May 1, 2023
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Last year, the child abuse pediatric team was consulted to see more than 200 admitted patients and over 500 patients in their outpatient clinic.

Providers who treat child abuse are particularly vulnerable to experience vicarious (or secondary) trauma, a process of change resulting from empathetic engagement with trauma survivors. This can lead to a range of negative physical and emotional symptoms like intrusive thoughts, flashbacks, anxiety, depression and burnout.

For Child Abuse Prevention Month in April, child abuse specialists from Texas Children’s spoke to other providers in a recent Respite Rounds conference on the unique challenges that come with treating difficult cases, and offered insights on protecting your mental health when caring for our most vulnerable children.

Navigating intense emotions and vicarious trauma

When asked to speak to her younger self, Dr. Marcy Donaruma said she’d offer up ways to better manage the intense emotions she felt. “I was always angry, and I learned that burning my fuel on anger wasn’t healthy,” she said. “You can be angry, but the time you take to sit in those feelings needs to be thoughtful, not sustained.”

Donaruma is a child protective health provider who spends most of her time seeing sexual abuse patients at the Children’s Assessment Center. “I always try to find ways to find the upside in rotten situations … even when it’s something major, you can always find an upside if you look hard enough,” she said.

Dr. Mackenzie Hughes, a clinical pediatric psychologist, shared her own perspective and tips on practicing self-care. “It’s OK to feel hopeless, especially when we’re hearing awful details and witnessing the horrors of child abuse every day,” said Hughes. “But when we stretch ourselves thin and spin our wheels trying to fix all the things, that’s when we start to burn out.”

“We each have a role to play,” Hughes continued. “I don’t have control over CPS or where the kids I work with are placed, but my role specifically is to help them process their traumas and give them what they need to heal and move forward.”

“My journey is my journey,” added Grace Harmon, a PICU social worker with 20 years of experience working with CPS and child abuse victims. “I’m here to support patients and families on their path, but I’m not doing them any benefit by taking it home with me … I can be present with them in the moment, but I had to learn how to say goodbye to the moment as well, for my own sake.”

Work-life balance is easier said than done, but incorporating small actions into your day that “wash off” the trauma you hear and interact with can make all the difference. Dr. Hughes suggests taking just five minutes to do a mindfulness activity, breathe, watch a funny video, or find something that activates your senses like taking the stairs.

Other tips and advice shared from the panel discussion include:

  • Surround yourself with positive and hopeful reminders of why you do this work.
  • It’s normal for the work to impact us … it doesn’t mean we’re not built for it or tough enough to handle it.
  • Try to place focus on caring for and healing the child, not the circumstances that led them to us.
  • Sometimes, the most patient-centered thing to do is let a child be surrounded by familiarity and biologic connection.
  • When the effects of vicarious trauma start to impact your functioning, tap into professional support like therapy and treatment.

Click here to join the Respite Rounds Repository group on Teams and watch a full recording of the discussion, hosted by Palliative Care Service (PACT).

You are not alone

Need support? The Employee Assistance Program (EAP) is designed to promote emotional health and wellness, and improve quality of life at work and home. The program is confidential and here to support all Texas Children’s employees and eligible dependents with experienced, licensed and credentialed professionals. If you or someone you know is struggling, please contact EAP at 832-824-3327 or EAP@texaschildrens.org.

May is Mental Health Awareness Month, and our Workforce Well-Being team is hosting a variety of events, trainings, conversations, and more for Texas Children’s employees to take advantage of. Check the SharePoint site for a full list of activities!

The Child Abuse Protection team is available on-call to support staff and providers through possible maltreatment cases 24 hours, seven days a week. You can reach out via the page operator at 832-824-2099 or through an EPIC referral. For additional training surrounding child abuse, trauma-informed care and human trafficking, please contact Diane Kaulen at dbkaulen@texaschildrens.org.

Lastly, thank you to our Public Health Pediatrics and Child Abuse Protection teams for their continued dedication, research and advocacy. Click the flyer above for a recap of their efforts to address childhood adversities in 2022. With a team as great as ours, the difference is truly life-changing.

April 5, 2016

4616childabuseinside640For the 10th consecutive year, Texas Children’s employees took a moment out of their day on April 1 to remember the more than 1,500 children evaluated last year by Texas Children’s Hospital’s Child Abuse Pediatrics Team for possible child abuse.

After listening to presentations on the causes of child abuse and the stress of taking care of those who have been abused, employees walked to the Texas Children’s Hospital Playground and tied blue and black ribbons to the iron fence that surrounds the slides and swings.

