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Good Information And For My Doubters

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How Medical Professionals should address Child Physical Abuse.

Medical Professionals – Trauma: How to address Child Physical Abuse

Arne H. Graff, M.D., is the division chair of Child Abuse Pediatrics at Mayo Clinic’s campus in Rochester, Minnesota.  His desire is to equip providers for potential child physical abuse (CPA) cases, helping them feel as comfortable as possible and removing the fear of reporting.  He offers perspective on CPA and what trauma professionals’ responsibilities are in this scenario.

How did you get into the child abuse field?

While I was working in North Dakota, a physician at Sanford Medical Center in Fargo talked me into working with him in a volunteer clinic.  While there, I ran into enough child abuse cases that I realized I needed to get out of it or get better.  So I did a fellowship in child abuse pediatrics.

Is child abuse common in Minnesota?

Around 84,000 reported cases of child maltreatment are reported each year in Minnesota, according to the Minnesota Department of Human Services and documented in the Child Maltreatment Report for 2017.   Minnesota has as high an incidence as some other states, like California, but doesn’t see as large of numbers due to population differences between Minnesota and the other states.

There are about 1,500 identified maltreatment deaths in Minnesota each year, but this is assumed underreported due to the difficulty in identifying many of the deaths as clearly caused by maltreatment.  In Rochester, Minnesota, and the immediate region, we have around 400 reported maltreatment cases each year.

(1,500÷365=4.1 Child Maltreatment deaths per day just in Minnesota, so how can so many distort the numbers by saying there has ever been 5 Child Maltreatment deaths each day in the last 100 years and possibly the last 150 years)

Which children are at highest risk of abuse?

A young child or infant is at highest risk.

Are any children overlooked for abuse?

Yes — teenagers.  I don’t want us as providers to just focus on little kids.  Teens have a similar CPA pattern as other children.  It’s important you consider whether abuse is occurring if you see a 15-year-old with an injury that doesn’t align with the history. Don’t assume because they’re teenagers, they aren’t experiencing abuse.

Who abuses children?

People who have access to children hurt children: parents, child care providers, grandparents and school personnel.  Anyone has the capacity to hurt children.

That said, it’s important to know that 82% of abusers are ages 18 to 44, and 80% of CPA is inflicted by parents, according to data from Child Welfare Information Gateway.

Is denial of mechanism of injury common in these cases?  If so, any advice?

Since we don’t know how often abuse is missed, we can’t guess at how often it’s denied.  Personal experience is that even with serious injuries, denial is common. Considering that one of the caregivers may not have knowledge of events that occurred with his or her partner, denial can be a normal answer.  Therefore, asking about domestic as well as pet violence is important, and also interviewing caregivers separately.  By emphasizing mandated reporting requirements and indicating concern about their child, we hopefully will maintain a working relationship with the family.

Any tips for assessing a child’s injury?

Every injury presented must be consistent with the child’s medical history and developmental ability.  If it doesn’t line up, ask why.  It doesn’t mean there’s abuse occurring, but it does mean something’s going on that doesn’t make sense.

Our job is to consider the injury’s cause — medical, accidental and then nonaccidental trauma — as well as medical history and mechanics.  It’s not our job to immediately assume, if we don’t like how it looks, that somebody’s abused the child. We have to start with ruling out other options, especially with a nonverbal child.

In 30% to 40% of cases we see, we have to say we can’t determine if an injury was abuse or accidental, and we need to consider potential options for the injury.

How should I determine which tests are needed?

First, it’s important to know that exams have limits.  You can’t determine abuse simply by physical exam.  However, being financially responsible means to not shotgun and do every test available.

If you need to consult on a potential CPA case, my colleague Donald (Chris) C. Derauf, M.D., and I are available 24/7 every day for curbside consults at no cost.  We do 300 to 400 of these a year.  You may call us through the MATC to discuss what you’re seeing in a case, and we can advise on screening.  We are your resource and encourage people to call and bounce things off us.

How do I figure out who did it?

You and I don’t care.  It’s not our job.  Our primary role is to prove it’s not abuse and look at accidental injuries or other conditions that may have caused the injury.  Also, our job is not to rule out people who may have abused the child, or determine reason or intent — leave that to the legal system.

How can I help stop CPA?

If you can recognize CPA early through a sentinel event — a case where injuries in children nonmobile or under age 4 can’t be explained by a simple accident, such as significant bruising to the head or neck — you can make a difference.  For these children, consider the injury to be caused by someone.  Bruising in a nonmobile child should be a red flag if not immediately explained by multiple people.

