How to Identify Sexual Abuse and What to Do

Below is the CME link along with the info for the podcast from Friday, 2/23.

Due to technical difficulties, we are posting this episode again!  

 

https://cmetracker.net/UTHSCSA/Publisher?page=pubOpen#/getCertificate/10095533

 

How to Identify Sexual Abuse

 

FACULTY:

Dr. Nancy Kellogg, is the Division Chief for Child Abuse Pediatrics at the University of Texas Health Science Center.

 

OVERVIEW:

In this enlightening episode of "Pediatrics Now," host Holly Wayment welcomes Dr. Nancy Kellogg, a respected authority in detecting and reporting child abuse. Dr. Kellogg shares invaluable insights on recognizing abuse signs, the role of Child Protective Services, and the struggles children face when disclosing abuse.

 

Dr. Kellogg talks about sentinel injuries and their relation to young infants who are at the highest risk of life-threatening abuse. This discussion dives into the importance of thorough medical examinations, empathy, and the power of collaboration with CPS. We conclude the episode by highlighting that despite declines in child sexual abuse cases, it remains a silent form of abuse that largely relies on children's disclosures for detection.

 

This thought-provoking episode shifts the conversation towards understanding trauma-informed care, high-risk situations like sleepovers and summer camps, and addressing parents' denial. Dr. Kellogg also provides an inside look into her work at the Center for Miracles, which supports CPS and aids in the fight against child abuse. This episode is a deep dive into the complexities of child sexual abuse and the effective ways to address and prevent it.

 

In an inspiring segment, we share the story of a brave sexual abuse survivor who fought not only for her justice but also sparked a global change in addressing and recognizing sexual violence. This tale of resilience is a beacon of hope for other victims facing similar situations and an illustration of how adversity can be a catalyst for societal change.

 

We wrap up this episode with a focus on children's right to autonomy during checkups, the crucial role of a pediatrician in identifying and responding to sexual abuse, and the rising rates of online-enabled abuse threats. We offer advice on preventive measures, emphasizing the importance of a strong parent-child relationship as a protective tool. Tune in to this enriching episode as we navigate the complexities of child sexual abuse, promote understanding, and advocate for preventive measures.

 

The Center for Miracles: 210-704-3800

 

DISCLOSURES:

Nancy Kellogg, MD has no financial relationships with ineligible companies to disclose.

 

The Pediatric Grand Rounds Planning Committee (Deepak Kamat, MD, PhD, Steven Seidner, MD, Daniel Ranch, MD and Elizabeth Hanson, MD) has no financial relationships with ineligible companies to disclose. 

 

The UT Health Science Center San Antonio and Deepak Kamat, MD course director and content reviewer for the activity, have reviewed all financial disclosure information for all speakers, facilitators, and planning committee members; and determined and resolved all conflicts of interests.

 

CONTINUING MEDICAL EDUCATION STATEMENTS:

The UT Health Science Center San Antonio is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

The UT Health Science Center San Antonio designates this live activity up to a maximum of 1.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

CREDITS: AMA PRA Category 1 Credits™ (1.00) Non-Physician Participation Credit (1.00)

 

 

Episode Transcript

(00:00):
It's important just as Child Protective Services does not always find abuse.
Neither do we at Center for Miracles. And so the way that we like this system
to be is to have a low threshold for reporting at the front line.
So those are the pediatricians, the hospital folks, the emergency department

(00:20):
folks. We want low threshold.
And then if we look at the injury.
I'm Holly Wayment, and this is Pediatrics Now, cases, updates.
Music.
And discussions for the busy pediatric practitioner.
Click on the link in this podcast for free credit that may include CME,

(00:41):
MOC, or ethics credit, depending on the topic or podcast.
Today we're talking about sexual abuse.
Joining me here in the podcast studio is Dr. Nancy Kellogg.
Dr. Kellogg is the Division Chief for Child Abuse Pediatrics at the University
of Texas Health Science Center, and she also works at the Center for Miracles.

(01:05):
Dr. Kellogg, you completed medical school and pediatric residency at the University
of Texas Health Science Center, and you evaluate children and adolescents for
suspected abuse or neglect at the Center for Miracles.
You're a professor of pediatrics, and you've served as a medical director of
the Forensic Nurse Examiner Program at Children's Hospital of San Antonio for

(01:27):
16 years, and program director,
establishing one of the first child
abuse pediatric fellowships following accreditation of a new specialty.
You were appointed for six years to the American Academy of Pediatrics Committee
on Child Abuse since 2006, and you've served as the medical editor for the American
Board of Pediatric Child Abuse Pediatric Sub Board for 17 years.

(01:52):
You've been helping children who suffer from abuse since 1988. Yes.
What a difference you're making, and it must be such a hard job.
I'm so honored to have you here in the podcast studio.
Oh, thank you. When we're talking about physical abuse, I would say to the biggest

(02:12):
focus, the biggest concern would be in very young infants.
So we have a term called sentinel injuries.
And so sentinel injuries are unexplained injuries, bruises that are visible
on a premarble infant. effect.
And so with sentinel injuries, if we have a child that has an unexplained bruise

(02:33):
on the chest or an unexplained subcontinental hemorrhage or has a lacerated
bunulum, which is the tissue inside the mouth,
and we don't know why, we don't have a good explanation for it,
those are things that need to be reported.
Our infants are at greatest risk for the severe life-threatening type of abuse.

(02:54):
And so those are the things that we need to report.
We also need to do the complete medical workup. So there's a lot involved with that.
It'll be blood work. We're looking for bleeding disorders, but we're also looking
for what we call more subtle or occult injuries, like small fractures that might be in that baby.

(03:15):
So we would be doing x-rays and we're doing CT scans.
Those are the the ones that have the highest concern, as they get older,
it really changes because the children get mobile.
They're going to fall. They're going to get bruises. And we have to begin to
look at where the bruises are.
Is there a pattern to it that suggests an object was being used?

(03:38):
What does the child say about the injury?
So I cannot overstate the importance of a child's history. When you have a child
who's verbal and who can tell you how they got that bruise or how they got that
injury, I think it needs to be taken seriously.
The same, especially for sexual abuse. If you ask a child, you know,

(04:01):
what happened, or if they're beginning to disclose sexual abuse,
it's to listen carefully.
It's very hard for kids to talk about their abuse.
And when you're attentive and you're receptive and you acknowledge your fear
and you acknowledge their anxiety in telling you,
that goes a long way in trying to help that child speak up and for the next

(04:27):
steps to happen to make sure that child's safe.
I always thank children that talk to me every single time.
I think we have to remember, especially when we talk about sexual abuse,
it takes about two years for a kid to tell about sexual abuse,
for a child to tell someone about sexual abuse.

(04:47):
And over those two years, a lot of things are happening.
They are constantly debating whether to tell.
And if they're school age, they're old enough to understand that if I tell,
Well, it might break up my family.
Somebody might go to jail. My mom is going to be unhappy.
All of these things. My little brother will lose his parent.

