1. Intimate Partner Violence: Effects on Children Why Do We Need to Screen? Heidi M. Sallee, MD University Pediatrics Saint Louis University Saint Louis, Missouri

2. 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.

3. 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.

4. 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.

5. 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).

6. 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.

7. 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.

8. 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.

9. 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

10. 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.

11. 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.  2x’s likely to report ETOH, illicit drugs, and smoking.  Increased school drop- out, & poor grades.

12. Effects on Parenting:  The effects on the victim’s ability to parent do not mean that the victims are inherently abusive of neglect.  The victim may be less attuned to the children’s 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 child’s needs as separate from the parent’s needs.

13. Assessing for Children’s 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.

14. Assessing for Children’s 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…)

15. 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 child’s 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.

16. Reporting Requirements for Child Abuse and IPV:  Know your state’s 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 state’s protocol for reporting.

17. Reporting Requirements for Child Abuse and IPV: Missouri’s 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.