Each ribbon represents a child evaluated at Texas Children’s Hospital for suspected child abuse or neglect over the past year. The black ribbons represent children who died as a result of suspected abuse or neglect during that same period.

The ribbons will remain on the fence for the month of April, which is Child Abuse Awareness and Prevention Month.

“We are here today to give these children the dignity they deserve,” said Texas Children’s Chaplain James Denham. “We also are here to recognize the caregivers who have placed gentle hands on them in their time of need.”

At Texas Children’s, the Child Abuse Pediatrics or CAP team is responsible for assessing and ensuring the safety of children where child maltreatment is suspected. The CAP team comprises physicians, nurse practitioners, nurses, forensic nurses and social workers, and evaluates hundreds of cases a week at Texas Children’s Hospital and the sexual abuse clinic at the Children’s Assessment Center. In 2015, Texas Children’s Hospital’s Child Abuse Pediatrics Team evaluated more than 1,500 children for possible maltreatment.

Every year about 65,000 children in Texas are victims of child maltreatment with more than 200 deaths directly attributed to this abuse and/or neglect across the state. The Texas Children’s Emergency Center team sees almost 2,500 of these child abuse cases each year.

“I urge everyone to make a difference in a child’s life by standing up for the safety and well-being of all children,” Denham said on Friday. “We all can make a difference even if it’s just opening our eyes to the injustice of child abuse.”

To learn more about child abuse and its widespread affects, Texas Children’s Section of Public Health Pediatrics will introduce upstream risk factors that influence a child’s health and the healthcare professional’s role to mitigate these risks through screening, early recognition, and connecting families to resources. By doing this, we will serve as advocates for healthy children and families. We encourage our colleagues to join us not only in our April events, but year-round to keep children resilient and safe.

Friday, April 8, noon to 1 p.m.
Child Abuse Awareness & Prevention Month Lecture Series
Judith McFarlane, DrPH, RN The Role of the Healthcare Professional in Household Violence Texas Children’s Hospital auditorium

Wednesday, April 13, 11 a.m. to 1 p.m.
Child Abuse Awareness & Prevention Month Bridge Event
Celebrating Community Partners that support healthy families
The Auxiliary Bridge (between CCC and WT)

Friday, April 15
All day Go Blue Day
Wear Child Abuse Prevention T-Shirt and Jeans

Friday, April 15, noon to 1 p.m.
Child Abuse Awareness & Prevention Month Lecture Series
Dr. Claire Bocchini
The Role of the Healthcare Professional in Advocacy 
Children’s Nutrition Research Center, Howland Auditorium

Monday, April 18, noon to 1 p.m.
Child Abuse Awareness & Prevention Month Lecture Series
Jeff Temple, PhD
Dating it Safe: Understanding & Preventing Teen Dating Violence
Children’s Nutrition Research Center, Howland Auditorium

Friday, April 29, noon to 1 p.m.
Child Abuse Awareness & Prevention Month Lecture Series
Shreela Sharma, PhD
The Role of the Healthcare Professional in Food Insecurity 
Children’s Nutrition Research Center, Howland Auditorium

April 7, 2015

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“I sat for a long time over that child’s body. He was cute as can be with his hair all over, almost like beach hair, and that look that he had always been a playful boy. But play was not in his future, at least not here anyway.”

They’re the words Texas Children’s Hospital Chaplain James Denham spoke before the annual blue ribbon tying ceremony on April 1, which kicked off Child Abuse Prevention Month. Denham wrote about just one of the many children who he’s seen affected by child abuse and neglect. This little boy didn’t make it. He represents some 17 children who have died as a direct result of their abuse or neglect over the last year at Texas Children’s. Last year, 1,319 children were identified as being victims of neglect or abuse after being treated at Texas Children’s Hospital. 1,319 blue ribbons and 17 black ribbons were tied on the fence of the children’s playground just outside the Abercrombie Building in remembrance of these children. Blue pinwheels were also placed around the playground, a national symbol for child abuse prevention efforts.

“By tying those blue and black ribbons on a fence that hundreds pass by every day, we dignify each of those children’s lives,” Denham said. “We proclaim that their story matters. The ribbons do not honor a statistic, they honor a child.”

Employees gathered to hear about the dreadful statistics and thank those who work tirelessly to advocate for these children. According to The Texas Association for the Protection of Children, in our state, there is an average of more than two deaths from child abuse or neglect every single week. Each day, 182 children are confirmed victims and more than seven children are maltreated every hour. As the largest children’s hospital in the nation, Texas Children’s advocates for these children. The Child Abuse Prevention team (CAP) works to identify abuse and educates families and the community in an effort to prevent it from happening.

