In 1962 Dr C. Henry Kempe and colleagues wrote their landmark paper on The Battered Child Syndrome which was widely regarded as one of the most significant events in creating awareness of child abuse. The paper provided clinicians with a way to understand such abuse but, crucially, to do something about child abuse and neglect.
Dr Kempe founded The Kempe Center (originally called The National Center for the Prevention and Treatment of Child Abuse and Neglect) which opened in 1972 with the clear vision to recognise that children were being abused, to recognise that the threat to children’s safety was very real and to do something about it. Dr Kempe, and his wife Professor Ruth Kempe, worked jointly at The Kempe Center which is now recognised nationally and internationally as a leader in the field of child abuse and neglect.
The Kempe Center, which is part of the Department of Paediatrics at the University of Colorado School of Medicine, has built a reputation as a world leader in the child protection movement by:
- Evaluating and diagnosing children who are suspected victims of abuse and neglect
- Providing treatment and therapy for abused and neglected children and their families
- Developing and testing new programs to help children.
- Training professionals to protect and heal abused children and support good parenting skills
- Conducting studies that assist in program development and public policy making
Dr Kempe also recognised that professionals would need the help of the entire community to end child abuse. The Kempe Foundation was established and community leaders, philanthropists and business people were called upon to spearhead fundraising and awareness and advocacy efforts in order to recognize and do something about child abuse and neglect.
The US Department of Health and Human Services Child Maltreatment report 2012 indicates that:
- More than 3.4 million reports of child maltreatment were received
- Approximately 686000 children were confirmed cases of child abuse or neglect. Of the unique children:
- Of these 26.8% were under the age of 3 years, 20% were aged between 3-5 years, 21.3% were aged between 6-9 years, 17.4% were aged between 10-13 years and 14.1% were aged between 14-17 years.
- 78.3% suffered from neglect, 18.3% suffered from physical abuse and 9.3% suffered from sexual abuse
- 1640 children died at the hand of their abuser with more than 70% of these being aged under three years of age
- Approximately 80% of child abuse is perpetrated by parents
As the first half of my project draws to a close in the USA I’m delighted to be able to spend the week in Colorado at The Kempe Center where child abuse paediatrics began in the USA over 50 years ago. It is going to be particularly exciting for me to see the research that is being conducted in the Emergency Department in relation to child abuse, to learn what tools, protocols and education are in place to help professionals pick up cases of possible child abuse and to discuss my findings so far with eminent clinicians working in this field including to meeting with one of the editors of the internationally respected medical journal, Child Abuse and Neglect.
Although the schedule that has been organised for me is very packed, the staff here have been very keen for me to see a little bit of Colorado and I’m currently writing this from an office over a mile above sea level. Earlier this week I made it to the highest point I’ve ever been on this planet (when not in an aeroplane) at 11026 feet (over 2 miles or 3360 metres) above sea level. As well as emergency medicine and child abuse medicine I’ve been given a very quick revision lesson in altitude medicine – this needed no lecturing, no powerpoint slides, no media and no preparation. All I had to do was to run upstairs between meetings without thinking about it and by the time I’d got to the top I’d very rapidly remembered my medical school teaching! With wry smiles from the staff who have worked here for some time I was reminded that, even at this altitude, there are noticeable differences compared with being at sea level:
The oxygen dissociation curve is a graph that shows the percent saturation of hemoglobin at various partial pressures of oxygen. The purpose of an oxygen dissociation curve is to show the equilibrium of oxyhemoglobin and non-bonded haemoglobin at various partial pressures. At high partial pressures of oxygen, usually in the lungs, haemoglobin binds to oxygen to form oxyhemoglobin. When the blood is fully saturated all the erythrocytes are in the form of oxyhemoglobin. As the erythrocytes travel to tissues deprived of oxygen the partial pressure of oxygen decreases. Consequently, the oxyhemoglobin releases the oxygen to form haemoglobin. Why is this relevant to me?
Atmospheric pressure at sea level is 100kPa but at 3360 metres, where I spent time earlier this week in the Rocky Mountain National Park, the atmospheric pressure is only 67kPa (two thirds of that at sea level) with a corresponding reduction in the inspired oxygen pressure (13.3 kPa compared with 19.6 kPa).
Put simply, I won’t be running up any stairs for the rest of the week if I want to avoid a headache, a feeling like my chest is about to explode, a racing pulse and a fast respiratory rate!
That first year medical school respiratory physiology has finally come in handy, after all!