Childhood Trauma and Risk Factors

Isolation and Violence

I have been very fortunate in that I have not suffered any of the stressors listed for this assignment and none of the people in my personal life have ever shared that they were affected by any of the stressors mentioned.  A woman that I worked with at one time did share some information about the violence, abuse and isolation that she suffered as a young child.  At birth, this person was rejected by her mother because of the color of her skin.  She was left on the porch of the grandparent’s home when she was just a few days old.  The grandparents were away for the entire day and so it some time before she was discovered.  It is amazing that she survived since the weather that day was exceedingly hot.  As a child, this person suffered at the hands of various adults.  She was beaten and sexually abused.  She still has scars on her back from where she was beaten. No new shoes were ever purchased for her.  She was expected to wear the one pair that she had even after she outgrew them.  Because of this, her feet were malformed and caused her pain all of her life.  Because of the rejection by her mother and sexual abuse, she suffered in silence for many years.  This person has never sought out any type of professional help.  She has relied on friends for support and I would guess has gotten some comfort in her work with children.  She is a very kind, caring and gentle teacher who has a gift for working with children with special needs.  With adults, she is very passive and quiet. 

Violence Against Children in Mexico and Latin American Countries

From the research that I did, I found that in Mexico and other Latin American countries, many children are exposed to violence- in the home, the school and in the community. According to Knaul & Ramirez,

“Violence is a severe social and economic problem, particularly in Latin America where it is more than twice the world average. An estimated 22 homicides per 100,000 people occur each year in the region, and every minute 54 families suffer a robbery. Evidence suggests that a large proportion of children suffer from intra- family violence, and that most live in poor families. Estimates indicate that almost 6 million Latin American and Caribbean children suffer some form of severe violence and an estimated 80,000 children die each year as a result of intra- family violence.  In Mexico, deaths due to violence constitute 3% of all deaths. Between ages 0 to 4, it’s one among the 20 principal causes of death”.

According the World Report: Violence against children, babies and minors have higher risk of death by homicide.  In Mexico, 77% of the victims are girls. The average age of female victims is 5.7 years old.  These statistics point to the high probably of a child in Mexico or other Latin American country either being a direct victim of violence or witnessing violence.

The U. S. Department of Health & Human Services website (2009) lists the following affects of violence. 

•    Behavioral, social, and emotional problems. Higher levels of aggression, anger, hostility, oppositional behavior, and disobedience; fear, anxiety, withdrawal, and depression; poor peer, sibling, and social relationships; and low self-esteem.

•    Cognitive and attitudinal problems. Lower cognitive functioning, poor school performance, lack of conflict resolution skills, limited problem solving skills, pro-violence attitudes, and belief in rigid gender stereotypes and male privilege.

•    Long-term problems. Higher levels of adult depression and trauma symptoms and increased tolerance for and use of violence in adult relationships.

According to the UNICEF website (2007), “The high levels of violence in Mexico, and in Latin America and the Caribbean generally, are often linked to extreme economic and social inequalities and to the “machista” culture”.  The UNICEF website details recommends that calls for immediate action be taken by government institutions to prioritize banning all forms of violence against children, including corporal punishment.  It also seems that it is necessary to address the causes of violence against children.   

References

Knaul, F. & Ramirez, M. A. Family Violence and Child Abuse in Latin America and the Caribbean:   The Cases of Colombia and Mexico

http://www.unicef.org/media/media_39505.html

UNICEF (2007). Violence causes the deaths of at least two children under 15 every day in Mexico.  Retrieved from http://www.unicef.org/media/media_39505.html

U.S. Department of Health & Human Services.  (2009) Domestic Violence and the Child Welfare System.  Retrieved from http://www.childwelfare.gov/pubs/factsheets/domesticviolence.cfm

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome- SIDS

The public health topic that I chose is Sudden Infant Death Syndrome (SIDS).  This topic is of particular interest to me because much of my career has been spent working with infants.  I am also interested in the possible cultural connections. 

Hauck & Tanabe (2008) report that SIDS is the leading cause of death for infants between 1 month and 1 year in the United States and most developed countries around the world. There has been a dramatic decrease in SIDS due in large part the Back to Sleep campaign.  The reduction for most countries was well over 50%.  The authors point out that risk factors for SIDS vary across countries and for certain populations.  For instance smoking rates among certain populations may be responsible for increased rates of SIDS related deaths.   According to the National SUID/SIDS Resource Center the SIDS rate remains significantly higher among certain racial and ethnic groups, including non-Hispanic Blacks and American Indian/Alaska Natives. In 2006, 12.2 % of all infants in the United States were placed in a prone position for sleeping while the rate for black infants was 21.9%.

SIDS in other Countries and Cultures

According to Gantley & Murcott (1993), “in various parts of the world (for example South East Asia) and in certain ethnic minority groups in this country-England (for example Bangladeshi people) the incidence of SIDS is very much lower in spite of greater social and environmental disadvantages that would generally indicate a higher incidence of SIDS and giving rise to the hypothesis that infant care practices could somehow be protective”.  In the book Our Babies, Ourselves, Small (1998) discusses the surprising distribution of SIDS across cultures.  She notes that while industrialized nations such as the United States and Canada where there is adequate access to prenatal care and good nutrition, there are also unexpectedly high rates of SIDS.  In contrast, SIDS is lowest in Asia. Studies of Asian immigrants in the California found that the rate of SIDS was half that of the non-Asian population.  She also states that the rate of SIDS for immigrants was highest for those groups that had been in the U.S. longer and had adopted Western childcare practices.  In Britain, immigrants from West Africa, Bangladesh and Pakistan all had low rates of SIDS.  Gantly & Murcott (1993) found that in addition to supine sleeping, the Bangladeshi infants in England experienced relatively low SIDS possibly because of their rich sensory environment. They concluded that  “long periods of lone quiet sleep may be one factor that contributes to a higher rate of sudden deaths in white than in Asian infants” (Gantley and Murcott, 1993).

