I am sure that in my long career, I have neglected to touch on many issues during “well” visits. I always believed that if doctors overdo their advice, it all becomes overwhelming. The child and the parent walk away remembering nothing. But there are so many issues! Safety, diet, exercise, reading to your child, giving children their space, avoiding praising or criticizing a child's appearance excessively. But one issue that could never be emphasized enough – and I'm sure I didn't – was child abuse. This is a very difficult subject to address appropriately. What one wants to say to parents often can't be said in front of children and vice versa. Perhaps I can help some parents with this discussion. 

There is physical abuse, there is sexual (physical) abuse, and there is emotional abuse. Let's address each of these in turn. Physical abuse is a punishment that might include hitting, using an object to hurt a child, and spanking. Yes, spanking has a long history as a punishment, but research has determined that it has never been effective as a deterrent for bad behavior. And let me insert this qualification: there is a difference between discipline and punishment. Discipline is a way of training that results in proper behavior. Punishment is a way of hurting someone because the punisher is angry and has poor control over his anger. All parents get angry. I suggest you plan what you're going to do the next time you're angry at your child. Call someone. Walk into another room. Put the child in time out. Count to 100 (in English! It's good practice. Or if you speak English, learn to count to 100 in a language you're less familiar with.) In short “corporal punishment” – hurting a child as a way to teach the child – is never a good idea. In addition, parents need to teach their children that they should never keep silent if someone does physically injure them – especially if it's an adult and even if it's a relative. There should be no secrets, and parents should try to develop a relationship with their children so there will be none.  

The same goes for emotional abuse, although many people have a lot more trouble recognizing what that is. Parents aren't forbidden from correcting or criticizing their children, but it should not be done in anger or in a way that makes a child feel totally inadequate. Criticism is very difficult to do right. It is important to remember not to confuse the child with the behavior. Saying, “You are a bad child” is much less useful than saying, “Your behavior was wrong.” Saying, “You're always making a mess” or “You're never paying attention” is also not as good as being more specific (“I would like you to clean your room today” or “Right now, let's listen to each other carefully”). Lashing out in anger verbally can be worse than lashing out physically. In particular, very young children are willing to act out and get punished because they prefer being yelled at to being ignored. A simple rule is to praise a child 10 times for every criticism.  

The subject of sexual abuse can never be ignored. Children need to know that any behavior by an adult or older child that makes them uncomfortable is not acceptable, and they must tell someone they trust immediately. This includes comments about their body as well as touching or requests for intimate behavior. If a parent learns of a forced sexual act, the authorities must be called. Your pediatrician can help. Do not panic! Parents should bring up the subject of sexual abuse. We hear about “stranger danger,” but most sexual abusers are well known to family members. Often the abusers live in the same house or building. Never ignore comments or accusations by children. Sometimes you'll see a sudden change of behavior that should prompt gentle but persistent questions.  

Children deserve a safe space to grow up in. Parents need to provide that space.  

Robert B. Golenbock, MD, is currently retired. He has cared for children in the Danbury area for 43 years, including at the Center for Pediatric Medicine. The CPM is located at 107 Newtown Rd #1D, Danbury, CT 06810. For more information, please call (203) 790-0822 or visit https://centerforpediatricmedct.com.