(05:11):
So all of these things are going through this child's head.
And they're constantly thinking about, should I tell? Should I not tell? I need to keep it secret.
So when a child first tells, it's very important that they know that the person
that they're talking to believes them.
You don't have to take off your friend or your parent hat when somebody is telling you about abuse.

(05:33):
You need to be listening to what they're saying, and you need to accept it,
and you need to convey that you believe them. Because right at that point, that's critical.
When kids first tell, they have these super sensitive antennas out.
And they know. They're reading your nonverbal. They're reading your verbal.

(05:53):
They're trying to see, does this person believe me?
And so if you're like, well, are you sure that happened? Or maybe it was just a dream.
Kids, they're going to take back what they said when they hear that.
If there's any doubt, they will take it back.
And so I would say that if you're one of the first people,

(06:17):
if you're the first person that a child is telling, it's very important that
you listen, you have empathic listening, thing and that you say,
I believe you, I want to help you. This is what we need to do next.
Dr. Kelly, what do you recommend we do next?
When you have a child that has made a clear statement, and I think you just

(06:40):
have to verify that, because if you say, so-and-so hurt me, that can mean a lot of things.
That could be sibling play.
That could be anything. And so just knowing if you get to the point where you
have a child who's verbal.
Who understands speech, who's normal development for their age,

(07:01):
can understand your questions, and can respond appropriately to questions and
they indicate that they were sexually abused, this person touched them in a
place that should not have been touched,
then I think the response is first, thank you for telling me.
I really appreciate that you trusted me with this.

(07:22):
We need to do some things to keep you safe right here and now.
This is what I'm going to do. And so you always want to be transparent with
kids. You don't want to make promises you can't keep.
You can't say, this will never happen to you again. You don't know that.
But you can say, I'm going to tell you everything I'm going to do,

(07:43):
and I will explain it to you.
So, of course, what happens next depends a little bit on the situation.
So if a child is telling you, and you're not in the family, if you're a professional,
you say, first thing we need to do is to talk to your mom about this,
and we're going to need to talk to some other people that can come and help

(08:03):
figure out everything that's going on.
And they can also make a plan to be sure that you're safe.
And again, that may be too strong a promise, but to say they're going to come
and look at ways to keep you safe, I think would be an appropriate thing to do.
You have to be so careful about what you say to kids. You don't,
again, want to make them promise.

(08:24):
Your heart jumps out to them.
You want to tell them it's not going to happen. and you want to make it better.
All you really can do is to be honest and transparent with the child and respectful
and grateful that they told you.
So say if we're in the exam room setting for the pediatrician,

(08:45):
you thank the child, then you can discreetly call CPS.
The parent doesn't need to know you're doing that because what if it is the
parent or caregiver who brought the child in who's right there in the exam room?
Right. And that's why it's important when a child makes a statement to you,
You need to understand who the adult is that's with the child right now.

(09:08):
And for sexual abuse, many times it's the mom bringing the child in.
And many times it's not the mom who's the sex offender.
So if it's not the abuser that's bringing the child in, I think it's,
and that's the person that the child is closest to.
I think you need to work with the child to say, look, we need to tell mom.

(09:32):
You can be in the room, you can tell her, I can tell her with you in the room,
what would you feel most comfortable with? So you can offer some options.
It's going to be anxiety-provoking for the child when they realize their parent is going to have to know.
But if you have a situation where you don't know who's hurt the child,

(09:52):
for example, which does happen more times when we're looking at physical injuries,
then it's difficult because you don't know how much to tell the parent that's there.
If there's any concern that that parent could be the one that's hurting the
child, then you have to think about what your plan is.
If you have an injury in a very young child, one thing to consider is transferring

(10:17):
them to the hospital before the workup, and then they can be in that safe setting,
and CPS will sometimes respond more quickly to that.
So they would come to the hospital and begin to collect information then.
So there's a lot of kind of case-by-case scenarios that can happen.
CPS can have this reputation of, and what we hear on the news,

(10:39):
like kind of being overwhelmed.
Caseworkers can't really give the time that's needed. And then a child goes
back to the family, and then that child is killed.
You know, you hear stories like that. And what do you say to that?
There's all these other things where they're helping the family.
That's not what you see on TV news or read in the newspaper.

(11:02):
I know. And I admire people going to child protection work. I do too.
Because they deal with a lot more than we do as professionals,
and they take a lot more flack from all ends, from not just parents.

(11:22):
You have angry, screaming parents often. You have frustrations.
You have doubt. Maybe things are not black and white. What do you do?
It is, I admire people that go into that, especially people that stay in the
work, because expertise is so
important in this field, and yet there's not much incentive to stay with.

(11:46):
I would just say that professionals should be cooperative with child protection,
and you can be, because if you suspect abuse and you report it,
you are free to share that information without consent of the parent with anybody
who's investigating the case.
And so making sure that you explain your concern in clear terms that CPS can

(12:12):
understand, being available for questions.
They struggle because they constantly are trying to get information from so
many different professionals and so many different individuals and collaboratives.
And it's a never-ending task, so it takes a long time to do that.
But if you can make yourself available and be helpful to them,

(12:32):
it makes the job so much easier.
And should you request that it be confidential if you're the pediatric practitioner
making this call? By law, if you're the reporter, it is confidential.
And you can make that statement, but it is supposed to be confidential, yes.
And Dr. Kellogg, so you work at a place called the Center for Miracles,

(12:53):
and you all are standing by. Why? There's always someone on call.
You're on call right now where a pediatrician, a pediatric practitioner,
or someone on their team could call and talk to you. We have an on-call number.
And yes, we take calls from all different kinds of folks. We're also on call 24-7 for CPS.

(13:13):
So they're workers that are in the field. What do you think of this?
What do I do? Do I send this child to the hospital? We are trying to help them
with those situations as well.
Of course, we do an assessment. We still don't have all the information.
CPS has a lot more information than we do. They know more about the circumstances
in the home. They know more about the background.

(13:35):
They know more about whether there's been previous referrals.
They hold all of the information. So you're not the one making the determination.
So the second Second thing to remember is that when you report,
it doesn't always end up being validated.
It's not a one-way street where the report happens, child's taken out of the

(13:56):
home, parents' custody is taken away.
That's actually a very uncommon situation when you report suspected abuse.
That doesn't happen very often. And most of the referrals that CPS gets are
not validated for abuse and neglect. So to keep that in mind,
but the other thing is to remember about CPS is they can provide the resources.

(14:20):
They can make those other things happen. If parents are having struggles,
perhaps they have a history.
Perhaps they have an untreated disorder of some kind, whether it's a medical or mental disorder.
CPS can be a resource to help those parents get healthier.
We do know that children do well when they have healthy parents,

(14:44):
when they have healthy caregivers.
You know, what kids need is a safe, secure, nurturing relationship with another person.
Well, that other person can't provide that if they are dealing with their own issues.
You know, their own, you know, maybe they can't, they're worried about money
or they're worried about food. You know, to talk about the social determinants

(15:05):
of health, that plays into it too.
So knowing that the caregiver, if they get help, they can care for their child better.
CPS can play a role in making that happen as well.
They are always looking at ways for that to happen, and they are very much aware
of the resources that would be available to families for that.