The success of the Back to Sleep campaign is undeniable, however, there are other risk factors that are associated with SIDS that have not received the same attention as sleep position.   Maternal smoking during pregnancy, infant overheating, child care and the sleep environment can all be all possible risks.  There is also research from several studies performed in the United States and other industrialized nations that demonstrate an increased risks of SIDS among babies who receive formula instead of breast milk.  Since I have daily contact with the parents of infants, I have the opportunity to share this information with  them.  My experience has been that many parents still are not aware of the risks associated with SIDS and how they can reduce these risks for their infant. 

http://www.sidscenter.org/Statistics.html National SUID/SIDS Resource center

Gantley, M. &  Murcott, A. (1993). The sudden infant death syndrome (SIDS): Possible socio-cultural links with infant care practices. Welsh Paedeatrics Journal, 5:15-16. Retrieved from

http://www.welshpaediatrics.org.uk/sudden-infant-death-syndrome-sids-possible-socio-cultural-links-infant-care-practices

Hauck F, Tanabe K. 2008. International trends in sudden infant death syndrome: stabilization of rates requires further action. Pediatrics 122; 660-666. Retrieved from http://www.ispid.org/fileadmin/user_upload/textfiles/articles/CPR17_Hauck_SIDS_Trends.pdf

http://www.sidscenter.org/Statistics.html National SUID/SIDS Resource center

Small, M. (1998) Our babies, ourselves: How biology and culture shape the way we parent.  New York, NY: Random House, Inc. 

Childbirth

The following is my own childbirth experience from my first pregnancy.

I chose this particular example because it is representative of all of my labor and delivery experiences and seems to be very typical of childbirth in the United States.   My labor and delivery took place in a hospital.  At the hospital, I was prepped and then left in a room with another woman who was screaming and moaning a lot.  The nurses were not friendly or helpful.  Periodically, a nurse would come and check on me until it was determined that it was time to move to the delivery room.   The delivery room in the hospital were I delivered was in the process of being remodeled and so a makeshift room was used.  There was a large window with no curtains in the room and I remember thinking that even though we were on an upper floor, I was on display for all to see.  My husband was there for the delivery, but he arrived with just minutes to spare.   Even though we had completed all of the required paperwork in advance, the hospital lost it and so my husband had to fill out all of the paperwork again.  There was also a medical student observing.  The doctor who I generally saw, was not the one on call, so the delivery was with a doctor that I did not know very well.  He was an older man and barely uttered a word the entire time.  I had attended Lamaze classes and so had a “natural” birth.  “Natural” births (ones with little or no anesthesia or painkillers) were very popular at the time.  Luckily, my labor and delivery were fairly quick and there were no complications.  I really can’t say I remember much about the actual delivery.  My daughter was born healthy and I thought that she was the most beautiful baby I had ever seen.  

The research I did was on labor and delivery in China. 

What I found was that the pregnant woman's mother is present at the first delivery but not for subsequent ones.  After the first birth, the woman is expected to deliver by herself at home.  The father is not present during delivery, although he is expected to give the baby its first bath.  It is expected that the woman be quiet during labor.  This is because it is believed that crying out will attract evil spirits to the new child.  The position for labor is squatting because it is believed that the baby will not have enough energy to come out if the mother is lying on her back.  Acupressure is sometimes used for easier delivery.  I would assume that the experience for Chinese women in large cities who have access to more advanced medical care is more like that of other women in industrialized countries than the traditional experience I researched. 

My childbirth experience was different from what would be typical in China.  In China, the father is not expected to be present or part of the delivery.  In my case, my husband was present and my Lamaze partner.  Unlike a woman in China, my delivery took place in a position that was convenient for the doctor and took place in a hospital.  If I was having a baby in China, I would not have been in a hospital and no one would have been screaming.  It seems that much of the practice surrounding the delivery in China is based on beliefs, not science. 

The way the infant enters the world is influenced by our view of child development and has an impact on the child’s development.  Is the child’s first experience harsh lights and a cold, sterile environment? Does the child enter the world influenced by drugs given to the mother to ease pain?  What are the first few minutes of life look like for the mother and her baby?  Is the infant physically separated from the mother for periods of time or are the mother and child rarely separated?  The biology and physiology of the birthing process is the same for all humans.   The way a baby enters the world and the customary delivery experience for the mother, however, is influenced by a number of factors.   One of the greatest concerns in the U.S. is the safety of the child and mother.  For this reason, the majority of births take place in a hospital and are overseen by doctors and nurses.  The perspective of the medical profession also influences the birthing practices in the U.S.  Factors such as the equipment used and the position of the mother are dictated by the medical profession.  This is very different from what a child in other places in the world experience.  For those who are interested Meredith Small does a wonderful job of exploring the biology and culture of the birthing process and the experience of the infant in her book Our Babies, Ourselves. 

http://en.radio86.com/chinese-culture/traditional-chinese-beliefs-about-pregnancy-and-childbirth

http://www.hawcc.hawaii.edu/nursing/RNChinese02.html