Partner Abuse: a Pediatric Problem

PARTNER ABUSE: A PEDIATRIC PROBLEM

Violence between adults in the home is a pediatric problem. Children who see or hear battering between parents or parent-figures realize they cannot rely on those adults for their safety and nurturance. They have fears, anxiety, and feelings of helplessness as they wait for the next attack. Children often are accidentally hit, pushed, or dropped during a violent outburst. Sometimes, children attempt to intervene, and the spouse redirects the anger toward the child. As a result of the inadequate role models, children sometimes act violently toward the battered adult. Delinquency and significant emotional disability are common, as the children become older.

Violence in the home is often pervasive. Forty to 75% of children exposed to marital violence are victims of physical abuse. Children living with an abused mother are 12 to 14 times more likely to be victims of sexual abuse.

Incidence

Wife battering is the leading cause of injury to women between the ages of 15 and 44 years, accounting for more injuries than car accidents, muggings, and stranger rapes combined. In the course of an intimate relationship, 25-30% of American women are beaten at least once. Violence against women occurs in about 20% of dating couples. Women who are assaulted by an intimate partner are more likely to be physically injured than if the assailant is a stranger.

Batterers and the Battered

Battered women typically have self-doubt and poor self-esteem. They tend to blame themselves for their partners' actions. They feel dependent on the battering men, doubtful they can make it on their own. They are commonly financially dependent on the men. Sometimes, traumatic bonding occurs, a Stockholm effect.

Men who batter tend to be angry, frustrated, and jealous. They blame the spouse for their own deficiencies. Commonly, they have a need for control and domination, but fear intimacy and abandonment.

Recognition

Partner abuse is suggested by the following:

· Explanations inconsistent with the observed injuries

· Accidents during pregnancy

· Substantial delays in seeking medical treatment

· Repeated emergency room visits for accidents

· Embarrassment or evasiveness when questioned about injury or abuse

· A man who speaks for the partner, has derogatory descriptions or a condescending attitude toward the partner, or is strongly resistant to separate interviews

Child indicators of adult partner abuse include fear of leaving the abused parent alone and abusive behavior toward a parent.

Pediatric Management

The physician should ask about partner abuse at health maintenance visits of children. Inquire about concerning bruises or recurrent injuries of the parent.

When abuse of the mother of a child is discovered, it should be managed as follows:

· Assess safety of the mother and child.

· If the child is being physically abused, report to the Child Abuse Hotline.

· If the child is not being abused, discuss with the mother moving out of the home, to a battered women's shelter if necessary. Discuss with her the risks to the child if she

remains in that situation.

· If the mother will not leave the home, discuss with her the signs of escalating violence. Encourage her to establish a safe place she can quickly go if needed. She should have keys, clothes, and documents hidden and readily available to take with her.

· The physician can report battering of the mother to law enforcement.

· The physician or social worker should discuss with the mother the procedure for obtaining an order of protection, other safety measures, and counseling resources.

When mothers are at a point of making a decision to leave home, the potential danger to the mother and children increases. Thus, appropriate management recommendations are critical and commonly involve medical, social, psychological, and legal issues.

Conclusion

Physicians who see children should be prepared to recognize, evaluate, and manage partner abuse in the home. It is a major pediatric problem.