AKWESASNE – A recent summit held at the Akwesasne Mohawk Casino encouraged people to think about and detect child abuse.
The St. Regis Mohawk Tribe hosted the first one-day conference on Oct. 10 and a second on Oct. 21 at the Akwesasne Mohawk Casino’s new conference facility.
All told, over 250 child welfare advocates representing some 50 community, Tribal, county, State and Federal agencies attended the Summit. In addition to local and regional service providers, the Summit drew representatives from the Department of Homeland Security, U.S. Border and Customs Protection, U.S. Marshall Service and the U.S. Attorney’s Office.
“We’re here to form a web to catch all the children we can,” said Tribal Chief Beverly Cook. “To do that, we need to work together. We love our children and we’re willing to do anything for them.”
Chief Cook acknowledged the graphic nature of the summit’s presentations, including forensic photographs and x-rays of healthy anatomy and physical injuries resulting from accidents and abuse – burns, bruises, lacerations and fractures. It’s important to know what you’re looking at, said Dr. Karyn Patno, a pediatrician and founder of the ChildSafe Program at Fletcher Allen Health Care in Burlington.
“These images are uncomfortable to look at,” said Chief Cook. “That’s because what happens to many children is not right.”
Dr. Patno walked attendees through the methodology of the ChildSafe Program, a diagnostic clinic for any child suspected of any type of abuse. The child protection report is a summary of the evaluation performed at her clinic. It is a medical-legal document that includes reviews of behavioral and medical systems, past medical history, a family and social history, a physical exam and interviews with the child.
In her evaluation of child physical abuse for non-medical providers, Dr. Patno reviewed risk factors and injuries indicative of abuse. Attendees learned to recognize patterned bruises and burns, which imply an object came in contact with the child’s skin or that a specific hot object was inflicted. Physical signs of strangulation were also discussed.
Understanding normal infant growth and development, Dr. Patno pointed out, allows one to monitor children’s progress and to identify delay or deviance. An important rule of thumb is that “simple mechanisms result in simple injuries and complex injuries require a complex mechanism.” For example, “rolling off the couch can result in a skull fracture or broken leg. It cannot result in a subdural hemorrhage, retinal hemorrhage and rib fractures.”
Dr. Patno asks the parent to give a detailed history of how an injury occurred and then compares that mechanism not only to the developmental level of the child, but also to the severity of the injury. She says the next step is asking, “Can the proposed mechanism result in the injuries seen?”
Abusive Head Trauma (AHT) is “absolutely a complex mechanism,” she reported. AHT includes “shaken baby syndrome,” which is often coupled with impact. It accounts for 10 percent of all deaths due to abuse or neglect.
There are very specific risk factors associated with AHT for perpetrators and victims. For example, although some women commit this act, the majority of perpetrators of abusive head trauma are male (nearly 40 percent are natural fathers and about 20 percent are boyfriends of the mother).
The doctor pointed out that infant crying is the most common event prior to shaking an infant, accounting for the fact that nearly half of all AHT victims are under the age of one.
Finally, Dr. Patno shared important elements in the evaluation of child sexual abuse and what it means when an exam is deemed “normal.” She pointed out that most child exams do not result in a finding of sexual abuse, but they are important to determine mental health needs. And, it’s “incredibly helpful” to the child to be told he or she is “normal.”