(15:27):
One thing to know is that child sexual abuse has been declining a little bit
in numbers through the years. It's kind of a slow decline.
That's the good news. Yes. The bad news is that it's still a silent type of child abuse.
It really depends on the child telling someone.
That's how we learn about it. And many children still struggle with letting

(15:50):
somebody know that they've been sexually abused. It's still very difficult for so many kids to tell.
But yet that's the most common way that we diagnose is that child would tell
someone that they've been sexually abused.
And on average, it's not until at least two years?
On average, what we found, we've done a couple of studies, and we did one many

(16:12):
years ago, more than 20 years ago, and then one about five years ago.
And in both of those studies, it was interesting to note that the average time
was about two years, 2.3 years.
Some children, of course, tell right away, and they may be seen in a hospital setting.
But for many of those other children that are outside that acute window,

(16:34):
they're waiting months to years to tell someone.
I know you have more than 135 publications, and you've been invited to present
at numerous national and international conferences.
What's the biggest question you get about sexual abuse?
Wow, about sexual abuse. Well, first, I want to know why I'm still doing this.

(16:57):
What do you say? And what I say is that I really think it's a privilege and
an honor to meet with these children. I'm kind of a glass half full kind of person.
I am too. The fact that they told somebody and they're in my office and we're
talking and we're making sure you're healthy and safe, those are all positive things.
I worry about the children that haven't told because if it's happening in their

(17:22):
home, they're living with this adversity every day.
And who are they turning to? Where are they going to find safety and peace?
So I do think this is a privilege.
I really do enjoy talking with the children that I meet.
And part of that is because they teach me something new.

(17:45):
Every time I talk with a child, I learn something new about how to do it better next time.
And I think a lot of this relates to what we call trauma-informed care.
It's understanding how to have a conversation with someone who has experienced
something that's changed their life.
And that's a skill that has to be ever-improving.

(18:07):
Always find ways to do it better. So I've changed a lot. They taught me so much.
They've given me so much.
Children have an amazing capacity for forgiveness.
And that always astounds me too. You talk to a child and they're not interested
in the other person going to jail. They don't have any anger.
They just want their childhood back. They want a life where they're feeling safe and secure.

(18:33):
And those are such basic things that we assume children have.
And we have to remember that some children don't have that. And it's something they yearn for.
Wow. And sometimes you're, I'm sure, talking to kids.
There's cases where they still, no matter what, will not say what's happened.

(18:54):
And then that child may test positive for a sexually transmitted disease or
something, and so you know they didn't tell, or what do you do there?
It's got to be so hard. Those are difficult situations, and actually it's an
interesting question because what we are finding is that the more severe the
abuse is and the younger the child, for example,

(19:16):
if children are subjects of pornography, Agati.
That involve other people. So actually filmed sexual acts, those children are
the least likely to tell anybody.
So that's an alarming thing to think about. So the more severe the sexual abuse,
the less likely they are to actually tell someone what's happened, even though we know.

(19:39):
We know because we have video, or we know because we have an infection,
or we know because we have an injury.
So that means that the child is probably groomed to the point where they are
not going to tell anybody.
That is so terrifying. Yeah, it is terrifying to think of those children.

(20:01):
That is a minority of the group, but it's still one that we worry about because
those are the hardest to find sometimes. times.
And Nancy, is that because of the trauma, like a protective mechanism, or we just don't know?
It could be protective mechanisms. It could be, and some of the children we

(20:22):
see have such trauma that they completely dissociate.
Or it could just be what we call grooming. So they've been told that they should
never, ever tell and that they are as much a part of the abuse.
They're not this isn't being done to them
it's being done with them so they begin to
change their mindset of how they view their own abuse

(20:44):
and so that's sometimes the reason
why these kids won't tell is there a misconception out there about abusers and
people who are grooming kids that they're these mean people who are obviously
bad guys you know or it's it's really they're They're often seemingly very nice to the child.

(21:05):
Yeah. So you cannot recognize somebody who sexually abuses kids on the street.
You cannot recognize children who have been sexually abused on the street.
There's nothing about them that looks off.
Most of the time, they just look like normal people. When people are sexually abusing children...

(21:26):
They usually begin that process by being nice, by paying attention to the child
at those talks, by basically violating their trust.
The child shouldn't be pressured to have to feel happy all the time.
No one's happy all the time.
Tell me something about your day. It made me feel funny. It made me feel awesome. Did you see any dogs?
They think adults are the ones that are right.

(21:47):
And they're taught to better not talk back to the mom or dad or to the teacher.
That's not everything a child is being. Yeah, I think sometimes kids are brought
up that way, that whatever happens to you, if it's an adult,
they know what they're doing, and you just have to accept it.
So again, looking for those topics.
I think it's less so now, because I feel like parents... And a lot of parents

(22:09):
might be thinking, like, oh, this wouldn't happen to my child.
You tell me, that makes you feel uncomfortable.
I want to know. Yeah, I think, you know, what we... You don't want it to ever be your child.
I've always said that the best prevention for sexual abuse would be to have
a bunch of little kids with a show.
I think to know that, so when people perpetrate, everybody abuse children,

(22:31):
they are looking for a certain child.
They're looking for a child who seems perfect. It does happen at all levels.
Why someone who doesn't, especially sexual abuse, is it something that bothers?
That's the kind of child they want. So, yes, that denial can be difficult to
the child who, you look at them, you say, you know, that's very important to

(22:51):
hear what your child says.
It doesn't have to be something to have for them. It can be something for the mother child.
They're going to speak up. That's not a good thing. That's not a good kid to pick.
And so I think it's really more of that type of mentality.
I hear parents say, you know, tell me a little bit.

(23:13):
And I think it's just more open communication about those issues.
And that can be the best preventative child.
No, I'm not even going to say that your time, when you say it's right,
I'm ready to hear more if you want to share that.
I know it's kind of, it's a hot button topic, but do you have any advice for
parents about sleepovers, summer camp, say to families and parents directly,

(23:38):
what should we be saying regularly to kids?
The opposite and somewhere in between.
I mean, and then how can you really know someone where they're going,
you know, to spend the night?
Yeah, I think that's a tricky topic.
Look at it and add guidance with parents. You would invest in day-to-day care.

(23:58):
You might send your child to need to know something about the home they're going to sleep over.
I will just say in turn, pick up on some of that. Some very subtle duration.
Child may say, I taught something today.
And maybe my kids were busy making dinner or something like that.
And it's like, okay, I can't pick up on that. They're texting the waters.

(24:22):
So they make a vague statement like that. But sometimes they're saying something
that really needs to be discussed. Is it usually?
You haven't seen any of those. That's great to hear. And is it more typically
someone who lives in the home or is it cared for? For the child to know.
Even if I can't talk about it right now, I'm not going to come back and talk
abuse happening in the home and have the opportunity there.

