GUIDELINES FOR PARENTS AND GUARDIANS OF CHILDREN
DURING OFFICE VISITS TO HEALTH OR SCHOOL PROFESSIONALS
Deborah Belanger Kettle, psychotherapist
Dana Raphael, medical anthropologist, in consultation with
Morris Wessel, pediatrician
.
Most physicians, pediatricians, social workers, teachers, nurses, dentists are honorable people, but others, both men and women, indulge in acts that are disrespectful, dangerous or seriously damaging to children. This guide has been developed to prevent such injury.
Recently, the American Medical Association issued guidelines for their members who are in a position to notice abuse, particularly of women and children. They have been given instructions as to what they can or must do when they uncover signs of mistreatment. No such guidelines exist to protect children, perhaps because the notion of abuse by professionals is so unsettling. These guidelines are written for parents and caretakers to help them guard their children against abuse by professionals.
Since there are many necessary medical procedures that are distasteful and may offend a child’s feeling of privacy, it is difficult to set strict rules and regulations. But, particular caution should always be exercised when it comes to examinations of the genitalia, buttocks, and breasts. The best advice is to listen carefully and to be sensitive to a child’s reactions.
One girl revealed how subtle the behavior that leads to violation can be. She explained, “It wasn’t exactly what he was doing, Mom. It was the expression on his face and the way he looked that scared me.”
When choosing a physician, dentist or therapist for your child, if possible, obtain a recommendation from another parent/guardian who has used that professional’s service. The opinion of a child who has been a patient is useful. A list of professionals in every specialty is available from hospitals, but does not assure the child’s safety. A second opinion is often helpful.
A parent or some adult “friend” should be with the youngster AT ALL TIMES no matter what examination is being performed.
Some physicians and dentists insist the child be alone for the entire office visit. Common folklore has it that children appear more upset when the parent is present. Armed with that questionable “fact,” the parent is often asked to leave the room. Beware of this attitude. Data show that the presence of a familiar, trusted person reduces the likelihood that a child will feel deserted.
Isolating the patient is a potentially dangerous practice.
Any procedure which involves the sex organs should be prefaced by an explanation of why it is necessary and what it entails. You must agree to the procedure. Remember, you have every right to say “No.”
A child should be informed of any inspection involving the genitalia, buttocks or breasts before it occurs and in detail appropriate for that child’s level of understanding. Some parents find it difficult to discuss the sex organs with their children, but they should try their best. Their hesitation can communicate a negative message and be frightening to the child. If a doctor is not comfortable talking about these issues with the child, it might be wise to consider another physician for this particular test. Many physicians today share in a group practice, one or more of whom may have special training for these more sensitive procedures.
HOW WE CAN PREVENT THE MISTREATMENT OF OUR CHILDREN?
Never ignore a child’s distress. Expressions of fear as well as physical complaints must be taken seriously. Refusal to go to school could be related to fear of abuse by a teacher. Children are often not aware of what makes them unhappy and frightened. It is up to the adult to be watchful and to separate real distress from normal, peevish childhood behavior.
If your child begins to act in a way that seems different or unusual, consider asking someone who knows the child well if he or she notices any behavioral changes. If the child balks about keeping an appointment with a professional, try to determine what is worrying her. Children trust their parents will keep them from danger, but parental trust of authority figures can leave children vulnerable. Perpetrators find it easy to threaten children and win their silence. This is why most abuse of children goes unnoticed and why it is so prevalent.
One adult reported that when she was a child she would never complain, no matter how ill she felt nor how high her fever, for fear she would have to go to the pediatrician, a woman in her case, who always gave her an enema.
Once you agree to the examination of the genital and anal areas, watch that it is done with courtesy, care, and privacy. Children very early get a sense of what their family and society deem proper and respectful.
Inappropriate behavior is sometimes couched in very subtle actions. Children admit to being frightened or embarrassed when someone other than the professional is present. One physician scoffed at such timidity. “It is harmless,” he remarked. Forcing someone to undress in American is related to sex and power and the young person may feel powerless and insulted. Insensitivity is not harmless.
A ten-year old boy was furious and miserable when he was “made” to undress during a spinal examination in front of his gym teacher.
What seems insignificant to the adult can be exceedingly traumatic for the child. Be careful not to define a child’s experience from an adult point of view.
An angry eight-year-old girl recounted how she was bullied into standing nude while being examined for an earache.
Commonly, the memory brings back emotions of humiliation even late in life.
At age 82, a woman wept when she spoke for the first time about how, at age ten, she was humiliated when her doctor forced her to stand naked in front of him as he patted her buttocks.