“We are very fortunate at Texas Children’s Hospital to have the CAP team to care for this very delicate patient population,” said Roxanne Vara, director of CAP. “It takes a very special skill set to be faced with the complexities that our CAP team is faced with serving these maltreated children.”

The ribbons will remain on the fence for the month and serve as a constant reminder of the disheartening reality.

July 8, 2014

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By Dr. David Wesson

As the head of Texas Children’s Level 1 pediatric trauma center, I have treated many children with severe head injuries sustained from vehicle crashes, sudden falls and recreation-related mishaps. One injury that is particularly heart wrenching to witness is abusive head trauma in infants. One of the most important missions of our trauma center is to prevent these injuries from happening in the first place.

Whether accidental or not, Shaken Baby Syndrome, the most common form of abusive head trauma, happens more frequently than you think. Just looking at the statistics from our pediatric trauma center, it is the number one cause of injury-related deaths in children during the first four years of life. As you can see from this pie chart, the largest child abuse age group comprises infants less than six months old.

childabusestatsShaking a baby can lead to severe injury or even death. Just a few forceful shaking motions in a period of just a few seconds can cause tremendous brain damage where the child may never be normal again.

Abusive head trauma is a community-wide problem that permeates all socioeconomic backgrounds. I believe the most effective way to address this epidemic is through public awareness, universal parental education and community involvement.

I encourage everyone concerned with child health to support The Period of PURPLE Crying, a broad-based initiative to increase awareness about the effects of Shaken Baby Syndrome. I first learned about the full extent of this program and its scientific rationale in April when the program’s founder, Dr. Ronald Barr, a pediatrician and world expert on infant crying, came to Houston to deliver the seminar.

The PURPLE acronym stands for the six characteristics of a newborns’ behavioral activities in the first few weeks and months of life. While incessant cries from a newborn can be frustrating and anger provoking, it’s important for parents and other caretakers to remember that this is a normal and temporary phase in their child’s development.

I am grateful to our physicians and nurses at the Pavilion for Women for implementing The Period of Purple Crying program to educate new parents before they leave the hospital about the dangers of shaking a baby as well as providing them with helpful information on child development, crying and managing parental stress.

In partnership with Dr. Charles Cox, medical director of the pediatric trauma program at Memorial Hermann Children’s Hospital, our goal is to ensure all birthing hospitals in the Houston area adopt this program and to increase public awareness of the problem of abusive head trauma with the help of our local public health departments, child abuse prevention experts, city leadership and other community stakeholders.

But, our mission doesn’t stop there. We need everyone’s participation. Spread the message of The Period of PURPLE Crying initiative to your colleagues, family members, new parents, grandparents, caregivers, neighbors and anyone else you come across.

“Our newborns’ lives are at stake. Will you join me on this mission?,” says Dr. David Wesson.

April 8, 2014

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April marks Child Abuse Prevention month. The Child Abuse Pediatrics team hopes this is a reminder for all of us to pay attention to the signs of abuse and take action. Last year, more than 1,400 children who came through the Texas Children’s Hospital doors were identified as being abused or neglected. Twenty-six of them died as a result of suspected abuse or neglect. The CAP team relies on you, the staff, to take action.

Child maltreatment can take on many forms. While a list of indicators would be very long, here are some red flags to watch out for:

  • If a child tells you they are being mistreated, take action. Call the child abuse hotline to help make that child safer.
  • Sudden unexplained changes in child’s behavior (regressive, aggressive, or sexualized).
  • Unexplained burns, bites, bruises, or black eyes particularly to the head, neck, torso, buttocks and insides of the thigh.
  • A parent who shows little evidence of care or concern for the child, or even expresses that the child is a burden.
  • Parents who appear to be overwhelmed or use unusually harsh forms of discipline. Offer comfort and support instead of criticism.

Ways to prevent or stop child maltreatment include:

  • Share information regarding appropriate child development. This may reduce unrealistic parental expectations on a child.
  • Offer resources for parents struggling emotionally and physically. When provided in a supportive and helpful manner, most parents are appreciative. 2-1-1 is available in most communities, and is an excellent general resource.
  • Listen to children when they are talking about their lives. Stay calm and do not show emotional reactions. Many children who have been the victims of chronic maltreatment may not be able to correctly interpret your emotions.
  • Call Children’s Protective Services if you suspect child maltreatment. CPS exists to help families get stronger, while keeping children safe.