(24:44):
So pick up on some of those subtle cues because kids will tell at the water.
It says something to gauge your reaction, to make them decide, I can say more as well.
No, it's better not to say it. So they're making their decisions, too.
And picking up on that, what the kid is saying, I think is important.

(25:05):
Fewer, if you will. It's not about breaking up a family.
It's not about disrupting the family structure of any kind. I think about,
you can say you're not going to be in trouble. Some kids would just hear, be in trouble.
That's a good point. It's just a little bit like when we go into a physical

(25:27):
exam, we say it's not going to hurt. All they hear is hurt. Why does she hurt the child?
Right, that's a really good point. Yeah, so I think it's touching base, talking to children.
So if somebody is, if you go to pick up on something and you start to talk to
the child and they seem hesitant, And for most children, it's important to be

(25:48):
in shape and not be in force.
Say whatever you need to say. It will be okay.
It's enough for them. And not get too much into the language.
It may trigger a negative. Let's look at a couple of cases.
You had a patient, the pediatric practitioner, as we all know,
they have so much coming at them.

(26:09):
You've never met her, but only her parents do so much stuff.
And it can be overwhelming, so much to keep up with.
But when it comes to child sexual abuse, it's that listening. And I was...
Still very much grown inside a new everyday mom, especially in the context of one of the families.

(26:32):
And if they have that, and what that dynamic, they will understand how that
happened, how they're groomed, how also if they have that, they can get through stressors.
And so perhaps something that bothers them, but they have a caregiver,
they identify with that.
They brought parents out to me because I had to be a publisher soon.
And also they They were just looking for information. Now, they were from Bolivia.

(26:55):
They were constantly building relationships with their child in Bolivia.
I think relationship can really affect violence.
The choices a child makes as they get older about whether to do something that
might get them in trouble versus not.
The child is worried about what their parent would be able to think.
And the child shouldn't tell because they could cause that other person to go

(27:19):
to jail making time to talk with the child alone.
And so it's hard, and sometimes it's not possible with the way we live now.
The parents did not understand why she waited until now. And do it on a frequent basis.
We sort of talk through emails and faxes and that nature.
And it doesn't, the child, the pressure to have to feel happy all the time.

(27:40):
No one's happy all the time. Tell me something about your day that made you
feel funny or made you feel awkward. He knew her, so he knew what to say to make sure.
We like the good braids. We like the nice papers.
Your parents will be devastated by this if you tell them. But that's not everything
a child is. He was a family member.
He wasn't an immediate family member. So they may struggle with other things,

(28:02):
but not be used to talking about remote family members. Things that don't feel so good.
I'll do this to your sister. So again,
looking for those topics and those opportunities. Okay, so this went on.
And a lot of parents might be thinking, like, oh, this family.
This wouldn't happen to my child.
He was an upstanding young man.
They held him up as a role model. And so the two of them were all engaged in

(28:26):
community projects, trying to build not-meals, education.
I think to know that, and they were doing this together. It does have lots of actors. Everybody.
And so I was just trying to have the parents, you know. She was also suicidal.
She was the whole spectrum. It does happen at that point. At all levels.
She finally came out and talked about it. Actually, sexual abuse in the family
was the one that really just tried to give her, you know, talk about denial to get past.

(28:53):
Bruce's family, Bruce's parents, it's very important to really heal with the
child. Sometimes, you know, in denial or you're stressed, everything will get well.
They brought her to court. So being aware of that. The prosecutor,
the one who's supposed to be on both sides, threatened her.
Parents said, if you're saying one lie, I'm going to send you to prison.
Well, she hasn't told me much about what happened. They had a trial.
They told me a little bit.

(29:14):
They basically attacked her. They humiliated her. They told me a little bit too.
In front of her. We have to keep our minds open. The family was physically threatened.
And all we can do is let the child know. Someone tried to put their house on
fire. On your terms, at your time. Two stones at the house. When you say it's right.
I'm ready to hear more if you want. Three years before they could even get a
judge to agree to hear it. I know it's a hot-button topic, but do you have any

(29:37):
advice for parents about sleepovers, summer camp?
There's parents who won't ever let their kids spend the night at another child's
house or go to summer camp.
And then there's the opposite and somewhere in between. And then how can you
really know someone where they're going to spend the night? And so I think a

(29:58):
few years ago, I lost contact with them. I think Jason and I were going to trial.
We would investigate a daycare. Did they find you somehow because they didn't
have a home in their own country to go?
And they found me because I had been in the intensive care experience.
I've had very, and they identified me from that. I reached out to the people,

(30:19):
put the educational material. I've had, they were looking for my contact,
and they got in touch with me. that occurred in contact with a case,
an overnight case. Somehow, just so...
Not only got through all this, she thrived. She's what I call a thriver.
She's amazing. But she came to the U.S. She got legal education.

(30:41):
Well, the biggest threat for a
child, basically, they had what they call a thematic hearing in the home.
Inter-American Commission for Human Rights sued Bolivia, a violation of human rights.
And so there is this long hearing. So when we do know that when children take
sexual media action, they need to establish by training, they need to establish

(31:03):
programs to help victims of sexual violence.
So in Bolivia, sexual violence is more common than it is here.
It's not about one in three girls, one in five boys breaking up with a sexual assault.
It's not about, you know, again, through Brisa, she has a nonprofit family structure of any kind.
It's not about that. They have a huge success in life trying to take the issues,

(31:28):
but the issues are different, and they tend to get abused. And the kids usually don't get that.
So trying to use education and awareness to try to hear these things.
They're the ones that are holding it. I don't like to call them victims because
they're not really. So if you go to a sleepover, you go to a camp,

(31:48):
you leave the camp. You leave that house. safe.
That's a great point. So the family created a website and in the title of the website it's.
AverysofHope.org who we are. Let's look at a couple of cases.
In the podcast text as well. So you had a patient, Brisa.

(32:11):
They want people to know. So you and in sharing, you're hoping to prevent more abuse.
Tell me about and they're really so they're going with the news the most I did
some of those while she is here her family's in Bolivia and,
you know they have they did get Bolivia to look at her a day in a day about

(32:33):
the day's disclosure of sexual abuse especially,
in the context of what they had to march and what that dynamic I remember how
that happened how they she indicated she was infected the first time they had
it was a few years ago and the And Teresa was 15 at the time,
and I never met her. I never met her parents.
They can see the things they're doing. But her parents reached out to me because

(32:55):
I had published this paper. And also, the government is not enough.
They were from Bolivia for the remedial options. They are in Bolivia.
They're still in Bolivia.
And they just persist. They have a very different view of sexual violence.
And I think it's because they're unable to help so many people.
It's not that to them. They've helped them with everything. They believe if
it happened, it would be the child fault. They've helped them with all those things.

