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MNAAP Newsletter

No Hit Zone at the U of M Masonic Children’s Hospital


By Rebecca E. Foell, MSW, LICSW, and Nancy S. Harper, MD, FAAP

In 2016, The University of Minnesota Masonic Children’s Hospital launched the first No Hit Zone in the state of Minnesota. A No Hit Zone is an environment in which no adult shall hit a child, no adult shall hit another adult, no child shall hit an adult, and no child shall hit another child. The purpose of the No Hit Zone is to create a safe and healthy environment for patients, families, visitors, and staff as well as to provide support, education, and resources surrounding effective discipline.

Definition and Prevalence
The United Nations Convention on the Rights of the Child in 2006 defined corporal punishment or physical punishment to include hitting with a hand or object as well as shaking, throwing, scratching, biting, kicking, and burning of children with a call for countries to enact legislation prohibiting violence against children as a form of discipline.

To date, 52 countries have banned physical punishment of children starting with Sweden in 1979. The United States has not yet banned corporal punishment. In fact, 19 states in America still allow corporal punishment in schools, but there appears to be a general shift in the use of corporal punishment in the United States. According to one study, the percentage of mothers reporting that they would hit or spank their kindergarten-age child in response to a child’s misbehavior declined by 20 to 26 percentage points across all income levels between 1988 and 2011. Likewise, the percentage of mothers reporting that they spanked their child in the past week declined by 26 to 40 percentage points. These declines emerged at all income levels.

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A Loss to us All

By Sarah Atunah Jay, MD

As a pediatric physician, I have only once attended the funeral of a patient. It is a rare situation that children die, and I have been fortunate to have encountered very few of those occasions. A child’s death is traumatic to all parties involved: family members, friends, medical providers. As the medical team, we cannot but wonder if there was anything we could have done save that child. Wonder if we are implicated in their death.

I knew I had to attend the funeral. I remember the child. I remember the family. I was fairly certain no one else would attend the funeral from the medical establishment in which this child breathed his last breath. While I knew we did not raise the child, that we did not witness his first step, hold his hand on the way to school, or pray with him every night, I knew that we, the medical team, were in fact intimately woven into the fabric of his life. Therefore, though I was sad and regretful that my profession could not save his life, I also could not obviate myself from joining in his family’s marking of that life.

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Suspicions of Child Abuse or Neglect Must Be Reported

By Lisa Guetzko, MD, HealthPartners Central Minnesota Clinic

LisaGuetzkoDiagnosing and reporting suspected child abuse or neglect is one of the greatest challenges a pediatrician must face. Besides the obvious primary concern for the child’s welfare, there are numerous other considerations that can affect our decisions about whether or not to file a child protection report. Time constraints, diagnostic uncertainty, logistical barriers, lack of knowledge about proper reporting protocol, and fear of alienating the patient’s family or losing them to follow up may all play a role in the clinician’s decision. Although we are all aware that we are mandated reporters, it is often unclear exactly when, why, and how to report a suspicion of child abuse.

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Reporting Child Maltreatment and Abuse: FAQs

By Alice Swenson, MD, FAAP, Children’s Hospitals and Clinics of Minnesota; Chris Derauf, MD, FAAP, Mayo Clinic; and Sarah Lucken, MD, FAAP, Hennepin County Medical Center

One of the toughest challenges that primary care physicians face is what to do when confronted with a child who may have been maltreated. This may occur in the inpatient setting when a child is hospitalized with suspicious injuries or failure to thrive. Or it may occur in an outpatient setting, such as an emergency room or clinic, derailing an otherwise routine day and requiring immediate action.

Physicians often have questions about who is mandated to report, which acts trigger mandated reporting, and to whom a mandated report must be made. These topics are addressed in more detail in the Minnesota Reporting of Maltreatment of Minors Act in Minnesota (Statute 626.556).

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Member Profile: Mark Hudson, MD, FAAP

Where did you grow up and complete your training? Why did you decide to pursue a subspecialty in child abuse pediatrics?
I grew up in Two Harbors, Minnesota. I attended undergraduate at the University of Wisconsin Green Bay and Medical school at the University of Minnesota. I stayed at the U of M for my pediatrics residency. Following residency I spent two years in a child abuse pediatrics fellowship with Carolyn Levitt, MD and Rich Kaplan, MD at Midwest Children’s Resource Center at Children’s Hospitals and Clinics of Minnesota.

Most of my career decisions occurred relatively late. In medical school I found that I enjoyed my pediatrics rotations more than any of my other rotations. Not only did I enjoy working with children but I also enjoyed the pediatricians. In residency I did an elective rotation in child abuse and found it very interesting. As residency was coming to an end, I didn’t really know what I wanted to do with my career, but I didn’t feel ready to get a job. Child abuse pediatrics was not yet a recognized subspecialty, which allowed me to spend the next two years creating my own fellowship.

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