Sentinel injuries, without witnessed accident, carry high risk of further injury or death.  According to an article by Sheets and others in the April 2013 issue of Pediatrics, 27% of kids who’ve been seen by a provider and demonstrated to have had a sentinel event will return with serious injuries or dead.

What’s my responsibility?

 These are critical steps for providers in potential CPA cases:

  • Identify other possible injury causes.
  • Recognize these things are serious.  Once considering CPA as a potential cause, you are a mandated reporter.  It doesn’t have to be proved, just suspected.  You can’t simply write in your notes that you’re concerned and not report.  You must contact child protective services about a safety plan and tell them why there’s concern.
  • Conduct testing in a timely manner; it’s important for safety and complete diagnosis.
  • Remember multiple types of abuse can coexist.  Do a complete exam for neglect; don’t just focus on a bruise.
  • Don’t send the family home until all test results come through, or the child potentially may be going into an unsafe environment.  While you’re doing your work, child protective services (CPS) will develop a safety plan.  We can’t send the family out until this plan is finished and documented by the physician.
  • Make a complete description of the injury, including photos.

Any suggested approach with the family if CPA is suspected?

Since it’s not our role to decide who did it, I usually use this approach and advise providers to consider it.  I say to the caregiver present: “With this type of injury, without a known medical problem causing it or a witnessed accident, I am concerned someone may have hurt your child.  Because of this, I am a mandated reporter and have already spoken with child protective services.  They will want to talk with you about safety plans for your child.  I also want to recommend some tests that may better tell us why the injury occurred and if there are other injuries present we cannot see on the exam.”

It’s important to help families understand that just because the child looks happy and OK, it doesn’t rule out other injuries.

Any pitfalls you’d suggest avoiding with CPA?

We fail to recognize our blinders.  If you’re homeless or a minority, statistics say CPA cases are overreported, according to a 2011 publication in Journal of the National Medical Association.  However, studies indicate if you’re white middle class and present with an infant to the emergency room, people don’t even think about abuse. Also, if we know members of the family personally, there’s a tendency to say, “They are nice people.  They wouldn’t do this.”

If we think there might be abuse, we need to get CPS involved, period.  Letting our biases influence who we report puts kids at risk.  Remember, reporting may help services be put in place to assist the family.

Which patients who’ve survived potential CPA need transfer for further work-up?

The work-up needs to be completed at the time the concern is raised.  Depending on the child’s age, it may include:

  • A dilated eye exam by an eye expert, to be completed within 48 hours
  • A skeletal survey immediately and again in two to three weeks
  • A head CT if under age 1 or obvious head trauma
  • Abdominal labs

If testing can’t be completed, transfer to a larger center is indicated.  If testing can be done and a safety plan put in place, the child may be evaluated at the local site only and be watched overnight or be sent home, depending on tests and exam.

Resource: MayoClinic.org
This publication can be seen HERE complete with links.

One Million Moms Can’t Be Wrong

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Disney isn’t for Children anymore, they are now pushing an #AntiChild Agenda.

Disney Announces First Official LGBTQ Character in ‘Onward’

Alerting all parents!  One Million Moms needs your help to make sure as many people as possible are aware of Disney pushing the LGBTQ agenda on families, particularly children, in the upcoming animated movie Onward, set to hit theaters Friday, March 6.

The character of Officer Specter, voiced by openly gay Lena Waithe, is a purple lesbian Cyclops whose dialogue reveals her sexuality.

In one scene, Specter and her police partner Officer Gore, voiced by Ali Wong, pull over a driver who claims he was distracted by the bad behavior of his girlfriend’s sons.  Specter empathizes by saying, “My girlfriend’s daughter got me pulling my hair out.”

This scene takes place toward the middle of a quest by two brothers, voiced by Tom Holland and Chris Pratt, as they head to the magical mountains to resurrect their father for the day.

There have been numerous attempts by Disney to indoctrinate children with the LGBTQ agenda discretely and now more overtly.  In 2019, Disney proudly admitted to there being a gay couple in the animated children’s series Star Wars Resistance.

In the past, there were mostly speculations about the inclusion of LGBTQ characters by Disney.  For example, Disney’s Finding Dory (2016) briefly depicts a lesbian couple in one scene.  The live-action remake of Beauty and the Beast (2017) continued testing the waters with a brief implication that LeFou was gay.  And more recently, Toy Story 4 (2019) showed two moms in the background dropping their child off at school then returning to pick up the child, who hugs them.  It is obvious that the child has two mothers, and they are parenting together.

These scenes are subtle in order to desensitize children.  But now Disney has traded its subtlety for intentionality.

Disney has decided to be politically correct instead of providing family friendly programming.  Disney should stick to entertaining, not pushing an agenda.