(33:18):
So it's really the child. That's it. There's a little miracle going on.
Maybe a big miracle going on. It caused that other person to go to jail.
It caused the family to be shamed. And so she sounds like she's doing amazingly well.
Is that often a side effect before a child tells the suicidal tendencies?
And as we know, there's an epidemic

(33:41):
in this country now with mental health problems in kids and depression.
In this case, he threatened her with the worst kind of things.
He knew her. So he knew what they related to the issue. They're quiet.
Your parents would be devastated by the school. He was a family member.

(34:05):
It wasn't an immediate family member.
I would say it's probably higher in the adult family members that I've seen.
I'll do this to your sister. They don't let me do it to you.
Okay, so this went on. And then again, it's very profound. But that was her family.
I believe that he was an upstanding young man. And they held him up as a role model.

(34:28):
When families come to the bank, we engaged in a community project in trying
to build intimate education for me in Bolivia. Oh, they're doing it together.
But the number one most common need that families tell us about is,
I just want my child to get therapy.
I want to get help for him to get it. She finally came out and talked about

(34:49):
it. That's encouraging.
And the family, most of the families, often have their own need for it.
Talk about safe, secure, no-turn relationship.
Reese's family, every day she'd be in her house and her stimulant path would
never, they would, they never got it because everything was against them.
It's a very comprehensive. It brought it to court.
And in this country, the statistics that I've read is that for girls,

(35:16):
every one in four will be abused in their lifetime, sexually abused.
They humiliated her. They fought her.
That threatened her. That's a prediction for boys. The family was physically
threatened. So one in five. But one in five.
But it does happen to boys? It was. So I think that might be a misconception

(35:37):
that's out there, that it can't happen to boys.
Yeah, I think that is a misconception. So we talk about you have the sexual
abuse trauma, then you have this whole other horrific trauma where the victim is the one on trial.
She was the one that had to defend herself. And what's amazing in all of this
is they believed it happened.

(35:58):
But it was her fault. You know, we have a questionnaire. And so,
a few years ago, I lost contact with them.
I knew they were going out at that time. They were having trouble in school.
Did they find you somehow because they didn't have it in their own country?
And I worry about that. Because at some point, I think they have to work on

(36:22):
what happened to them so that they can be healthy in the future.
I worry about it. I'm looking for my contact.
And they got in touch with me. I tell kids sometimes that it really helps,
not just to get what happened to you out, but to get the feelings underneath out.
Because it's like a splinter. It's what I call it. You have a splinter in your fiber.

(36:43):
And it hurts a whole lot. But she came to the U.S. and she got legal education.
And so I think that's where they had a, what do you call it, a dramatic hearing.
The Inter-American Commission on Human Rights. It does happen. It's a violation.
And to see and aware there is this long hearing. And the court ruled that Bolivia

(37:04):
had to take sometimes remedial action.
They needed to establish training. They needed to establish programs to help
victims of sexual violence.
So in Bolivia, sexual violence is more common than it is here.
It's like one in three girls, one in five boys.
So it's something that they, I think, struggle with more sometimes.
And, you know, again, every cell, she has a nonprofit now. They've helped.

(37:28):
When I was a news reporter at one of the stations I worked at,
KSAT here in San Antonio,
but all news stations, You hear the police and fire scanner all day,
and the assignment editor is listening for that.
It's called spot news that's happening, and most of it ends up being family

(37:50):
violence and abuse that's happening.
And most of it doesn't make the news, but you hear it all day as a reporter.
It's just horrible to hear. a website.
So it's more common than I think most people realize. And the title of the website
is Rees of Hope, abreezofhope.org, who we are.

(38:11):
And we'll put that in the podcast text as well.
Rees's stories, we ask them separately because again, it's so great to share stuff with them.
I don't know how this is going. And in sharing, they're hoping to prevent more
abuse. And they're really, they're going where the need is the most.
And while she is here, her family is in Bolivia.

(38:34):
And, you know, they have, they did get pregnant.
And they can put a day in bargain. They understand the day for sexual violence.
I have to remember that violence was on March.
I remember talking about the journal. The first time I had it was a few years
ago, and they shoot them at second-hand products, or they have a caregiver that

(38:56):
has challenges with mental health.
They can see the things they're doing.
It's so slow because the government is not stepping up yet.
There are times when for the remedial actions, yes, that's going on in my home.
But they just perceive, you know, I've heard this person because they've been
able to help so many people. And the caregivers say.

(39:19):
They've leaked out to them. So again, we don't cut in kids. They're very attentive.
They're very aware of what's going on in their home.
And that's a little miracle going on, maybe a big miracle going on in Bolivia
that's very heartening.
Nancy, for the pediatric practitioner, can you explain the process of how does
the family get to you? Does that often get a side effect before a pediatrician

(39:41):
calls the Child Protective Services?
Suicidal tendencies and what happens? As we know, there's an epidemic in this
country now with mental health problems in kids and depression. There's sexual abuse.
It's very common in adolescents.
And recently, we're talking about like within 90, sometimes it is.

(40:02):
It's an incident that happened within 96 hours.
Well, you know what happened within 96 hours. But there's also just a lot of
trauma. Or that child has some pain or bleeding. A lot of bullying.
We want them to go to the hospital. And right now, I would say probably higher
in the adolescent that I see compared to those that do not experience the Christus Children's, rather.

(40:23):
And then we have, again, it's very, not that it was the older adolescent,
but mostly it would be many years ago, much more increased.
If it is beyond that period of time and something has happened,
when families come to our clinic, we are very tuned into trying to meet their
needs. So what will happen next is initially that child will get a parent.

(40:46):
But the number one most common use is that family tell us about,
I just want my child to get out of there. I want a child healthy, him to get help.
And do most cities, states, they have a child protective services?
It's called that? Or is it called, it depends.
The number to call when you suspect abuse, is it called different?

(41:10):
It's a statewide number.
Sometimes families will call a law enforcement.
And so law enforcement is also... And in this country, the statistics that I've
read is that for girls, every one in four will be abused in their lifetime, sexually abused.
But that one in five, due to law enforcement, who also coordinates for boys,

(41:32):
it's less common. So one in five. One in 20, yeah.
But one in five. Nancy, another child that stands out, but it does happen, 11-year-old Rachel.
So she had experienced numerous traumas. The misconception that's out there
that it can't happen to boys.
So I think that is a misconception. Rachel taught me a lot.
I really had to respect her. A little bit different. She was very upfront about

(41:54):
what she was going to allow and what she was going to tell them.
And as I met her, one thing I did realize with her before I share her story,
is that every child, every child that we see, we have a questionnaire.
We have questions set. We have questions. Unspoken fears.
Unspoken questions. When they come to us. We ask them about what they're mad at.
What they're afraid of, are they having trouble in school? They're not sure

(42:16):
whether to share those or not. And for boys, it's really likely to be jobs to try to not earn it.
And I worry about that because at some point, I think they have to work on what's happening to them.
Well, Rachel came in, and she had a lot of history. I worry about her sneaking
out. She'd been in several different placements. I'd tell kids about it.

