Casting light on the shadow of abuse

James and Lilian Motz of Surprise.

Lilian Motz of Surprise was just 5 months old when she was brutally shaken by a caregiver who was a relative by marriage. Her father, James, was out of town when the sitter called to say that Lilian was not breathing. The caregiver refused to call 9-1-1, so James did it himself.

By the time an ambulance arrived, the caregiver had fled. Lilian was taken, alone, to Banner Del E. Webb Medical Center and then transferred to Phoenix Children’s Hospital (PCH), where she was diagnosed as a shaken baby. She was in the hospital for about two weeks. But she was lucky. Probably because the bones in her skull had not yet fused (allowing her skull to expand to accommodate swelling), there was no permanent brain damage.

When the abuser showed up to apologize and tried to give Motz a hug, he lost it. The police got involved, he was charged with assault and he spent a night in jail. “I feel bad that I beat her up,” he says, “but I couldn’t help it. I don’t even remember doing it.”

Motz hired someone else to run his company. He now stays home full time with  his two children. Lilian’s doctors recently gave her family the good news that she will have no lasting effects from the abuse. Motz willingly shares his story with anyone who will listen, hoping it will prevent even one child from suffering at the hands of a trusted family member or friend.

On the condition that her last name not be used, Beth, of Phoenix, shared the effect abuse by a caregiver has had on her family. At the age of 4 months, a licensed day care worker shook her son David, now 12. The injury to his brain left permanent damage. He now lives with cerebral palsy, learning differences and difficulty walking.

“It was really hard when he was in the hospital and the doctors knew it wasn’t an accident,” says Beth. “He was in the ICU (intensive care unit) and I still didn’t get it that someone else had done this to him. Of course, parents are the first suspects. The nurses and social workers were talking to us and listening to us in a different way. They were actually helping us with our trauma while they were gathering evidence.”

The day care worker’s license was revoked but she was never prosecuted. In an effort to begin healing, Beth and her family decided to get involved with child abuse prevention and education.

“Looking back, we had to be strong for David, to help him recover as much as he could,” she says. “There was some grief, yes. His injury is a result of the fact that someone got frustrated. One third of shaken babies die, and many are left in a vegetative state. David is able to walk and talk and he’s charming. He is doing some things that are typical for a 12 year old. We can’t get frustrated with him. We look for what he’s achieved and we don’t compare him to anyone else. We celebrate his success.”

The words “child” and “abuse” should never have to appear in the same sentence. But because they do, the words “pediatric” and “forensics” must appear in this article about a team of people at Phoenix Children’s Hospital who treat the victims of child abuse—and work to prevent it.

One of the hospital’s leading child abuse prevention advocates is social worker Marcia Stanton. The mother of three sons (one in college, and twins in eighth grade), her interest in child abuse began in 2005, when she happened upon an article on the Internet that described a 10-year study with profound implications for adults who had been childhood victims of abuse.

The Adverse Childhood Experiences (ACE) Study affirmed the longterm damage that results from child abuse, neglect and household trauma. Such experiences leave a child vulnerable, disrupt the normal development of the brain and lead to risk factors for disease or addictions in adulthood. Prevention of abuse is the ideal solution; intervention and treatment when abuse has occurred is critical.

Shortly after Stanton read the article, she went to a conference in Florida where she listened to one of the study’s authors, Vincent J. Felitti, M.D., of San Diego. When he came to speak in Phoenix, she sat in the audience asking questions. She arranged for him to visit PCH.

Stanton organized a luncheon in Felitti’s honor and one of the attendees was Mary G. Warren, Ph.D., IMH-E(IV) of Never Shake A Baby Arizona. Warren joined Stanton in her efforts to educate other community members about the ACE study.

Stanton and Warren put together a series of events to spread the word to about 225 participants from social welfare agencies, non-profits, philanthropies, the medical community and the media. By August 2007, several of those participants formed what Stanton termed the “ACE Think Tank” to keep a conversation going.

In 2009, the group became a consortium. Organizers wrote a grant to create a public awareness campaign (it wasn’t funded) and gave presentations about the ACE study at various conferences, schools and organizations around Arizona.

The goal for 2010 is a statewide public education campaign, beginning this month. PCH is hosting the Children’s March on Child Abuse on Saturday, April 3, at the Phoenix Zoo to build awareness and raise funding for prevention efforts. Other entities around the state also have planned activities during April, which is Child Abuse Prevention Month. (See page 21.)

Most cases of physical abuse affect children under the age of 5. The incidence of abuse rises during specific developmental phases: when a child can only communicate by crying, during toilet training and during what is typically thought of as the “terrible 2s,” when a child begins developing some sense of autonomy and begins to say “no.”

Many factors can precipitate an abusive situation between an angry parent and a frustrated child. Without intervention—therapy, parenting classes and the courage to ask for help during times of crisis—parents who endured abuse during childhood are at risk of passing the behavior on to the next generation.

In rough economic times, parents struggling to provide for their families may be forced to turn neglectful unless they find assistance with housing, food or clothing. With so many family services and resources being reduced or eliminated during a stalled economy, the pressure on families is increasing. As a community, we need to be aware of the consequences of abuse and vigilant about recognizing it.

