How to recognize child psychological abuse

 Brody School of Medicine  Comments Off on How to recognize child psychological abuse
Aug 092012

A recent online Time magazine article highlighted a disturbing fact: one of the more prevalent forms of child abuse is also one of the more difficult types of abuse to identify.

The July 30 article stated that a group of pediatricians, writing for the journal Pediatrics, called on parents to stay alert for signs of psychological abuse. But even then, the doctors acknowledge that it can be difficult to figure out whether a child is being abused in this fashion.

From Time’s Healthland blog:

“What makes this kind maltreatment so challenging for pediatricians and for social services staff, however, is that it’s not defined by any one specific event, but rather by the nature of the relationship between caregiver and child. That makes it unusually hard to identify.”

Dr. Elaine Cabinum-Foeller is a board certified child-abuse pediatrician at East Carolina University’s Brody School of Medicine and is the medical director of the TEDI BEAR Children’s Advocacy Center. Speaking of psychological abuse by a caregiver, Cabinum-Foeller said such abuse can take many forms but that it’s important to understand that isolated incidents do not necessarily mean that abuse is occurring. Psychological abuse often refers to a pattern and can include the following actions:

  • Ridiculing and terrorizing a child
  • Exploiting or corrupting a child
  • Being excessively detached or uninvolved in that child’s life

“You must remember that these are extremes of behavior,” Cabinum-Foeller says. “Putting a child in an appropriate time out is not psychological abuse. Isolating them in a room and not allowing them contact with others for extended periods of time may be psychological abuse.”

What makes this type of abuse difficult to identify is that a concerned person has to know how these actions make a child feel, and that these actions are part of a pattern. To correctly identify psychological abuse, a person can refer parents and children to mental-health counselors, domestic violence organizations, and pediatricians. In North Carolina, all people are required to contact Child Protective Services if they believe a child is being abused. (Reports can be submitted anonymously, if need be.)

People can also be supportive by listening to the child in question, but there are things that person should not do in this situation.

“A person should never make promises that they cannot keep,” Cabinum-Foeller says. “For example, don’t tell a child that you won’t tell anyone if you know that you might have to report what they tell you to CPS or someone else.”


Nurse burnout: staffing isn’t the only problem

 College of Nursing  Comments Off on Nurse burnout: staffing isn’t the only problem
Aug 072012

In a recent NBC News report on the association between burned out nurses and patient infections, the reporter discusses a new research study that examines the relationship between a nurse’s workload and hospital acquired infections. Doesn’t this just make sense?  The more things a nurse has to do leads to less time with each patient, and that leads to taking short cuts and increasing mistakes as the nurse works faster and harder to get all of the work done. This would not be unique to nursing; it would be true of any person who is working in an environment without what they need to optimize their productivity and effectiveness.  However, when we’re talking about nurses and patients, there are lives at stake in the process.

The problem of nurse workload, burnout, and patient safety has been studied for over 10 years.  We know that having the right amount of staff matters, but that is not the only thing that contributes to the burnout of nurses. Burnout happens when nurses are working in situations that are in conflict with their beliefs and values. Burnout is impacted by the quality of nursing leadership on a unit, by the way physicians and nurses work together, and by whether or not a nurse feels they can do what is needed for patients. It is not just staffing that impacts burnout. Many nurses work long hours or work during high periods of stress similar to what occurs during a natural disaster – but that alone doesn’t burn out a nurse.

In the past, patients stayed in the hospital much longer and there was a balance of new, very sick patients with those who were more stable. But now, patients do not stay overnight unless they need 24 hour surveillance by a nurse and almost all of those patients are new and very sick. Additionally, hospitals are facing new rules for reimbursement that link patient outcomes to payment for care. So it is more important than ever to acknowledge the value nursing brings to health care systems and to find a way to optimize the care they bring to patients.

Fortunately, much of what is needed to reduce burnout and improve patient outcomes doesn’t cost more money – it just means nurse leaders need to be well educated, physicians and nurses need to respect each other and collaborate, and hospitals need to be designed in a way that supports the nurse’s ability to care for patients.  Keeping patients in hospitals safe is less about a miracle formula for staffing and more about people working together effectively to keep the patient at the center of care.

Elaine S. Scott, PhD, RN, NE-BC
Associate Professor
Director, East Carolina Center for Nursing Leadership

Myth and Reality Regarding Early Children’s Dental Care

 School of Dental Medicine  Comments Off on Myth and Reality Regarding Early Children’s Dental Care
Aug 032012

There are many common myths in our society related to the dental care of both adults and children.  This discussion will highlight some of the common myths and misconceptions regarding early children’s dental care.

