My youngest, Gray Squeal, is 9 months old and Monday she fell off a table while her grandmother was watching her. I took her to a local hospital that evening to take some radiographs. She had a greenstick fracture of her femur just above the knee. Just as she has been really taken off scurrying all over the house and having a good time exploring. A splint was applied and we put her on some acetaminophen and gave a call to her pediatrician the next morning. The pediatrician gave us a few options or orthopedic specialist to see. Her Mom and I decided to take Gray Squeal over to St. Louis Children's Hospital.

We were told she would have to have a set of full body x-rays taken to establish there was not a pattern of abuse. I have a problem with this.

Radiographs do not expose a person to much radiation, perhaps a week to two weeks background radiation given in a split second. Yet, they could cause some harm, one in a million or two, perhaps. These x-rays were doing nothing to help Gray Squeal and they had a remote chance of doing her harm. In medicine, you are always making sure that if you can not do anything to help combat a lesion you at least make sure you are not doing anything to hurt the patient. We as parents, nor the doctor, has an option on this. It is required in the State of Missouri to have full body x-rays if there is a broken bone anywhere with children. If we as parents had refused the x-rays, Gray Squeal would have been taken away from us.

I believe this law to be unreasonable. I know some children are abused. However, this does not give the State the right to make decisions on what is best for my children. Frankly, they are not looking out for my child's best interest. Her Mom and I do. This is socialism at its worst. A large expense is created and unnecessary treatment was performed. Only bad could have resulted from the procedure. The State should not be given authority to supersede in families in this manner. No just cause was established. We were considered guilty unless we could prove otherwise.

Do you agree with my opinion or do you think it is reasonable for the State of Missouri to have such power?

P.S. Gray Squeal has a Spica Cast and is much more comforable but will have restricted mobility for 3 weeks. She will be off like a rocket, then, I expect.

First, let me say how sorry I am that she fell. I know how that feels when one of your kids get hurt.

My wife is a Family Nurse Practitioner. She has seen a lot of abused kids, and has called CPS on numerous occasions. I know it makes you feel frustrated when this happens, and they do the x-ray, but trust me, this is probably the number one way of discovering evidence of child abuse. I agree that in general, I do not approve of these kinds of laws, but what is the alternative?

Do parents have a right to abuse their children? What can one do in response to abuse besides remove the child from the home? There are even problems with this. Often kids are removed, the parents are sent to counseling, and then the kids are sent back home. But it is rare that a short counseling session is enough to roll back this often inherited behavior.

I don't know what the ultimate solution is for child abuse, but who besides the state is going to enact it? I have heard enough horror stories from my wife that I can never feel that a parent always knows best. And the present laws are not predicated on the state knowing what's best for the family, it's based on what groups of professional pediatricians, child psychologists and the like have seen as intractable problems within certain families. The state acts as the arm of policy, because, like I said before, who else will do it?

My question back to you is, are you willing to go back to a place where a parent can do with a child as he/she wishes, with no consequence for their actions? I believe the state needs to view and act differently when facing people's ultimate responsibility for their own actions and when facing people who are responsible for other people (ie parents).

My answer is yes. If in order to acquire evidence to convict more people of child abuse results in the loss of parenting rights the cost is too high. Is it worth it to harm some children who would not otherwise be harmed in order to help some other children? Not for my child it is not. My primary responsibility is to my own children and I do not agree to harming them in order to help some other child. The problem with socialism is the state is looking out for the good of the population and not the individual. It is shoddy thinking in my opinion and ultimately dangerous. It is shoddy medicine to harm some in order to help others. There are alternatives which do not involve the loss of liberty nor performing invasive procedures.

Are you really willing to give up the status of presumed innocent until proven guilty in order to catch more bad people?

Would you support a law requiring all people boarding aircraft to have full body x-rays? What sort of limits to civil liberty are you willing to give up?
I hope you have some sort of limit and where do you draw it?

And remember folks this is not theory in my example, it is happening now.

Neither is it theory when my wife sees abuse case after abuse case. I have consulted her about this, here's what she had to say:

It is very, very hard to fracture the femur, even moreso for infants, as their bones are still so flexible. Unless there is a known event, like a high speed motor vehicle accident, a physician is going to do some follow-up x-rays related to abuse. A nine-month old coming in with a fractured femur and the story of "falling off a table" would be marked very high on the suspicion scale - it's possible, but it had to be just the right fall. Of course I'm not saying I doubt your story at all - merely that will be the reaction from any responsible pediatrician.