(42:36):
It really helped. She was there for sexual. Not just to get what happened to
you out, but to get the feelings underneath. and she did not want to explain to him.
So I said, what's wrong with you about that? Well, I have four rules.
And it hurts a whole lot when you take it out, but then it's, tell me what they are.
And then she said, you know, don't lie to me. Don't give me shots.

(43:00):
Don't talk about my mother. You know, it does happen to boys.
To do something immediately after, I will be aware of that.
Because I think boys... And so I think sometimes people come in And they have
these burdens, and they have these demands, and they have this anger.
And they're expecting us to say something I don't like. You know,
you can go away and come back another day.

(43:21):
I think they expect to push back. And I said, okay, let's talk about it.
Okay, I promise not to tell you. I promise no shot. You can look at my arm.
I'm going to have a shot. Okay.
When I was a news reporter at one of the stations I worked at,
KSAT here in San Antonio,
but all news stations, you hear the police and fire scanner all day,

(43:45):
and the assignment editor is listening for that.
It's called spot news that's happening, and most of it ends up being family
violence and abuse that's happening. And that was, I mean, as— And so what's
funny about that— And most of it doesn't make the news, but you hear it all day.
As a reporter, it was just horrible to hear.

(44:08):
She talked about her mother. It's more common than I think most people realize.
She talked about everything that she said.
So family violence is, it's a matter of violence. We always ask about that.
And she went through the exam.
We had no issue. We asked, and we also asked the caregivers.
We asked them separately. There's always something to do. Sometimes caregivers
think, oh, I was just thankful that she knew it. which you had to tell me about

(44:29):
what the rules were for the child.
You know, the rules are often the kids. Children know more than the caregivers think.
Recognize that they are often very much aware. And trying to build that bridge to someone.
To me, it's always been a gratitude. On their caregivers the next day,
and they can put it together.
I mean, understand what's going on. Can I build the bridge? Yeah,
we have to remember that violence in the home hasn't been an adverse childhood event.

(44:53):
We talk about the kids. A lot of kids won't tell you that up front.
I'll talk to you if this, this, and this. I'll tell you the truth.
It's up to you to try to figure it out as you go into the conversation.
I try to understand what their concerns are, what their children were saying.

(45:15):
And Rachel was protective of her mother?
She did not like her mother. She blamed her father for all the different placements.
So, again, we don't credit kids.
It sounds like her father had a lot of her own issues, and they were not getting
on their own, hopefully, or completely addressed.
It's not for her to be a safety person. It has an effect on them.

(45:38):
Nancy, for the pediatric practitioner, can you explain the process of how does
the family get to you or the child get to you?
If the pediatrician calls Child Protective Services, then what is that?
So we have a pretty good person protocol. They're a person. They're a safe person.

(45:58):
And she knew that because she was in those situations, that is what put her at risk. hours.
Yes, and she blamed her mother for all her different, I don't know exactly,
and I didn't want to push her to do it because, again, their background,
they can share as much about it as they wish.

(46:20):
Right now, here in San Antonio, whatever was going to work for her,
whatever was going to make her feel better, I wanted her to share.
But as a medical provider, I didn't have to know that.
I try to stay very focused on what I actually need to know. Mostly it'll be
quick to shut them. You know, I'm not going to.
It's beyond that period of time. That will be in too detailed.

(46:40):
If something has happened, at least I don't have to have time.
If they want to share it and that helps them, that's great. The report is the
first step, but I am not going to try to. What will happen next is that usually that.
Any other take home messages about Rachel that you would want a pediatric practitioner
to know about in learning moments?
We will schedule the child to be seen. And nothing that I can think of,

(47:01):
I just think it's, you know, being transparent and honest with kids.
I think a lot of times when we're in a pediatric office, we have the caregiver
there, we have the child there, we're not talking with the child alone. own.
And so many times, I think we preferentially always talk to the parent,
but talking to the child first and say, you know, how are you doing today?

(47:24):
Not how are we today or what's going on today to the parent,
but addressing the child directly.
I don't know if children are as used to that.
And to let them know they have a voice in this checkup. That's a great point,
Right, to say the child's name.
Right, right. Nancy, another child that stands out is 11-year-old Rachel.

(47:46):
So she had experienced numerous traumas.
Tell me about her case.
Rachel taught me a lot. I really had to respect her.
She was very upfront about what she was going to allow.
This is about their body, their health. And I met her.
So understanding that even a five-year-old deserves some of this back is that

(48:09):
every child that we have to be thinking about,
Has a set. That's really wonderful. Is there anything else you want to say about
sexual abuse to the practitioner?
And they're not sure what to say. Well, I mean, I think there's really three
basic ways that I've learned that children can present to a pediatrician.
We can't expect that we have to try to earn it and to try to urge them to be

(48:32):
able to share their questions. They told somebody.
Well, as Rachel came in, she had a lot of ways that we find out.
She's been in several different places. I think when a practitioner gets a call
from a caregiver, my child just told me this, this, and this.
And the child said it very clearly. Came in, and she did not want the exam.
Five and older. I said, well, tell me about it. She said, I have four.

(48:53):
She didn't take a legitimate statement, okay?
That is something that should be referred to either in the hospital or to first, she said.
Don't lie to me. I don't think the pediatrician needs to check a child unless
the parent has about my mother, which is the reason why they don't want the exam.
Tell me to do something immediate so they can be referred.
I think where the trick is when the child tells someone, and so I think sometimes

(49:15):
people come in and they have these demands and they have the anger,
and so it's not always clear that sexual abuse is a change here.
You can go away and come back in a day.
I think they expect a pushback. And I said, okay, let's talk about it.
I promise not to lie to you. A lot of these kids are coming to me. I promise no shots.

(49:36):
You can look at my office. I have no shots.
About their sexual behaviors. I will not talk about your mother.
We've learned a lot about sexual behaviors in children. I know that it's very frequent.
There's a wide variety of sexual behaviors that their young children can have.
So be knowledgeable about what's normal.

(49:57):
So, again, in terms of sexual behavior, it can go a long way because sometimes
caregivers get very anxious when they see their children sexually touching themselves
too much, touching themselves in public,
not knowing what to do with it, getting angry.
She talked about her mother, so the perception of the caregiver sometimes affects

(50:20):
the frequency of the behavior.
And she went through the exam fine. And I think the pediatrician can have a
really important role in trying to clarify what's normal and clarifying the
appropriate responses to those.
I was just thankful that she knew what she had to tell me about what the rules were.
And is there anything you want to mention specifically for the pediatric listener to say?

(50:42):
Yeah, that's it. So, sexual behaviors in children is a whole other topic.
We could do another podcast on that. But I will say, in general,
it's actually part of my job.
If children don't understand the social taboos, like they don't know you're
not supposed to pick your nose, get to the point where they probably won't know
you're not supposed to put your hand on your private to share with that.