A man recalled an experience at age ten: He awakened from a fitful “sleep” induced by nitrous oxide (laughing gas) for a dental exam only to find he was being fondled.
Adults are mortified when they realize they found it difficult to stand up to unwanted advances by an oppressor who represents authority and power. What can we expect from a ten-year-old?
WHEN IT IS APPROPRIATE TO EXAMINE A CHILD?
ROUTINE INTERNAL EXAMINATION OF THE GENITAL OR ANAL AREA SHOULD NEVER BE DONE
In an emergency, when the symptoms call attention to a potentially serious problem, the professional should observe the courtesy recommended in this guide. It is always appropriate to question why a procedure is required.
Shortly after birth, any adhesions between the foreskin and the penile shaft should be treated to avoid having to deal with them later on. At the same time, it is routine to palpate the testicles to determine if they have descended into the scrotum. If this has not occurred, remedial action is required. With an older child, such an examination should be discussed beforehand and conducted with sensitivity, otherwise it can be very upsetting. The attention to his genital area or, on occasion, the stimulation it may cause, could leave him confused and frightened.
A parent’s concern that his son is fondling his penis or even masturbating does not mean an examination is indicated. Rather, a simple discussion, reassuring him that masturbation and “wet dreams” are normal, is in order. If the doctor or the patient feel this discussion should be private, the adult can withdraw out of hearing, but not out of the room. On the other hand, sometimes adolescents prefer a private conference and they should be granted that choice.
In sexually active teenagers, complaints of painful urination or discharge justifies collection of a urine sample and an examination of the white blood cells. The “milking” down of fluids from the urethra can be done by the boy himself. Examining the pubic area for lesions or the anal area for venereal warts should not be done as a standard practice but only when absolutely necessary. A visual “check” is usually sufficient.
An examination of the newborn girl is appropriate, as there may be a thin web, or evidence of a tear or other abrasions. A thin covering is occasionally present and can be easily repaired at this early stage.
In an emergency, when molestation is suspected because of an enlarged or torn vaginal opening suggesting insertion of a finger or penetration by an object, an examination should be done with an instrument appropriate to a child’s size, for example, a pediatric speculum. The physician’s attendant or another adult representing the child should be nearby.
No examination is necessary if a child, even as young as seven, is beginning to develop breasts and has a discharge on her underpants. The discharge is normal if it is not of an unusual nature, such as a thick, yellow secretion.
One new program that some physicians are challenging is the teaching of breast self-examination to young girls. The incidence of malignancy at such a young age is so infinitesimal that emphasis on the breast with such negative overtones is unwarranted.
Pediatricians are often hesitant to examine the vaginal area of young girls and adolescents. Should it become necessary, for example when a tampon is lost in the vaginal canal, you should consider taking her to a female gynecologist. Examinations by male pediatricians are very traumatic for adolescents.
Should you prevent the physician from carrying out any procedure if you are apprehensive about it? Yes, but this is easier said than achieved. We learn from birth to respect and trust professionals, especially doctors. Sadly, some do not deserve that trust and so you must not be intimidated. The safety of the child comes first. If anything doesn’t seem right or warranted, always question. If possible, delay the examination to give yourself time to consider other options.
WHAT TO DO IF YOUR CHILD HAS BEEN HANDLED IN AN INAPPROPRIATE MANNER BY A PROFESSIONAL
If you suspect your child has been abused, the parent/guardian should examine the child’s body as well as the clothes and save any garments or other pieces of evidence.
If there is any visible damage to the body, the child should be brought to the hospital immediately or to a trusted physician. You should be cautious here as well since not all hospital personnel are trained to handle cases of child abuse with the sensitivity the child desperately needs. Be aware not to allow the victim to be traumatized once again.
An Important Reminder:
Any professional who is advised that a child has been abused is compelled by law to report the case to the appropriate authorities.
If there is a reason to believe a youngster (under 18) has been abused, parents can contact the Department of Children and Youth Services in their area. Sometimes a local agency obligates workers to hear cases of abuse or of “reasonable suspicion of abuse.”
Check the telephone directory for a CHILD ABUSE HOTLINE. This line goes directly to a central office. During the normal business hours, the service will refer the caller to one of several regional offices. After hours, the person on the phone works directly with the caller. The regional offices are staffed by social workers who, after hearing the accusations, will initiate an investigation. They can offer advice regarding the implications of police involvement. It may be wise to contact a lawyer as well.
