thank you it’s a pleasure to be here
today thank you for having me speak
today at TEDx was what I told you
that in a survey of 3000 Dutch parents
5% that’s five out of every 100 of those
parents admitted to having smothered
slapped and/or shaken their baby because
it was crying too much and what if I
also told you that a lot of children in
one out of every 100 children will
so here it is you can see a hundred
squares up there and you can see the
five children that will be smuggling for
shaken or slapped and one of those will
become a confirmed case of child abuse
we don’t know what happens to the other
four they might be okay
it might have been an isolated event or
they may also be truly cases of child
abuse because not all child abuse is
discovered so today what I would like to
do is present three ideas I have about
how we could prevent child abuse before
it starts so there are definitely people
working hard to prevent child abuse but
most of the people working on that their
goal is to help us identify children
there
better identify them and get them into
treatment coming from the perspective of
Public Health
my goal is a bit different my goal is to
try to prevent child abuse before it
so let’s look at one example of child
abuse
this is shaken baby syndrome so parents
who might shake there may be a little
bit
babies crying too much and shake the
baby a little bit they’re angry they’re
tired some of those parents shake the
baby too much a babies don’t hold their
neck up very well and the forces of that
shaking can result in bleeding in the
brain brain damage and blindness in some
of these babies I guess I think it’s
kind of a good example because there
have been people they shook their baby
too far they do realize it and they
really were kind of innocence in a way
they just didn’t realize that something
so terrible could happen to their baby
from shaking so at public health we
often go for a simple message because we
have a lot of quick messages we have to
get out there and the quickness
shaken baby syndrome you sometimes see
it around on posters never ever shake a
baby so one of our our messages FAQ
which is trying to get into the public
brain never ever shake a baby there are
four types of child abuse and I’m
focusing on trying to prevent two of
them the two that are kind of the most
obvious and well not most obvious but
the easiest to measure so I’m focusing
a while ago this is just a blank slide a
while ago the difficulty of caring for a
young baby was really underscored for me
when I received a phone call picked up
the phone and I heard salty
I really didn’t know who it was at first
but then I realized it was a friend of
mine what’s wrong I’ve been having
thoughts of taking the baby outside and
putting her in the trash can and leaving
her there but she didn’t do it right
the only thought about it and so my
friend and I talked and we talked about
how if it got worse she could just put
the baby in another room make sure the
baby was safe close the door sit outside
if she had to and I was really happy
that she had called me that she had felt
comfortable to call me and to ask for
help she went on to be an excellent
mother for a brief period of time she
had this disturbing box so you could see
from some of the material I’m going over
that caring for a young baby can be
really stressful what can we do about it
so my first suggestion the first idea is
that we need to publicize the fact that
parents have thoughts of abuse and
neglect sometimes it’s okay to have
those thoughts and it’s okay to talk
about it so we need to remove the stigma
around having those thoughts if we don’t
remove the stigma around the boss the
parents will not feel free to come
forward and to get help
they will not be feel free to talk to
their friends and their doctor whoever
else about it so we need to remove the
stigma and we need to stop sugarcoating
the first year of parenting it’s not the
glorious experience that it’s put out to
be for many it’s very difficult so we
need to prepare parents for that we can
also teach parents techniques
hi infants techniques for rebellious
toddlers but it is very very important
so some of you may say this is not a
very realistic solution for such a
difficult problem
stay with me let me tell you about the
experience I had that convinced me that
child abuse is preventable years ago I
was working as a public health nurse and
I was asked to go out and visit a young
mother because the pediatrician thought
she was disciplining her daughter too
strictly I was worried about visiting
many of the nurses in the agency were
judgmental about our clients and how
they bothered their children but my
supervisor had a different attitude
she said to me Kim when you go visit
that young lady I don’t I only want you
to do one thing I just want you to build
a trusting relationship now this was
surprising for me I really thought that
somehow is gonna be more complex than
just having one instruction but she
stuck with it she said I just want you
to build a trusting relationship you
could visit her as many times as you
want so I went out to see my client I’ll
call her Jennifer and she had a newborn
baby boy who was 6 weeks old and she had
a two year old daughter so when I got
there I’ve noticed that she held the
baby really close of normally like you
would hold the baby she was very she
appeared to be bonding well with her
newborn son her two-year-old daughter
stood by her side silently
[Music]
throughout the 45-minute this
the two-year-old never left her mother’s
side and she never spoke she I didn’t
see any verses so we visited with this
woman a number of times and I came to
find out that she was fourth daughter of
her parents
and when she was born her father was
really hoping for a boy but she turned
out to be a girl so she became her
father’s substitute son and then when
her first baby was born she was really
hoping it would be a boy and she could
give her father this grandson that had
not happened but now normally with the
second child she was very warmly
attached to her son very happy to give
her father a grandson so at one point
she gave me a beautiful pair
earrings I was a little startled and
very happy because it meant that our
visits were meaning some
to her and things were only well and
then at one of the final visits I did
get down on the floor and attempt to
play the tuba and she very tentatively
acted as if she might engage with me a
little and Jennifer the mother said to
me I’ve never seen someone play with an
infant like that before with child like
that before and I said who have you seen
play with children and she said only my
family so Jennifer was parentid as she
so I what I took away from this series
of visits with Jennifer was the power of
home visits if we approach parents
Nansha judgmentally it will allow us to
visit them and they will benefit from a
relationship with somebody outside their
normal circle so a question though does
arise
can we really spend healthcare dollars
on this with just these subjective
impressions that it works don’t you need
some hard evidence this is the hard
evidence that was first published 20
years ago 20 years ago a randomized
clinical trial is published in the JAMA
showing that home visits and prevent
child abuse so we do have the hard
so my second idea is that we identify
high-risk families at birth and we offer
them home visits I don’t know the slope
here that’s my second idea okay so if we
offer them home visits will probably do
home visits on about 10% of babies it’s
casting a wider net that we need to
that’s how screaming works I will base
that screaming on risk factors
especially on whether either parent has
a history of themselves having been
abused and how sensitive all the
scrutiny be early work shows that the
stream can be about as sensitive as our
screening for heart disease I’m
suggesting we put the screening in the
hospital at birth because that way we
can catch every one and we can start
home visits very early because a lot of
abuse happens quite early in in the
baby’s life my third suggestion is that
we eliminate
for children under the age of two so
spanking which is usually what we’re
talking about does it is a deterrent for
behavior in the short term in the long
term it causes more aggression and
that’s why the American Academy of
pediatricians advises against it there
are a number of countries those in green
in Northern Europe that have laws
against any corporal punishment in the
whole home or in the school so although
it will be controversial in the United
States it will be quite controversial
here because 50 percent of mothers of
babies under the age of one spank their
children so will be controversial here
but I suggested we have a law make it a
misdemeanor that we do not spend or use
physical punishment for children under
the age of two my time is running short
here
so this is my wrap-up slug so how do we
stop child abuse first we allow parents
to realize that costs of abuse and
neglect are common and there are healthy
responses to excessive crime and
rebellious toddlers second we identify
high-risk families at birth and offer
home visits and third we make physical
punishment of children under the age of
two a misdemeanor and that is how we
stop child abuse before it starts
[Music] [Applause]