X-rays pose very little risk. Kids with asthma get repeat chest x-rays, over and over. There are no studies linking repeated x-rays with long-term cancer.

I did make a differentiation between the way we treat a responsible individual adult, and an adult who is responsible for the lives of others. An airline pilot may be required to take a drug test, for example.

I see a hard line between the state intervening in child abuse and other types of intervention into the lives of responsible adults just doing their own thing. Again, I ask, who will look out for abused children? There must be some apparatus in place to deal with the problem.

That is a piece of fiction.

Quarkhead, you seemed to avoid answering my direct questions to define how important protecting abused children is in your viewpoint and just gave the positive side to my situation without addressing the negative aspect.



I presume you feel this is justified when it comes to protecting kids.

Would you support legislation to require children to be given full body x-rays on a yearly basis until the age of five? How many more children are being protected by the law I was subjected to? If the goal is to protect all children would it not be prudent to require all children to be screened? Why not try to catch all abuse? If you are an abuser, are you not just driving them away from hospitals with such laws and left with the practice of abusing parental rights?



The orthopedic surgeon a St. Louis Children's Hospital, ranked in the top ten for whatever that means, told us that such injuries can happen easily. I do agree it is difficult to break long bones at any age. It does take just the right force to do so. That is not the question. Easily, very hard, these are nonspecific terms. What percentage of fractured femurs in children are due to accidents and how many are caused by abuse? I do not know. I doubt the vast majority of them are caused by abuse as your wife's comment verbage seems to indicate. Does she have a study which backs this up?

I'm doing some research on the rest, and thinking about the law aspects, but I wanted to address this point. What my wife was telling me is not that this type of break is usually caused by abuse; only that these types of breaks give cause for a pediatrician to look farther.

i think the hospital was going overboard in thinking you were an abusive parent

I'd understand if they did something like that if they found bruises all over "Gray Squeal" but just one broken knee is just going a little nuclear

1. The hospital was not going overboard, they were complying with SOP when it comes to well child care.

2. The hospital did NOT think that Gray Seal was an abusive parent. When they scan you and search your bags at the airport, it's not because they think you are a terrorist. They are confirming that you are not.

3. A fractured femur is more likely to be caused by abuse than a cut finger or a sprained ankle. The health care providers are not trying to antagonize or criminalize anyone. This has nothing to do with guilty until proven innocent. This is preventive health, and identifying patterns of abuse is extremely important. This isn't some little point of law, this is about kids who cannot speak for themselves being systematically abused, injured, and killed by their parents.

Let's look at it from a different angle. A single mother beats her kid. That is a crime. Does the state then have the power or responsibility to remove the child from the home? Or do they just leave the kid there by themself?

I'm still thinking, and still searching for studies about the long-term effects of radiography. Not CT scans, but regular x-rays, which is what I guess your speaking about, gray seal.

And lest I seem insensitive as we discuss these details, I do feel very sorry for what happened to your baby. As a parent myself, I know how hard it is to see your kids getting hurt.
Peace

I would much prefer this situation to be a diagnosis of possible child abuse. If what you are saying is true Grey Seal, a law requiring all children to be tested for child abuse in the case of a broken bone is a bad law.

I don't want parents abusing children. (I wonder is their is a pro-child abuse faction out there) But I think the state and public opinion are invading the rights of parents. Get caught on tape spanking your child and you are a suspect. People call for the removal of children awfully quickly these days, but the system we are calling to put the children routinely loses track of children at the national and state level. My wife's best friend is dating someone who was in the foster care system and ran away but was never reported so the checks would keep coming.

We need to be careful what we do in the name of children. They are an easy crutch to lean on to make a complicated issue seem simple. For example both sides of the pending war in Iraq are claiming in part to hold their position because of the affect the war will have on children.

And yes, I am willing to accept that my objection to this law may allow a child abuser or two or ten to keep abusing that child. We will not allow other types of searches and seizures that violate the 4th Amendment, why is it ok in the case of children. Where does it stop, a routine visit from a social worker to make sure no children are being abused?