If you feel you need psychological support and counsel for yourself or the child, you should contact a mental health professional through referral from a friend, a trusted school counselor or from a hospital list, the Mental Health Association in your state or the American Psychological Association.
IT SHOULD NOT HURT TO BE A CHILD!
Most physicians, pediatricians, social workers, teachers, nurses, dentists are honorable people, but others, both men and women, indulge in acts that are disrespectful, dangerous or seriously damaging to children. This guide has been developed to prevent such injury.
Recently, the American Medical Association issued guidelines for their members who are in a position to notice abuse, particularly of women and children. They have been given instructions as to what they can or must do when they uncover signs of mistreatment. No such guidelines exist to protect children, perhaps because the notion of abuse by professionals is so unsettling. These guidelines are written for parents and caretakers to help them guard their children against abuse by professionals.
Since there are many necessary medical procedures that are distasteful and may offend a child’s feeling of privacy, it is difficult to set strict rules and regulations. But, particular caution should always be exercised when it comes to examinations of the genitalia, buttocks, and breasts. The best advice is to listen carefully and to be sensitive to a child’s reactions.
One girl revealed how subtle the behavior that leads to violation can be. She explained, “It wasn’t exactly what he was doing, Mom. It was the expression on his face and the way he looked that scared me.”
When choosing a physician, dentist or therapist for your child, if possible, obtain a recommendation from another parent/guardian who has used that professional’s service. The opinion of a child who has been a patient is useful. A list of professionals in every specialty is available from hospitals, but does not assure the child’s safety. A second opinion is often helpful.
A parent or some adult “friend” should be with the youngster AT ALL TIMES no matter what examination is being performed.
Some physicians and dentists insist the child be alone for the entire office visit. Common folklore has it that children appear more upset when the parent is present. Armed with that questionable “fact,” the parent is often asked to leave the room. Beware of this attitude. Data show that the presence of a familiar, trusted person reduces the likelihood that a child will feel deserted.
Isolating the patient is a potentially dangerous practice.
Any procedure which involves the sex organs should be prefaced by an explanation of why it is necessary and what it entails. You must agree to the procedure. Remember, you have every right to say “No.”
A child should be informed of any inspection involving the genitalia, buttocks or breasts before it occurs and in detail appropriate for that child’s level of understanding. Some parents find it difficult to discuss the sex organs with their children, but they should try their best. Their hesitation can communicate a negative message and be frightening to the child. If a doctor is not comfortable talking about these issues with the child, it might be wise to consider another physician for this particular test. Many physicians today share in a group practice, one or more of whom may have special training for these more sensitive procedures.
HOW WE CAN PREVENT THE MISTREATMENT OF OUR CHILDREN?
Never ignore a child’s distress. Expressions of fear as well as physical complaints must be taken seriously. Refusal to go to school could be related to fear of abuse by a teacher. Children are often not aware of what makes them unhappy and frightened. It is up to the adult to be watchful and to separate real distress from normal, peevish childhood behavior.
If your child begins to act in a way that seems different or unusual, consider asking someone who knows the child well if he or she notices any behavioral changes. If the child balks about keeping an appointment with a professional, try to determine what is worrying her. Children trust their parents will keep them from danger, but parental trust of authority figures can leave children vulnerable. Perpetrators find it easy to threaten children and win their silence. This is why most abuse of children goes unnoticed and why it is so prevalent.
One adult reported that when she was a child she would never complain, no matter how ill she felt nor how high her fever, for fear she would have to go to the pediatrician, a woman in her case, who always gave her an enema.
Once you agree to the examination of the genital and anal areas, watch that it is done with courtesy, care, and privacy. Children very early get a sense of what their family and society deem proper and respectful.
Inappropriate behavior is sometimes couched in very subtle actions. Children admit to being frightened or embarrassed when someone other than the professional is present. One physician scoffed at such timidity. “It is harmless,” he remarked. Forcing someone to undress in American is related to sex and power and the young person may feel powerless and insulted. Insensitivity is not harmless.
A ten-year old boy was furious and miserable when he was “made” to undress during a spinal examination in front of his gym teacher.
What seems insignificant to the adult can be exceedingly traumatic for the child. Be careful not to define a child’s experience from an adult point of view.
An angry eight-year-old girl recounted how she was bullied into standing nude while being examined for an earache.
Commonly, the memory brings back emotions of humiliation even late in life.
At age 82, a woman wept when she spoke for the first time about how, at age ten, she was humiliated when her doctor forced her to stand naked in front of him as he patted her buttocks.
A man recalled an experience at age ten: He awakened from a fitful “sleep” induced by nitrous oxide (laughing gas) for a dental exam only to find he was being fondled.
