“A child’s world is fragile and new and beautiful, full of wonder and excitement…” – Rachel Carlson
If I told you that a major and well-established risk factor for several top 10 causes of death in the United States and worldwide had received relatively little attention from the media, the National Institutes of Health or other funding agencies, would you be surprised? If it resulted not only in premature death but in a marked increase in risk for abject misery — unhappiness, loneliness, drug and alcohol abuse as well as risk for asthma, irritable bowel syndrome, obesity, heart disease, diabetes, stroke, and suicide, would that surprise you further? Well, all of this is true about child abuse and neglect.
Remarkably, I initiated this piece long before the world witnessed the painful scenes of immigrant families seeking asylum in the United States on our Southern border and the heart-wrenching photos of those children as they are separated from their mothers. Such images are painful to all of us, but actually pale in comparison to what pediatricians, child-care workers, child psychiatrists and psychologists and Departments of Family Services see on a daily basis in this country and abroad.
In 2016, Child Protective Services in the United States received more than 4.1 million referrals involving 7.4 million children. Of these, 2.3 million referrals were deemed worthy of investigation. Remarkably, two-thirds of the referrals were from professionals and one-third from the general public. After investigation, 676,000 children were verified as victims of abuse and neglect, with children in the first year of life most commonly victimized. Approximately three-quarters of the victims suffered neglect, the remainder abuse with 1,700 fatalities.
These startling numbers, however, blur the human tragedy. As Joseph Stalin reportedly stated years ago, “a single death is a tragedy; a million deaths is a statistic.” These defenseless victims include those who have been coerced into human trafficking, those who are malnourished, those who are ill and receive no treatment, and those who are victims of violent alcoholic parents, as well as those in abusive foster care environments.
Three decades of research has demonstrated the devastating biological consequences of child abuse and neglect —long lasting hyper-responsive stress reactivity, marked increases in inflammation, and profound brain changes demonstrated by state-of-the-art brain imaging studies. There is now emerging evidence that the specific type of early life stress, e.g., sexual abuse or emotional abuse or neglect, produces a specific pattern of changes in the brain, both structural and in functional activity and responses to stress.
At the heart of this tragedy is what we, of course, know all too well — that children need love, security, safety, parental warmth, and a nurturant environment. Without it, the human capacity to attach — to our friends, spouse/significant other, parents, grandparents and, yes, even our pets is severely compromised. The Beatles said it well — “All you need is love…”
Shouldn’t we address this public health disaster and prevent a lifetime of human suffering. It not only makes sense from a health economics point of view — it will reveal who we are as Americans. An unknown author stated that “childhood is the most beautiful of all life’s seasons.” Let’s work to preserve that for all children.
Charles B. Nemeroff, M.D., PhD, is the Leonard M. Miller professor of psychiatry and behavioral sciences and biochemistry and molecular biology at the University of Miami Miller School of Medicine and the chairman of the Department of Psychiatry and Behavioral Sciences.