Please share this with your friends and family to make sure they are aware of the gay character in Onward and not blindsided by it.  As moms, we all want to know when Disney is attempting to desensitize our children by normalizing the LGBTQ lifestyle.

One Million Moms webpage

Weber Draws Five Life Sentences

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Stanley Patrick Weber, 71, of Spearfish SD was sentenced in federal court to five consecutive life sentences.

Former Pine Ridge doctor sentenced for Child Sex Abuse

RAPID CITY, SD  –  A former Indian Health Service pediatrician was sentenced Monday for sexually abusing Native American children while on the Pine Ridge reservation in South Dakota.

Stanley Patrick Weber, 71, of Spearfish was sentenced in federal court to five consecutive life sentences for five aggravated sexual abuse charges, the U.S. Attorney’s Office said.  Weber also was sentenced to 15 years on each of three counts of sexual abuse of a minor.

Weber was sentenced last year to 18 years in prison for similar crimes against boys on the Blackfeet Indian Reservation in Montana.  His sentences in South Dakota all will be served consecutively to each other and also consecutive to his Montana sentence, the U.S. Attorney’s Office said.

Weber also was ordered to pay $800,000 in fines.  The government says evidence at his trial showed that Weber sexually abused multiple Native American children between 1999 and 2011 while he was employed as an IHS pediatrician at Pine Ridge.

U.S. Attorney for South Dakota Ron Parsons said the sentence ensures that Weber “will never roam free again.”

So You Are Expecting A Baby

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Your child deserves good parents.

Baby Proofing Essentials

Start Early

It may seem odd to baby-proof your home when your infant can’t even roll over yet, but you may be surprised at how soon he’ll be getting around and getting into things.   So it’s never too soon.  Take the time to baby-proof when your little one is still brand new or even before he arrives.

Tie It Down

Time to secure your TVs and furniture — just in case.  Use furniture straps to hold TVs, bookshelves, dressers, and other heavy furniture in place in any rooms where your child might be left alone, even for a minute.  Don’t put a TV on top of a dresser — the drawers can be used for climbing.  Put corner or edge bumpers on any furniture with sharp edges.

Potty Precautions

You might not see your toilet as a hazard, but the water in it, and the toilet lid, can be a danger for a curious child.  So prevent any problems: Remember to always keep toilet lids down and secured with a lid lock.

Control Your Cords

Use cord holders to keep longer cords fastened against walls.  That way, your little one can’t tug on a tangle of computer cords and other electrical wiring.  That could keep your baby safe from electrical hazards or heavy equipment that falls after a couple of tiny tugs.

Give Baby a Safe Night’s Sleep

Make sure your baby’s crib has fixed rails.  Or if you must use an older crib, don’t use the drop-side rail, or get an immobilizer for it.  (Cribs with drop-side rails are banned.)  Test the crib to make sure your baby can’t fit his head between the slats.  If you can slide a soda can between the slats, they’re too wide.  Always keep soft items like blankets, pillows, stuffed toys, and bumpers out of your baby’s sleep space.

Manage Your Medication

Store all medicines in a high, locked cabinet.  Never take medicine out of its original childproof container.  Try not to take medicine in front of your child or he may want to imitate you.  Never call medicine “candy.”  And don’t flush old pills down the toilet. Get rid of them through your local drug take-back program, or put them in a sealed bag with something your child won’t want to eat — like kitty litter or coffee grounds — and throw it in the trash.

Blind Danger

Tie all blind cords high out of reach, or cut the ends and attach breakaway safety tassels.  Never put a crib or child’s bed near window blinds or drapes.  Those dangling cords can be a choking risk.

Prevent Shocks

Put outlet covers on all exposed electrical sockets to keep your little one from getting an electric shock.  Some small outlet covers can be a choking hazard if a baby or toddler pries them out of the wall.  Look for “childproof” covers that require two hands to remove or cover plates that screw on.  For double protection, place large furniture in front of outlets.

When It’s Time for a Change

You’ll probably be surprised at how fast your baby learns to roll over — and the changing table becomes a falling hazard.  Be sure your changing table has safety straps and always buckle up when diapering your child.  Don’t ever leave baby alone on the table.  Plan ahead and have all the items you need — diapers, wipes, baby cream, nail clippers, and a small toy — handy before you start to change the baby.

Lock It Up

Protect curious kids from household cleaners and other chemicals by storing those items in locked cabinets or installing safety latches that lock when you close the cabinet door.  Do the same for any low cupboards that contain risky items like small appliances.  For added safety, store hazardous items up high and far away from small fingers.