Adults are mortified when they realize they found it difficult to stand up to unwanted advances by an oppressor who represents authority and power. What can we expect from a ten-year-old?
WHEN IT IS APPROPRIATE TO EXAMINE A CHILD?
ROUTINE INTERNAL EXAMINATION OF THE GENITAL OR ANAL AREA SHOULD NEVER BE DONE
In an emergency, when the symptoms call attention to a potentially serious problem, the professional should observe the courtesy recommended in this guide. It is always appropriate to question why a procedure is required.
Shortly after birth, any adhesions between the foreskin and the penile shaft should be treated to avoid having to deal with them later on. At the same time, it is routine to palpate the testicles to determine if they have descended into the scrotum. If this has not occurred, remedial action is required. With an older child, such an examination should be discussed beforehand and conducted with sensitivity, otherwise it can be very upsetting. The attention to his genital area or, on occasion, the stimulation it may cause, could leave him confused and frightened.
A parent’s concern that his son is fondling his penis or even masturbating does not mean an examination is indicated. Rather, a simple discussion, reassuring him that masturbation and “wet dreams” are normal, is in order. If the doctor or the patient feel this discussion should be private, the adult can withdraw out of hearing, but not out of the room. On the other hand, sometimes adolescents prefer a private conference and they should be granted that choice.
In sexually active teenagers, complaints of painful urination or discharge justifies collection of a urine sample and an examination of the white blood cells. The “milking” down of fluids from the urethra can be done by the boy himself. Examining the pubic area for lesions or the anal area for venereal warts should not be done as a standard practice but only when absolutely necessary. A visual “check” is usually sufficient.
An examination of the newborn girl is appropriate, as there may be a thin web, or evidence of a tear or other abrasions. A thin covering is occasionally present and can be easily repaired at this early stage.
In an emergency, when molestation is suspected because of an enlarged or torn vaginal opening suggesting insertion of a finger or penetration by an object, an examination should be done with an instrument appropriate to a child’s size, for example, a pediatric speculum. The physician’s attendant or another adult representing the child should be nearby.
No examination is necessary if a child, even as young as seven, is beginning to develop breasts and has a discharge on her underpants. The discharge is normal if it is not of an unusual nature, such as a thick, yellow secretion.
One new program that some physicians are challenging is the teaching of breast self-examination to young girls. The incidence of malignancy at such a young age is so infinitesimal that emphasis on the breast with such negative overtones is unwarranted.
Pediatricians are often hesitant to examine the vaginal area of young girls and adolescents. Should it become necessary, for example when a tampon is lost in the vaginal canal, you should consider taking her to a female gynecologist. Examinations by male pediatricians are very traumatic for adolescents.
Should you prevent the physician from carrying out any procedure if you are apprehensive about it? Yes, but this is easier said than achieved. We learn from birth to respect and trust professionals, especially doctors. Sadly, some do not deserve that trust and so you must not be intimidated. The safety of the child comes first. If anything doesn’t seem right or warranted, always question. If possible, delay the examination to give yourself time to consider other options.
WHAT TO DO IF YOUR CHILD HAS BEEN HANDLED IN AN INAPPROPRIATE MANNER BY A PROFESSIONAL
If you suspect your child has been abused, the parent/guardian should examine the child’s body as well as the clothes and save any garments or other pieces of evidence.
If there is any visible damage to the body, the child should be brought to the hospital immediately or to a trusted physician. You should be cautious here as well since not all hospital personnel are trained to handle cases of child abuse with the sensitivity the child desperately needs. Be aware not to allow the victim to be traumatized once again.
An Important Reminder:
Any professional who is advised that a child has been abused is compelled by law to report the case to the appropriate authorities.
If there is a reason to believe a youngster (under 18) has been abused, parents can contact the Department of Children and Youth Services in their area. Sometimes a local agency obligates workers to hear cases of abuse or of “reasonable suspicion of abuse.”
Check the telephone directory for a CHILD ABUSE HOTLINE. This line goes directly to a central office. During the normal business hours, the service will refer the caller to one of several regional offices. After hours, the person on the phone works directly with the caller. The regional offices are staffed by social workers who, after hearing the accusations, will initiate an investigation. They can offer advice regarding the implications of police involvement. It may be wise to contact a lawyer as well.
If you feel you need psychological support and counsel for yourself or the child, you should contact a mental health professional through referral from a friend, a trusted school counselor or from a hospital list, the Mental Health Association in your state or the American Psychological Association.
IT SHOULD NOT HURT TO BE A CHILD!
