May 13, 2005

Child abuse ‘snapshot’ shows youngest victims worst injured

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Chris Greeley, M.D., assistant professor of Pediatrics, has been compiling a database of the injuries associated with cases of child abuse and neglect.
photo by Dana Johnson

Child abuse ‘snapshot’ shows youngest victims worst injured

About a quarter of infants who are violently shaken by an abuser will die from brain damage. Three quarters of these infants will literally have the retinas of their eyes torn away from the back of the eye wall from the force of the motion. These shocking results are part of an internal survey conducted at the Monroe Carell Jr. Children's Hospital at Vanderbilt and are no surprise to the survey's author, Chris Greeley, M.D., assistant professor of Pediatrics and medical director of the VCH Child Abuse and Neglect Program.

“This is consistent with what is reported in the literature,” Greeley said. “And this tells me the database we have begun here is likely an accurate snapshot of child abuse in our region.”

Greeley already has 600 entries in the child abuse database he began compiling a few years ago. He presumes a large number of injuries seen at Vanderbilt's Pediatric Emergency Department and in other areas of the hospital that may be related to abuse are not brought to his attention because the findings may not be compelling enough to prove the cause was related to abuse or neglect.

“This is the tip of the iceberg,” Greeley said. “In the world of child abuse, there is a spectrum of certainty. These are the cases where the physician feels compelled to call the child abuse expert to document the case. These are the worst of the worst, the kids that any reasonable physician would say “yes, this is abuse.”

While only a small percentage of the total number of injured children seen at VCH, the numbers represent a very vulnerable group of children.

There are also a large number of neglected children seen at VCH and Greeley is beginning to get a sense of them as well.

“About two-thirds of all child abuse is neglect. We here at VCH see a large number of child neglect cases as well, but they seem to fly below the radar,” Greeley said. “This database is the first step in getting a real handle on the scope of the problem seen here at VCH.”

Greeley says his database is not part of a formal research project. He explains there may be some difference in what is medically diagnosed as child abuse and what is found to meet the legal definition.

While each case in his database is also reported to the state — as required by law — for official tracking of suspected abuse rates in Tennessee, the information which returns to the public is spotty and frequently scarce. The database is a result of multidisciplinary evaluation by the hospital's child abuse review and evaluation (C.A.R.E.) team.

This year Greeley feels the numbers in his database are solid enough to share publicly, and he says he has strong reasons to do so. He wants people to know the types of injuries he sees at VCH in order to boost awareness and to grow support for programs to prevent abuse. The most compelling fact that comes to light in Greeley's database is that tiny infants are hardest hit by violence. Of the 64 official abuse consults in his database from 2004, 37 involved children 1 year old or younger.

“These are completely preventable injuries, and, in fact, some research has shown you can make an impact on the rates of child abuse with startlingly simple actions,” Greeley said.