(From Pediatric Directions, Issue 40)
As a medical student, my education on intimate partner violence (IPV) was limited to resources available in the community (which were few) and reasons why physicians don’t talk to their patients about IPV (which were many). As a resident, IPV was presented almost exclusively as an adult issue that affected grown women. During a rotation at our community shelter to learn more about the “adult issues” of IPV, however, I remember my first day turning the corner and being greeted by a child running full speed with an arm full of books. Naïve as it was, my first thought was What is a child doing in a shelter for victims of IPV? They never taught us that victims have children.
But they do, of course…15 million children by recent estimates. Rates of IPV, in fact, are disproportionately higher in homes with young children. Once rarely ever mentioned as a consequence of IPV, the effects of childhood exposure to IPV (and other toxic stressors) are now a foremost area of medical and behavioral health research. We now know that the infant brain exposed to IPV develops with a different architecture than the infant not exposed to violence. This abnormal brain development is the nidus for a cascade of cognitive and developmental problems that can ultimately lead to early mortality, with a host of social, medical and behavioral health consequences in-between.
It is important to acknowledge with colleagues that IPV is not an inherently easy subject to discuss. As pediatricians, however, we discuss the most sensitive of subjects with our patients and their families, from delivering a diagnosis of cancer in a child to obtaining the most personal of sexual histories from teenagers. Why should the issue of IPV be any more difficult? I think it is equally important to recognize that screening is not a one-time discrete event, but rather an ongoing conversation between the pediatrician and the caregiver. “Caregivers lie to me,” I’m often told. Perhaps, but by initiating a discussion on IPV, you have told the caregiver that your office is a safe place to discuss the topic if and when she is comfortable doing so.
Remember—with our relatively frequent contacts in the context of well-child and sick visits, we are in a unique position of having ongoing discussions with the caregiver. The American Academy of Pediatrics advises pediatricians that “the abuse of women is a pediatric issue.” If we know that IPV is frighteningly common and we know that the adverse effects on the child are innumerable and undeniable, I argue that it is no longer acceptable for pediatricians to simply ignore the issue. When discussing IPV screening by pediatricians, it is time for the conversation to shift from, Why don’t I ask? to How could I not?
Jonathan D. Thackeray, MD, is clinical director of the Center for Family Safety and Healing at Nationwide Children’s Hospital and assistant professor of clinical pediatrics at The Ohio State University College of Medicine. This essay was originally published in the May 2013 issue of Contemporary Pediatrics and is reprinted with permission.