For the first time in more than a decade, pediatricians are getting new guidelines for identifying and addressing abuse of children with disabilities.
In a clinical report this week, the American Academy of Pediatrics said children with disabilities are at least three times more likely than other children to experience abuse and neglect. And cases of such abuse are likely to be underreported, as many of these children have communication difficulties and are unable to report problems.
The guideline notes that several factors can explain this increased risk. Families can be overwhelmed by the complex nature of their children’s needs, the extra financial demands or a lack of respite care. Parents may also overestimate their child’s abilities and resort to physical punishment to deal with what they consider stubbornness, the report indicates.
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The pediatric group in particular said research suggests that children with milder disabilities are actually more at risk for abuse and neglect than children with more severe disabilities.
“Raising a child with a disability is often a challenge,” said Larry W. Desch, a pediatrician at Chicago Medical School and author of the clinical report. “Some children with disabilities respond differently to the usual ways we think about discipline and reinforcement of good behavior. This can become very frustrating and add to caregiver stress. “
Pediatricians should take an active role in assessing the well-being of the family at each medical visit and discussing appropriate discipline, the pediatric group said. Families should be given reasonable expectations of their child, given concrete ideas on how to respond to developmental challenges facing a child, and referred to local resources and agencies for support.
In addition, physicians should recognize signs of abuse and, if appropriate, report concerns to authorities. But the guideline points out that pediatricians also have a responsibility to document self-harming behaviors and other factors that can be critical in discerning whether injuries are likely to result from abuse.
“As pediatricians, every day we see families trying to do their best for their children, but who may not have the coping skills and resources to help cope with stress or difficult circumstances,” said Lori A. Legano of New York University, the lead author of the clinical report. “Pediatricians can provide a non-judgmental perspective, help families focus on their child’s strengths and guide them through difficult times.”