Safety in the Car

Keep your baby safe in your car, too — in a rear-facing car seat until he’s 2.  Don’t use a car seat if you don’t know its history.  It may have been involved in a car crash or it may be past its expiration date.  Avoid a used car seat that looks damaged or is missing parts or the instructions.  Avoid recalled models, too.  You can find out more about car seat safety from the manufacturer or the National Highway Traffic Safety Administration (http://www.safercar.gov).

Tub Time

Make tub time fun, but safe, for your little one.  Prevent scalding by adjusting your hot water heater so that the water is no hotter than 120 degrees.  Install no-slip strips on the bottom of your tub and a soft cover on the faucet to protect tender heads.  Most important, never leave your baby or toddler alone in the tub, even for a moment.

Limit Baby’s Movement

If there are some rooms you don’t want to baby proof, use baby gates to keep your little one from getting into them.  Also install gates at the top and bottom of the stairs beforeyour baby gets mobile.  Don’t use accordion-style gates, which could trap the baby’s head.  Look for gates that attach securely to the wall but won’t pinch small fingers.

Prevent Window Falls

Place your child’s crib and other furniture away from windows.  Don’t rely on standard window screens — they’re meant to keep insects out, not children in. Instead, install childproof screens, or even better, window guards, which are proven to prevent falls.

Around Pools and Water Features

Take steps to safeguard areas around pools, hot tubs, and other home features with standing water, like fish tanks and ponds.  Backyard pools should be completely surrounded by a 4-foot fence, preferably with a self-latching gate.  Pool covers and alarms may provide additional protection.  Don’t leave toys floating in pools.  And just like in the tub, never take your eyes off a child near water.

Practice Toy Safety

Baby toys should be safe for babies.  Your child’s toys should be much larger than his mouth, to prevent choking.  Check that all the parts attached to a toy — like doll eyes or teddy bear bows — are securely fastened and can’t be torn off.  Remove mobiles attached to a crib as soon as your baby can push up on his hands and knees.

Unplug Appliances

You may leave appliances such as the toaster, coffee maker, or paper shredder plugged in for convenience.  But some appliances can harm your child if she turns them on, pulls them down on her, or gets tangled in a cord.  Unplug them when you’re not using them and put them away, out of reach, if you can.

Alarms

Smoke and carbon monoxide detectors are essential to your family’s safety.  Install a smoke alarm outside every bedroom or sleeping area, and make sure there’s at least one on every floor.  Don’t put smoke detectors near the kitchen or bathroom — these areas can trigger false alarms that may leave you inclined to ignore them.  Check the batteries every month.

Choose a Safer Toy Box

Choose a toy box with a safe design.  Avoid containers with hinged lids that slam down.  You want one with a light, removable lid or one that slides.  If yours has a hinged top, make sure it has a lid support that can prop the lid open.  Pick a toy box with ventilation holes or a gap beneath the lid — in case a kid climbs in.

Get Your Child’s Point of View

The best way to baby proof is to see things the way your baby does.  Get down on your hands and knees and crawl around.  What’s at baby’s eye level and within easy reach?  Kids can be curious about anything they see, like computer cords and glassware on low shelves.  You might not notice breakable or hazardous items when you’re towering above them.

Resource: WebMD.com
Reviewed by Dan Brennan, MD on September 27, 2019

The AntiChild Agenda Is Not Welcome Near My Family

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The Destruction of Sodom and Gomorrah.

WARNING: Child Predators Do Not Belong Near A Child

I remember the NFL Championship Game on January 1, 1967, which was played here at the Cotton Bowl, Dallas, Texas…

Green Bay Packers 34, Dallas Cowboys 27

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Bart Starr in Super Bowl 1.

Super Bowl I, Sunday, January 15 at Los Angeles Memorial Coliseum, Los Angeles, California…

Green Bay Packers 35, Kansas City Chiefs 10

  • MVP: Bart Starr, quarterback
  • Al Hirt was one of the half time shows.  I saw Al play in New Orleans when I was a very young teenager.

Incidentally, I started playing piano at a very young age(before I started playing cornet and trumpet), bad thing was, I could watch or listen to Liberace… but I got toreup if I got caught playing or listening to The Killer (Jerry Lee Lewis).

That pretty much says it all.

Long before Super Bowl 1, Dallas Cowboys has always been a family get together tradition, just like The Killer and Al Hirt.

Now, here we are just before the 54th Super Bowl, and I got some things to say…

Tomorrow, my Family will be getting together, in many places, and they will hear ME…

BUT, there will be NO FOX SPORTS, and NO MORE NFL!!!!

As far as we are concerned, FOX SPORTS, the NFL, and the Alphabet Sewer Rats deserve each other, and you all are not welcome around OUR FAMILY… and NOT IN MY WORLD!!!!