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Growing concerns (04/07/2004)
By Dr. Martha Erickson

Eleven-month-old Jeffrey was having seizures when his mother and father rushed him to the emergency room. As doctors worked to stabilize Jeffrey, his father confessed that just before the seizures began he lost his temper and shook Jeffrey because he wouldn't stop crying. Further physical examination revealed that both of Jeffrey's legs had been broken in the past without being diagnosed or treated at the time. Again, the father confessed he had caused those injuries by twisting Jeffrey's legs when he wouldn't hold still to have his diaper changed. Tragically, Jeffrey's story is just one of millions across America. And without intervention, Jeffrey is at risk of passing on such pain to the next generation when he is an adult; children who are harmed by the adults who should protect them often learn to be both victim and victimizer.

But it does not have to be this way; child abuse is preventable, and intergenerational cycles can be broken. Each of us has a part to play in making sure children in our families and communities never experience the physical and emotional pain little Jeffrey endured. It is up to us to make sure parents get the education, support and counseling they need so that they never get to the breaking point Jeffrey's father reached. April is Child Abuse Prevention Month, a time to focus on what we can do to make a difference for children and in our community. Here are just a few suggestions of ways to make a difference:

* Learn as much as you can about the indicators, causes and consequences of abuse. By understanding how and why abuse happens, you can know where to direct your energy for prevention. For example, perpetrators of abuse often are parents or other family members who have unrealistic expectations of their children, too much stress in their lives and too little emotional support. These are things that caring communities can work to change. Substance abuse and mental health problems also are major contributing factors, so appropriate treatment needs to be available, accessible and affordable.

* Reach out to support parents in your community--when you see a parent struggling with an obstinate toddler in the grocery store offer assistance and make the parent aware of parent education and support groups are available through schools, workplaces, child care centers, clinics and places of worship.

* Mentor an abused child. Research shows that a caring, supportive adult can play a critical role in allowing a child to move beyond the pain of abuse and grow up to become a caring parent. Most communities have organizations that recruit, train and support volunteers who want to be that caring adult in a child's life.

* Contribute to reputable organizations that work to prevent child abuse. Most of these organizations are underfunded and rely largely on individual contributions.

* Advocate for programs that get at root causes of abuse, reminding policy-makers in your community that prevention is far more cost effective than intervention.

For more information about the causes of abuse, how to prevent it or where to get help for your own family or someone you know, contact Prevent Child Abuse America at 1-800-CHILDREN or www.preventchildabuse.org.

Question: My husband and I are about to have our first child. My 75-year-old father-in-law is retired and has lots of time on his hands. He says he is eager to baby-sit and to take the baby on outings when my husband and I are at work. (My mother-in-law still works full-time, so she will seldom be around to help.) I really love my father-in-law and appreciate how excited he is about becoming a grandfather. However, over the past year he has become increasingly absent-minded and disorganized and my husband and I are not comfortable leaving the baby alone with him. I especially don't want him to take the baby in the car because he has become a very erratic, dangerous driver. How can I draw these boundaries without offending him?

Answer: This is an awkward situation and it will be hard (if not impossible) to handle without hurting your father-in-law's feelings. Nonetheless, as you well know, the consequences of not addressing the issue could be very serious.

As an in-law, you are not in the best position to take this on alone. I'd suggest that you and your husband decide together how to proceed. The two of you may decide that your husband should talk privately with his father--or that the two of you should do it together. Either way, you will need to talk with your mother-in-law too and express your concerns. Most likely she has noticed the decline in her husband's competence and, hopefully, will be supportive in helping make sure he has time with the baby within safe, manageable circumstances. She may even be relieved to know you've noticed these changes in her husband's behavior and may welcome your support in helping her address her own concerns.

However you and your husband decide to address this sensitive issue with your father-in-law, I encourage you to lead with positives. Emphasize the things he will be able to do with his grandchild. For example: he can help care for the baby in your home to give you time to catch up on housework or take a break; go along when you run errands or take the baby to the park; take the baby for a stroller ride around the block or rock the baby at naptime. Be straightforward about your concerns, but also tell him--and show him--how much you appreciate his involvement in your baby's life.

Although your question to me was specifically about how your father-in-law's poor driving and absent-mindedness could endanger your baby, what you describe raises a broader concern as well. You describe a significant change in your father-in-law's mental capacity and behavior, which could be a sign of Alzheimer's or some other serious illness or condition. Such decline often can be slowed by early diagnosis and treatment, so I urge you and your husband to pay close attention to these behavior changes and do what you can to see that your father-in-law is carefully evaluated by a physician. As difficult as it is to acknowledge that a loved one is slipping, denial or avoidance can cause much greater harm in the long run. 


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