(51:03):
So it's not necessarily... Because a lot of kids won't tell you that up front. It's not even sexual.
I'll talk to you if this, this, and this. I'll tell you the truth. They don't tell you.
It's up to you to try to figure it out. There's not always a sexual gratification
to try to understand what the curiosity is.
And Rachel was protective of her mother?

(51:25):
She did not like her mother.
She blamed her mother for all the being polite that she had to go to.
I think it sounds like her mother had a lot of her own issues.
They were more, we're not getting them appropriately addressed enough for her
to be a safe, secure person. But they're still very interested in sexual talk.

(51:45):
And, you know, that's how...
Something that kids sometimes talk about. Obviously, if we have a child...
Being disappointed in their parents.
Who is engaged in sexual behavior with another child and one or both.
And that's how I don't know, very distraught. I want every child to be able to have a person.
That's a situation that can be their person. And you have to find out more about

(52:06):
that. And that's just not something we can take for granted.
And she knew that because she was in those situations, that that was what put her at risk.
Like the aging. Yeah. I mean, she blamed her mother for all her different. point.
I don't know exactly, and I didn't want to push her to do it because,
again, their background, they can share as much of that as they wish to.

(52:27):
For me, it was more of a whatever was going to work for her,
whatever was going to make her feel better, I wanted her to share.
But as a medical provider, I didn't have to know that. I try to stay very focused
on what I actually need to know. You know, I'm not going to delve into details
that I don't have to have.

(52:49):
If they want to share it and that helps them, that's great.
But I am not going to try to pull things out.
Any other take-home messages about Rachel that you would want the pediatric
practitioner to know about? Any learning moments?
None that I can think of. I just think it's, you know, being transparent and
honest with kids. I think a lot of times when we're in a pediatric office,

(53:13):
we have the caregiver there, we have the child there. We're not talking with the child alone.
And so many times, I think we preferentially always talk to the parent,
but talking to the child first.
You say, you know, how are you doing today? Not how are we today or what's going
on today to the parent, but addressing the child directly.

(53:34):
I don't know if children are as used to that. and to let them know they have a voice in the checkup.
That's a great point, to say the child's name. Right, right.
And, you know, explain to them, so you're here for your five-year checkup today,
so this is what we're going to do because we have to make sure you're healthy.

(53:54):
We're going to check your body from head to toe, you know, and then we're going to do some tests.
But just respecting that they should have this information. This is about their body, their health.
So understanding even a five-year-old deserves some respect for their role and
what that pediatric visit is about.

(54:16):
That's really wonderful. Is there anything else you want to say about sexual
abuse to the practitioner?
Well, I mean, I think it's really three basic ways that I've learned that children
can present to a pediatrician's office with concerns of sexual abuse.
So first is that they told somebody.
And as we said before, this is the most common way that we find out about sexual abuse.

(54:39):
I think when a practitioner gets a call from a caregiver, my child just told me this, this, and this.
And the child has said it very clearly. and they're of an age,
you know, five and older, where it seems like a legitimate statement,
that is something that, you know, should be referred to either the hospital or to CPS immediately.

(55:00):
I don't think the pediatrician needs to see that child unless the parent has
some specific reason why they want to bring them in.
So they can be referred. I think where the trick is when the child tells someone,
when you have a very young child, let's say a three or four-year-old,
Sometimes they'll make a statement that's difficult to interpret.
And so it's not always clear that sexual abuse is a concern here,

(55:23):
and it may require some further clarification.
So those are, you know, that's the most common way of sexual abuse.
But a lot of these kids are coming to pediatricians because parents are concerned,
caregivers are concerned about their sexual behaviors. Yes.
And we've learned a lot about sexual behaviors in children. We know that it's very frequent.

(55:44):
There's a wide variety of sexual behaviors that very young children,
preschool children, can have.
So being knowledgeable about what's normal and what's not normal in terms of
sexual behaviors can go a long way because sometimes caregivers get very anxious
when they see their children sexually touching themselves too much to touching themselves in public,

(56:09):
not knowing what to do with it, getting angry with the child.
So the perception of the caregiver sometimes affects the frequency of the behavior.
And I think a pediatrician can have a really important role in trying to clarify
what's normal and clarifying the appropriate responses to those kinds of behaviors.

(56:30):
So the third thing that can happen... And is there anything you want to mention
specifically for the pediatric listener to Yeah, so sexual behaviors in children is a whole nother topic.
We could do another podcast on that. But I will say in general,
as a rule of thumb, if children don't understand the social taboos yet,

(56:51):
like they don't know you're not supposed to pick your nose in public,
they probably won't know you're not supposed to put your hand on your privates in public.
So it's not necessarily a deliberate action. It's not even sexual for some children.
Maybe they have an itch, or they're curious, or they simply want to do something
that would draw the caregiver's attention.

(57:12):
So it's not always a sexual gratification motive behind these behaviors. It's curiosity.
It's a lot of different things. It's soothing. Sometimes it's self-soothing
to children, and that's not bad, but sometimes it has to be redirected.
It may not be appropriate.
As they get older, these behaviors are still there, but they're more covert. We don't see them.

(57:35):
We don't see kids doing this in public anymore.
But they're still very interested in sexual topics.
So obviously, if we have a child who is engaged in sexual behavior with another
child, and one or both children are very distraught by it, they're agitated,
or one child is being very forceful,

(57:56):
that's a situation you have to intervene with.
And you have to find out more about that behavior to see what the best management is.
Not all of those kids have to be reported to CPS. There's a lot of things to
think about, like the ages of the children, the type of sexual behavior it is. Is it persistent?
All of those things have to be considered. So it gets complicated when we get to that.

(58:20):
So, you know, there's clinical report in AAP on sexual behaviors of children.
We're getting ready to redo that. Sexual behavior is really on a spectrum.
So there's some things are completely normal, and then other things are gray zone.
And then there's some that are clearly not normal, require intervention,

(58:40):
treatment, and sometimes reporting.
So being kind of aware of those types of behaviors and being able to guide the caregiver.
Many of the ones we get are in the normal range, but the caregiver doesn't like
it, and they're worried that something's happened to the child.
And many times that's just not

(59:00):
something that we find or we're not able to determine if that happened.
So sexual behavior is a big topic, but it's one that probably presents to pediatricians'
offices not infrequently.
And we could put the AEP link about sexual behaviors in there? You can.
And you're working on that? Well, it's not going to be for a while before it

(59:24):
comes out. I'm working on it with Dr.
Kassoun, actually. And so the reiteration of the original one,
which I did when I was on the AAP committee, that'll be coming sometime in a
couple of years, probably, the way the process is. And that's Dr.
Natalie Kassoon, who's part of the Child Abuse Pediatric Team,
a doctor on the team here at the University of Texas Health Science Center.

(59:48):
Yeah. So that's important. part. There's just so many things to think about
with sexual behaviors, and cultural factors are also very big because different
cultures and ethnicities view these behaviors differently, too.
So the perspective, again, of the caregiver, their culture, their background,
their own experiences can play into the interpretation of these behaviors.

