Identifying abuse when it happens, and when it doesn't


My sister warned me that your first child lives packed in cotton, but your second child will have stitches before his second birthday. It is the result of the chaos that increases with each new baby.

She should know. She has four kids, and they are practically on a first-name basis with the emergency-room staff.

So I found some comfort in her words when my second child propelled herself down the cellar steps in her infant walker at 9 months. And needed stitches across the bridge of her nose at 14 months. Her high chair collapsed -- while she was strapped in it.

But then Jessie crawled up on a kitchen chair at 2 -- after some cheese and crackers that were none of her business -- and broke her collarbone when she slipped off the chair and fell on her shoulder.

I called her pediatrician in barely suppressed panic. My baby girl was hurt. Worse, a broken collarbone is a classic child abuse injury. With Jessie's growing history of calamities, would they believe me about the cheese and crackers?

It is a measure of our times that I worried as much -- maybe more -- about what might happen to me as I did about what had happened to Jessie.

Like the mother I described in Sunday's column -- whose son's complaint to a teacher resulted in an investigation of the family for child abuse -- I did not know how I could prove what did not happen behind the doors of my home.

"A broken collarbone in a 6-month-old would worry me," said Sam Libber, my pediatrician and a friend. "But not in a 2-year-old. Injury is the name of the game for kids. They don't understand gravity."

The injury matched my description, Dr. Libber said. "What you described was within the realm of appropriateness. You were not telling me that she just woke up one day and wouldn't move her arm."

Dr. Libber did not report me to the Department of Social Services. The continuity of his care for our family -- the fact that he knows us -- the plausibility of my description of the injuring incident -- all confirmed for Sam that this was an accident.

But it isn't always so easy, Dr. Libber said.

"There is so much more of this going on than any of us dreamed," he said. "It is often difficult for pediatricians to identify abuse when there are no suspicions voiced, no allegations made. A lot of sexual abuse is done in a non-injuring fashion.

L "We miss them all the time. But we over-diagnose them, too."

The over-reporting of child abuse -- a confusion about what is abuse and what might simply be inappropriate parenting -- has become just as significant a problem for child welfare workers as underreporting ever was. Not only are the chronically understaffed agencies overwhelmed and less able to protect children in real danger, but investigations of unfounded charges also are devastating to a family.

Douglas Besharov, a resident scholar at the American Enterprise Institute and the first director of the U.S. National Center on Child Abuse and Neglect, says that over-reporting may have a third result.

"If public agencies don't address over-reporting, they will eventually have their public support undermined. That's already happening in a number of places," said Mr. Besharov.

"So many people are reported improperly. So many people have gone through investigations that couldn't be turned off until every stone was turned. And the politicians are hearing about it."

Edward Bloom is director of Anne Arundel County's Department of Social Services. As happened with the case of the family in Sunday's column, half the complaints are dismissed immediately.

Not because of understaffing -- though his caseworkers are flooded with suspicions in the wake of Ron Price, the high school teacher convicted of having sex with his students -- but because only half of the reports are believable.

"We received more referrals than any jurisdiction other than Baltimore City," Mr. Bloom said. "And that includes Montgomery, P.G. and Baltimore counties -- all bigger jurisdictions."

Mr. Bloom considers these numbers an indication of the public's increased awareness of the requirements of reporting. "And of the community trying to reach out and protect its children."

But I fear something darker, something that gripped me before I could feel empathy for my injured child. Something like fear, hysteria, paranoia, witch-hunting.

And I wonder if it is not too late to wrap my children in cotton.

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