies the existence of—or blames the child for—the child’s problems in school or at home

Asks teachers or other caregivers to use harsh physical discipline if the child misbehaves

Sees the child as entirely bad, worthless, or burdensome

Demands a level of physical or academic performance the child cannot achieve

Looks primarily to the child for care, attention, and satisfaction of emotional needs

The Parent and Child:

Rarely touch or look at each other

Consider their relationship entirely negative

State that they do not like each other                                                                                                                  https://www.childwelfare.gov/pubPDFs/whatiscan.pdf#page=5&view=Recognizing%20Signs%20of%20Abuse%20and%20Neglect

If people suspect a child is being abused, they must get involved. Every Child Matters can very useful and can be found at http://www.everychildmatters.org/ and another organization, which fights child abuse is the National Coalition for Child Protection Reform http://nccpr.info/   People must push for tougher standards against child abuse.

Many Single Parents are not Going to Like these Comments

Queen Victoria had it right when she was rumored to have said something to the effect that she did not care what two consenting single adults did as long as they did not do it in the streets and scare the horses. A consenting single parent does not have the same amount of leeway as a consenting childless single adult because the primary responsibility of any parent is raising their child or children. People have children for a variety of reasons from having an unplanned pregnancy because of irresponsibility or hoping that the pregnancy is the glue, which might save a failing relationship, to those who genuinely want to be parents. Still, being a parent is like the sign in the china shop, which says you break it, it’s yours. Well folks, you had children, they are yours. Somebody has to be the adult and be responsible for not only their care and feeding, but their values. I don’t care if he looks like Brad Pitt or Denzel Washington. I don’t care if she looks like Angelina Jolie or Halle Berry or they have as much money as Bill Gates or Warren Buffet, if they don’t like children or your children, they have to be kicked to the curb. You cannot under any circumstances allow anyone to abuse your children or you. When you partner with a parent, you must be willing to fully accept their children. If you can’t and they are too gutless to tell you to hit the road, I’ll do it for them. Hit the road.

Where information leads to Hope. © Dr. Wilda.com

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