By Fernanco A. Guerra, MD, MPH
Director of Health, San Antonio Metropolitan Health District
There it is. Another news headline about a child dying at the hands of the mother. We feel grief for the child, disgust over the parent’s actions and then anger about why “somebody” didn’t do something to prevent it.
In my years as a public health director, I have learned these cases don’t just happen. Almost always, there are warning signs of the troubles ahead–lots of them. As physicians, it is imperative that we broaden our medical perspective to anticipate and act on these warning signs. By the time you see patients with unexplained bruising or repeat injuries, the pattern of abuse may already be set.
One of the earliest signs is an unwanted pregnancy, especially among very young women in their teens and 20’s. The unwanted pregnancy paradigm usually involves conception that was unplanned or poorly timed in relation to other events going on in the woman’s life.
The “unwantedness” of the pregnancy can manifest itself in several ways. The mother may put off getting prenatal care. She may use drugs and alcohol. In some cases, there may be additional risk for infections and disease during the pregnancy. All are strong indicators that the young mother is not preparing physically or mentally to take care of her newborn child.
Consider the additional risk involved if the unwanted pregnancy is the second or third child for the young mother. Statistically, studies have shown that close interconceptional intervals of less than 18 months add greatly to the physical and emotional demands placed on a young mother.
In many of the child abuse cases recorded in San Antonio, the mothers were overwhelmed with taking care of several children with little or no time away from their child care duties.
Did their doctors ever discuss the problems of having another child too soon? Was any counseling given about family planning to prevent the next pregnancy? Doctors who see Medicaid-funded patients have an obligation to do more than just the delivery. It’s important to recognize that the economic situation of most Medicaid patients may not support their having additional children.
Doctors have a special responsibility to anticipate the dangerous circumstances that may be building in a young woman’s life and discuss the options and services available to her.
Pediatricians also should be watchful for signs that a young family is in distress. It may begin with a missed appointment or a delay in getting the child’s immunizations. Children at risk often show lack of development early on or appear to have inconsistent support from caregivers, such as the father or boyfriend, or other adults watching over the child while the mother goes off to work or school or to keep appointments.
These warning signs alone should trigger a series of questions from medical professionals. Ask the mother who is helping take care of her child. Does she have family support? When was the last time she had time for herself? What does she do when she’s feeling stressed?
For every physician, it is time to look beyond the obvious. Anticipate what factors could lead to dangerous conditions for children and their families. By law, we must report suspected cases of child abuse, but our duty goes beyond that. If we truly want to end the downward spiral, we must position ourselves in front of the problem.
We have to be that “somebody” who can and will do something to change the tragic statistics of children who are abused and neglected.
Dr. Fernando Guerra’s accomplishments and credentials far exceed space allowed in this magazine for a brief bio. To learn more about his exemplary career and outstanding accomplishments, please visit http://www.ci.sat.tx.us/health/guerra.pdf.
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