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When Kids Fall Through The Cracks



February 26th, 2009

How does a health care system learn about neglected and abused children—the ones who’ve fallen through the cracks—so they can be helped? That was the story and exploration in a Narrative Matters essay by Janette Kurie titled “Where’s David?”

Kurie recently read an excerpt from her essay on NPR’s “Morning Edition.” In it she tells a tale of pediatric vigilance when a young boy’s chart is discovered in a pile of “no-shows,” records of children who’ve missed their scheduled doctor’s appointments. “What caught our eyes,” she writes, “was the number of appointments this boy had missed. And his growth chart. Instead of curving upward to show a height and weight increase, it swerved south. It took protective services to physically bring him in.” Within hours he was hospitalized for failing to thrive, a diagnosis of severe malnutrition that is usually the result of parental abuse or neglect—in this case, as it turned out, a situation that was multigenerational.

One result of the incident was a Family Support Program to help thousands of these children established where Kurie is director of behavioral medicine education at Penn State University/Good Samaritan Hospital family medicine residency program in Lebanon, Pennsylvania. “Maybe,” she concludes, “there is hope for other children if health care providers make that first phone call to find out: Where is he?” Give a listen to her NPR excerpt, then read the full essay for all of Kurie’s insights.

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1 Response to “When Kids Fall Through The Cracks”

  1. fmullan Says:

    Janette Curies’ Narrative Matters article and recent NPR commentary pin point a problem that has long troubled me as a pediatrician. The office visit is such a tiny and astigmatic keyhole through which to view the life of a child. We see families in the examination room in what are often the best of (their) circumstances – washed, dressed, best behavior by everyone. This cameo is often representative of the life of the family but, sometimes, it is not. When examining children, we are always alert for bruises, broken bones, and cigarette burns as signs of abuse. Fair enough. But what has happened to a child before a bone is maliciously broken or a cigarette is purposefully applied to the skin? Child abuse is such a tough area because our diagnostic tools are so primitive. Suppose we had nothing but the emergence of a mass under the skin available to diagnose a cancer that had, in fact, been growing for months or years. Sounds a little 18th century-ish, but that is the level of sophistication at our disposal in dealing with child abuse. This is not a criticism of research technology but a reflection on the complex, human, non-technological nature of child abuse. And this is what makes the sort of all-court concern described in Janet Kurie’s trenchant essay so important. Watchfulness on the part of all of us working with children is the only plausible early warning system for the defense of abused children. Kurie has given us an important story of how that vigilance can work.

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