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Severe Child Abuse: a Sad Reality on the Increase in Idaho

By Dr. David C. Pate, News and Community
March 31, 2014

I am so proud of the work that Dr. Paul McPherson, medical director of St. Luke's CARES Clinic, and the entire team of professionals with St. Luke’s Children’s carry out every day. The causes of child abuse are multifactorial and contributors seem to be increasing with frequency. We must equip new parents and other caregivers for children with strategies, and our prenatal and parenting classes, including “The Happiest Baby on the Block," are among the useful resources with which we support families.

My blog editor, Roya Camp, interviewed Dr. McPherson. Her report follows.

Although national data suggests the incidence of some forms of child abuse and neglect has slightly decreased over the last few years, cases of severe physical abuse that result in severe disability or death are rising.

This is no distant tragedy. St. Luke’s Children’s has experienced a 40 percent increase of severe physical abuse cases involving "shaken baby syndrome" from 2012-2013.


Paul McPherson, MD, FAAP

Here is a sad, very real example of what Dr. Paul McPherson, medical director of CARES Clinic St. Luke’s Children’s, tries to prevent all too often.

It starts with a phone call no parent ever wants to receive. 

"As I was watching your toddler son, he fell off a coffee table, hit his head and became unconscious,” the caller says. “He is being taken to the hospital.” 

The situation goes from bad to worse to devastating. The mother of the little boy arrives at the hospital and learns that her son has bleeding on both sides of his brain. His brain is experiencing life-threatening pressure build-up. There is bleeding behind his eyes. 

And despite the best efforts of the hospital medical staff, her son succumbs to the injuries and dies.

This is one day, one case, in 2012. There have been more, and far too many.

In this case and many others evaluated at St. Luke's Children's, the injuries are significantly more severe than what is expected, based upon the initial story provided by caregivers. In this case, as in many others, it turns out to have been a caregiver who became frustrated with the child's crying or some other “annoying” behaviors. 

In this case, as in many others, the caregiver confesses to causing the injuries by violently shaking and hitting the child. 

In this month of April, National Child Abuse Prevention Month, St. Luke's Children's, the Idaho Children's Trust Fund, and many community organizations will raise awareness of “shaken baby syndrome” and how to implement simple, powerful steps to prevent devastating tragedies. 

St. Luke's own child abuse clinic (CARES, which stands for Children at Risk Evaluation Services) will host an open house so that the community can learn more about child abuse and how can be prevented.

The CARES clinic is one of about a half-dozen nationwide that functions within a highly collaborative web of social services, law enforcement resources, health and welfare case workers, and medical programs for victims of adult sexual assault and domestic violence and is co-located with the agencies that provide these resources. Dr. McPherson is its medical director and the sole physician on staff; he is supported in the clinic’s work by two full-time nurse practitioners and several social workers.

Dr. McPherson joined St. Luke’s nearly three years ago, coming from Akron Children’s Hospital in Ohio, where he completed his pediatric residency training and then worked as attending physician, child abuse pediatrics. He completed his specialty training in child abuse pediatrics at Columbus Children’s Hospital in Columbus, Ohio. It’s an area of expertise, Dr. McPherson believes, in which he can be highly effective at intervening, educating, and treating.

“I love taking care of children and in cases of child abuse, there is an opportunity to intervene right away to improve their physical health as well as their social and home environment,” he said. “We know the social environment can affect the health and safety of children.”

The multi-disciplinary environment in which Dr. McPherson and his team do their work may be a model for the sorts of team-based, collaborative approaches St. Luke’s knows it will increasingly take going forward in population health and with community partners.

The disturbing increase in shaken baby syndrome and severe physical abuse cases involving children parallel disruptions in the national economy, he observes. And those connections, between human health and well-being and the community setting, are the reason it’s becoming more important than ever that St. Luke’s and other healthcare delivery systems engage in population health efforts.

 “There has been an increase in the incidence since the economic recession, and I think that’s the biggest driver of it,” Dr. McPherson said.

The challenge is to support high-risk families so that physical harm does not start or escalate. Signs Dr. McPherson and his colleagues know to watch for include: 

  • Drug and/or alcohol abuse within the family.
  • Caregivers with underlying mental health issues.
  • Significant psychosocial and financial stressors on the family.
  • An unstable home environment, with many caregivers and changes of address.
  • A generational or parental history of abuse or neglect and domestic violence.
At least 90 percent of the cases he sees have involved at least two of these risk factors, Dr. McPherson estimates, and many have involved many more of these characteristics. Just because these factors are present does not necessarily mean child abuse is happening, however, he cautions.


Onesies that St. Luke's CARES Clinic and other organizations will display to bring awareness to violence against children during National Child Abuse Prevention Month.

St. Luke’s CARES Clinic and other community agencies are working to educate daycare providers, teachers, and others who encounter young children outside home

Onesies that St. Luke's CARES Clinic and other organizations will display to bring awareness to violence against children during National Child Abuse Prevention Month.

environments to be able to identify when a child might be at risk for abuse.

 “If we can identify less severe abuse, and help the family at that point, then there is less chance for the abuse to escalate,” Dr. McPherson said.

Very often, the trigger for abuse is a simple one: a child’s crying. And the solution, when applied before the violence begins, is equally simple: Walk away. Checking a baby’s diaper and assessing to see if a baby is hungry, sick, or tired can ease a baby’s discomfort. If all else fails, put the baby down safely and go away to cool down before trying again.

“They don’t know what to do when a baby cries,” Dr. McPherson said. “It’s OK for a baby to cry for a while.”

With a little bit of caregiver education and the development of a "crying plan," he said, the tragic and life-altering events he attends can be prevented.

CARES will host an open house April 4 from 2 to 5 p.m.

St. Luke’s offers many classes, including “The Happiest Baby on the Block.” 

During this, National Child Abuse Prevention Month:

  • Encourage someone you know who is pregnant to attend a prenatal class on how to calm and soothe a crying baby, and invite them to bring their spouse or partner.
  • If you have a family member or friend with a child, offer to watch their youngster so they can grab a nap, go to a movie, or do something to relax.
  • If you know of an at-risk family, refer them to CARES. 
  • Help support the childhood wellness and well-being programs we offer to our communities. Donate to St. Luke’s Children’s.

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.