Myth #1: A Mother’s dental health does not affect her Child’s dental health.

This is False.  Research has shown that the dental health of both parents and especially that of the mother affect the dental health of children.  This even extends to the mother’s dental health before the child is born, making it extremely important for expectant mothers to maintain good oral health throughout their pregnancy.  This means not only maintaining an excellent at-home oral hygiene regime but also adding professional dental check-ups and care to the recommended pre-natal care that many women now seek.

Myth #2: A developing baby that has not yet been born can “strip” or “steal” calcium from the pregnant mother and then cause her to develop cavities, soft teeth or bad gums as a result.

This is False.  This is also related to the first myth discussed.  Many women have developed cavities during pregnancy, sometimes even a large number of cavities.  Some of these women have even reported that they never had a cavity before getting pregnant, leading to this myth.  The reality is that some women may develop gum disease (a.k.a. gingivitis) associated with the hormone changes that occur with pregnancy, but maintaining good oral hygiene throughout the pregnancy should ensure that no cavities develop and no teeth are lost.  The risk of developing cavities during pregnancy is also increased by changes in eating habits that often accompany pregnancy as well as issues like “morning sickness” and frequent “heart burn”.  By adding professional dental care to the pre-natal health regime, we give expecting mothers the opportunity to discuss the specifics of their pregnancy with their dental professional and helpful recommendations can be made.

Myth #3: Baby teeth are not important because they are just going to fall out.

This is False.  Baby teeth have an important role in the normal growth and development of a child.  Baby (primary) teeth help the child to eat a proper balanced and healthy diet, have a role in proper speech development and are very important to the normal development of the face, jaws, and permanent (adult) teeth.  The health of the baby teeth has an important effect on the health and alignment of the adult teeth, so to have healthy adult teeth means keeping the baby teeth healthy.

Myth #4: The baby teeth all fall out at one time or over a very short period of time.

This is False.  Many people think that the baby teeth fall out all at one time or even over a relatively short period of time (within a year).  In reality it takes 5 to 6 years for most children to lose all of their baby teeth.  Most children can be expected to have their first adult tooth grow in at 6 years of age. Many parents are unaware that these permanent teeth have even erupted, because in most children, this will begin before the first baby tooth falls out.  Many children will not lose their last baby tooth until they are about twelve years old.  This means that over this six-year period there are some adult teeth present and some baby teeth present.  Since tooth decay is an infectious process, if there have been any cavities present in the baby teeth, they can then spread to the adult teeth.

Myth #5: Since baby teeth are not important it is not important to take children to the dentist until they are at least 3 years old and 5 years old may be even better.

This is False.  We have already discussed the importance of baby teeth and the country’s leading organization for children’s dental health care, the American Academy of Pediatric Dentistry ( and the American Academy of Pediatrics (, recommend that all children see a dental professional within six months of the first tooth starting to grow in and no later than one year of age.  They also recommend that all children have a “Dental Home” established by one year of age.  This gives the child a chance to see a dental professional with whom they may become familiar and comfortable over time and it gives the dental professional a chance to be proactive in helping the family to prevent cavities before they develop.  One way this can be done is through monitoring and adjusting the child’s exposure to fluoride.  In the proper dosage, fluoride is one of the most effective tools in the prevention of cavities.  An early dental visit can be very beneficial in allowing your dental professional to assist you in ensuring your child receives the proper daily fluoride exposure.

Myth #6: My child wants to brush their teeth without my help, so I should let them do so.

This is False.  It is not only important to put the tooth brush in the mouth, it is extremely important to use the tooth brush in the proper manner to maintain good oral hygiene.  Just as we would not put a child in a tub of water by herself and expect her to come out properly clean without assistance, we cannot expect our children to clean their own teeth without our help.  Many parents are surprised to learn that it is even important to help their older children to brush their teeth.  The general rule of thumb is that if a child cannot yet tie their own shoelaces, then they are not yet able to use their hands well enough to be able to do a good job brushing their own teeth. A pea-size amount or small “smear” of toothpaste on the toothbrush is sufficient to get its positive benefits and will help avoid the negative effects possible from over exposure.

There are many more myths and misconceptions regarding dental health, too many to try to address in this one forum.  To maintain good oral health throughout life, it is important to not only brush at least two times a day, floss at least once a day, and control sugar intake in the diet, it is also important to see a dental professional on a regular basis and to start early for your children.  Additional information can be obtained at both and or you can ask your own dental professional.


Christopher A. Cotterill, DMD
ECU School of Dental Medicine
Division of Pediatric Dentistry
Assistant Clinical Professor