It is always injurious to  shake an infant.

It is damaging to use spanking to control behavior.

Constant yelling, screaming and nagging never bring positive results.

It is both criminal and illegal to sexually abuse a child.

Child Abuse pediatrics is a fairly new specialty in the field of medicine. The American Board of Pediatrics first approved it as a board-certified specialty in 2006. Last November, Jennifer Geyer, M.D. and Stephanie Zimmerman, M.D., both in the section of forensic pediatrics in the department of emergency medicine at PCH, were two of more than 200 doctors nationwide who sat for, and passed, the first board examination.

PCH child abuse forensics team.

It takes a special person to take care of damaged children in pain and to question their caregivers.

“It’s difficult,” Zimmerman says. “If a child comes in critically injured, my focus is on what I can do to get the child past the crisis medically. I look for the most beneficial return. Sometimes I know from the moment they come in the room that it’s an abuse case, but I take care of the child and then I go to the parents or caregivers. I know that a lot of information will be omitted. A pediatric emergency room doctor knows about child development and what’s possible and impossible in terms of physical injuries, yet our training is to accept the information we are given as the truth. My radar is up a little further when I’m taking care of a child in the ER.”

Or when she’s looking into a child’s eyes. “In so many of the kids we see, there is nothing in their eyes,” Zimmerman says. “As they spend time in the hospital interacting with staff, child life, psychology, over time you see the spark in their eyes and that is what keeps me doing my job.”

Clinical social worker Alaina Raetz is also on the forensics team at PCH. As keeper of the statistics on child abuse cases, she sent a total of 549 reports to Child Protective Services in 2009. “Of those, there were five deaths, 195 cases of physical abuse [which includes sexual abuse and misconduct]and 275 cases of neglect,” she says. Neglectful treatment of a child covers abandonment, ingestion of harmful substances, drug-exposed newborns and leaving the hospital against medical advice.

Statistics compiled by the Arizona Department of Economic Security’s division of Children, Youth and Families show that in the six months between Oct. 1, 2008 and March 31, 2009, there were 17,094 incoming communications to the Child Abuse Hotline. Of that total, 10,686 were investigated and closed;684 were substantiated.

Raetz and coworker Nicole Ordway are responsible for case management while a child is hospitalized. They pull together information from caregivers, doctors, nurses and law enforcement and make the decision on where to place the child upon discharge. Sometimes children are sent to foster care, “but the new norm is to place the child back in the home with a friend or family member (after a background check by police) who will be with the child 24/7 until the investigation is over,” says Raetz.

PCH pediatric nurse practitioner Amy Terreros developed an interest in forensics in 2003, when a baby she’d treated came back to the emergency room a second time because doctors had missed the fact that he’d been abused. While caring for the child, she decided to learn as much as she could about potential signs of abuse so that a case like his would never again be missed.

In December 2009, she experienced the “two most horrific cases” of child abuse she’d ever seen.

“I cried when I saw the girl,” she says. “She was injured so badly by an uncle that her case made the news. He had broken her pelvic bone by kicking her with a steel-toed boot. Her teeth had been pulled out with pliers, her arms and legs had been broken and the cartilage in her nose looked like it had been rubbed away.”

The second case was illustrated by an x-ray Terreros pulled up on her computer screen. “The boyfriend broke this 3-year-old’s back in half,” she says. “Just snapped it.”

Not all child abuse involves critical physical injuries like the ones Terreros sees in the ER. Emotional abuse is more insidious, and harder to treat. Healing the emotional scars of abuse is the realm of Karen E. Peterson, Ph.D. a licensed psychologist at Phoenix Children’s Hosptial.

“Although psychologists certainly cannot offer any guarantee that therapy will work, there is plenty of research evidence to suggest that psychotherapy can be very beneficial,” says Peterson. “Depending on the type, severity and chronicity of the trauma, various approaches to psychotherapy might be applied.” This includes the use of medications.

As a child, Lorel Stevens of Phoenix was sexually abused. As an adult, she suffered unhealthy relationships and domestic violence. But she eventually found—on her own—a way to heal the pain. She owns Revitalize Body Work, a business based on her training in the spiritual art of Reiki.

“Abuse of any kind is difficult but sexual abuse is the most difficult to talk about,” she says. “I was abused at age 9 and 10 by an adult male friend of my mother.” She could not find the words to talk about it, and when she finally did tell her mother she was told it was “too late.” Nothing was done to help her.

She grew up acting out her inner torment. After enduring an abusive relationship, she escaped with her son and eventually found help through massage therapy and the book The Courage To Heal For Women Survivors of Childhood Sexual Abuse by Ellen Bass and Laura Davis.

Stevens works with victims of domestic violence and speaks nationally against sexual abuse. Her message affirms the devastation of abuse but offers hope for healing. Victims of abuse, she believes, do not have to live in its shadow.

Learn more

  • The ACE study
  • To report suspected abuse: Arizona has a statewide, toll-free Child Abuse Hotline at 1-888-SOS-CHILD.