(01:00:10):
So just keeping that in mind.
And the third way that these children can present to a pediatric office is with
some type of genital complaint.
So, maybe there's redness there, there's irritation, there's a discharge.
There's maybe even some blood, and the caregiver is concerned that this is trauma,

(01:00:32):
that this could be sexual abuse.
And so, those children would obviously need to be examined.
But I will say that in the absence of a history or anything else,
most of the time, those kids with genital complaints are going to have something
else. It's not going to be trauma.
It's going to be something else
that mimics trauma or it can be trauma that's not due to sexual abuse.

(01:00:57):
So, for example, children can get small anal fissures that cause spots of blood
in the underwear or the diaper.
And that is a common cause of seeing blood in the diaper or the underwear.
That has nothing to do with sexual abuse. Right.
Right. So, so those are the three basic ways. Okay.

(01:01:17):
Anything else you want to, this is, has been so enlightening. Anything else you.
It's important just as Child Protective Services does not always find abuse.
Neither do we at Center for Miracles. And so the way that we like this system
to be is to have a low threshold for reporting at the front line.

(01:01:39):
So those are the pediatricians, the hospital folks, the emergency department
folks. We want low threshold. told.
And then if we look at the injury, usually what happens is we identify additional
information we need to have. It might be seen information.
It might be more details from the parent. It might be details from the child.

(01:02:01):
So we, through Child Protective Services, get this additional information.
And very often, it goes from a suspicion to either nonspecific or no concerns.
And that's okay because we're watching out for kids. That's the whole goal here.
So it's been a nice system for working that way because then we,

(01:02:23):
that's like in this children that really do need help, really do need those assessments.
So if you suspect something, call Child Protective Services,
just as that, just the suspicion. Suspicion is all the law requires for your report.
And again, you're not making a decision. You're not making a determination.
You're saying, I'm suspicious more is needed to look into this.

(01:02:45):
That's what you're saying.
You're not going to do everything. You're not going to do the investigation.
So I think it's, and sometimes if pediatricians get frustrated, oh, nothing happened.
Know that there's a lot that happened in between, but they may not be aware
of the additional information that was collected.

(01:03:07):
I know you've made such a difference and you continue to do that,
but you consider your family your greatest contribution.
And here on Pediatrics Now, we like to promote having a life outside of medicine
with all of the high stress of this career and high burnout.
You enjoy hiking and camping with your family. Yes.
Yeah. Well, you know, I never take it for granted that I was blessed enough

(01:03:34):
to be able to give give a safe, secure, nurturing relationship to my children.
So many families I meet, by no fault of their own, they just have too many challenges,
are not able to do that for their children.
So for me, being able to provide that, that's why it's my greatest accomplishment.

(01:03:56):
I was able to do that for them.
And my work has made me understand how important a gift that is.
But getting away from it all, and really having a whole different perspective
of there's a whole other world out there and just becoming immersed in looking
around you beyond your very small universe,

(01:04:18):
look at the big universe and just understand that you're one piece in the big picture.
It's always helped me with perspective and being able to come back and get back to work.
We did camping with my kids all through their childhood years and I hope they
had good memories with that.
I think they did, but it was just a wonderful time.

(01:04:41):
And again, we didn't have cell service when we went. So nice.
Phones were off or even if they were on, they weren't working.
And it was just wonderful to be able to devote that time to each other and just
talking and just reconnecting.
You know, my kids would connect with each other. It was just a great time that we all look forward to.

(01:05:04):
And so we just try to keep that tradition through all the way up until about high school.
That's really beautiful. And I'm going to edit this part back in.
But one question I forgot is, do you want to say anything about social media and sexual abuse there?
Or also a whole other... Right.
So our concept of sexual abuse has expanded greatly and not in a good way.

(01:05:26):
And so we have trafficking.
Now, we have a lot of children involved in pornography.
We have, unfortunately, a lot of adolescents involved, a lot of them not by choice, with sexting.
So they will receive nude pictures from random strangers.
For some, it's distressing. For others, they think it's funny.

(01:05:48):
I worry a little bit about that being a new norm for kids because they kind
of giggle about it when they tell me.
And I'm just concerned because I have seen situations where these sexes have
been used for blackmail, have been used to humiliate kids, have been used as a form of bullying.

(01:06:10):
And so they can be, it's a huge leverage for someone to have over an adolescent. adolescent.
So I think, again, there's a lot of the adolescents I see, they're meeting somebody
online and they're having, they're meeting up with them and then not expecting
and not prepared to protect themselves. And then they're being sexually assaulted.

(01:06:33):
So they're very open with their trust. And I'm worried about what I call the
self-protective skills.
And, you know, when I work with them and work with families,
I tell them, you know, what I really hope from all this is that that they learn to protect themselves.
They begin to recognize and anticipate the dangers because the choices they're
making are sometimes devastating choices in terms of lifelong.

(01:06:57):
Adversities that they face. Is the sexual abuse online, is that,
that's happening with photos, words, videos, and then sometimes someone in person
trying to connect with them?
Yeah. So it's all different types now. It's not just about touching anymore. It's verbal.
It's harassment. Again, there's a spectrum of behaviors that are highly concerning.

(01:07:20):
Exploiting people, that's very
worrisome to me. and it just seems that so many kids are at risk for it.
And anything you want to mention quickly just about how do we protect our children
from that? Is it know what they're looking at online?
I know. I know. How do we do that? It's like, yeah.
And there's all these new website, news, social media stuff.

(01:07:43):
It's how do you access that?
Yeah, I don't know. I'm not on social media at all. I'm not either anymore.
Yeah, I've long given that up.
I ask them, what do they do when they get these images from people they don't know or they do know?
And many of them just say, oh, I just block them. And I said,
well, why don't you have a conversation with your parent about it too?

(01:08:06):
So again, going harkening back to the importance of a parent-child connection,
I'm not sure parents can completely protect their kids from this, which is worrisome.
Them, but they can be there for them to help them make healthy choices when they get to that point.
Remember, so if the adolescent is trying to decide, do I send a nude picture of myself or not?

(01:08:30):
And the next thought is, what would my parents say? That's going to be a modifier.
So again, building those very strong, healthy, close relationships can be a
preventative measure for things like that when they get into trouble. with.
Music.

(01:09:15):
Their children from this. And Dr. Nancy Kellogg with the University of Texas
Health Science Center, University Hospital, and the Center for Miracles,
thank you for being here.
Thank you so much for listening to Pediatrics Now.
Don't forget to click on the link in this podcast for a free credit that may
include CME, MOC, or ethics credit, depending on the topic or podcast.

(01:09:47):
For episode ideas, you can email me.
Go to our website, pediatricsnowpodcast.com.
You'll find my email address on there. I'd love to hear feedback and let me know what you think.
If you know anyone who may be interested in Pediatrics Now, please share.
I'm Holly Wayment. Thank you so much for listening and for making a difference.

(01:10:12):
One pediatrician said to me the the other day, it's really hard to be a pediatrician these days.
We hope by listening to the podcast, we can help make it easier.
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