The trouble I see is with the assumption of guilt, and this leads to emotional backlash in parents. How dare you suspect ME of CHILD ABUSE!!!!!

I've been there. Treated like dirt until proven innocent. I think Gray Seal's experience was pretty minor. Back in the 1980s, law enforcement was very rabid about child abuse. I was step-daddy to a 13-year-old girl who had been abused by her natural father. This was in her school records, and upon starting in a new school, those records were reviewed. She had started using my last name due to obvious emotional reasons, and so when it came up that her father abused her, I was called on the carpet.

By two sheriff deputies. Long story short, my step-daughter cleared up the confusion, and my lawyer sent a nastygram to the sheriff department for the shabby way I was treated.

Gray Seal, take it easy, man. At least you weren't arrested, interrogated, and nearly thrown into the slammer. If you feel abused by the system, get a lawyer.

Now, as to the protection of children. I think it is better to err with overprotection than underprotection. I know for a fact that real child abusers are often very clever with hiding abuse. There's something about getting a whipping with a clothes hanger--that was one that the step-daughter got from the ages of around 7-10 while she stayed with her natural father. I guess it doesn't leave any marks. There was other pretty horendous stuff going on that I won't go into because it just gets me all riled up again.

Are there people who think child abuse is okay? Oh sure. Spare rod/spoil child types. The various religions that restrict health care. Sexual predators. People who start a spanking, get out of control, and wind up beating the stuffings out of kids.

I'm sympathetic to Gray Seal's reactions to being accused of child abuse. Any good parent would react the same way. But I'm also saying that adults understand that ego confrontations do nothing to help kids. These laws are on the books because kids get abused *regularly*. Do the laws solve the problem? Heck no. Real abusers, like real criminals, are often clever. Are the laws overenforced? Shoot yeah they are, and that keeps lawyers in business.

So is the answer to do away with the laws? I don't know. If the arguments revolve around just intellectual musings of rights versus restrictions, rights will win out. But if ideology is put aside and reality faced, the need for laws and enforcement become clear.

Before leaving this idea, just one more thing. Too many people consider their kids to be property, like pets. This, to me, is just a tad bit on the ill side.

I agree. There is a slim chance the full body x-ray would do any significant damage, however, it is better to err on the side of safety and this should not be done.



The law was not over-enforced. The law was applied as intended. I have a problem with the law, not the enforcement of it.



You have lost me here. Rights are of utmost importance but not really? This seems like a conservative point of view such as used by the Bush administration to squash the civil rights of some groups of people in this country in their attempt to find terrorists. That does not sound like you, AuthorMusician. Say it in another way so I can better understand.

Gray Seal,

Okay, let me try again.

Ideology and reality are two different things. In ideology, compromise is easy to avoid. For example, if the ideology has as one of its core ideals the freedom to raise children as the parents see fit, then there's no question as to the methods used to accomplish this--beyond other ideals like not killing, not beating, and so on.

So we live in reality and try to apply the ideology, and doggone it, we find that we need laws that compromise the ideal.

Actually, I do have a classical conservative streak when it comes to law. I am all for the rule of law. I'm also liberal on a lot of issues, but realistic too. For example, I am liberal in that I'd like this country to lead the way to better energy generation (meaning clean and sustainable). However, I am realistic in that this will not come about through mandating law but through economics nudged by law (R&D, rebates, shift in subsedies, a whole lot more).

Regarding the Bush administration and its handling of the war (wish we had a better word) on terror, I am quite critical and remain so. The set of laws that was passed after 9/11 reflect a nation in mourning, panic, and fear. This is not a good setting for making law. Making this law last for five years--well, I'm not going down that path right now.

Child protection laws have not been formulated in the same way. More time for thought, reflection, debate, and adjusting of law was and is available. This process has a better chance at churning out effective compromise between ideology and reality.

So, the touchstone is the amount of time in which compromise is made. Bad compromise is made in a hurry.

I thought of something while writing--how come ultrasound isn't used instead of x-ray? That would reduce possible injury, wouldn't it? I suppose it's more expensive though and maybe not available in some places. Maybe it isn't good for looking at bones either.

Anywho, hope I've made things a little more clear. Hope Gray Squeel heals up quick!

Ultrasound would not be a good choice to look for bone damage. Ultrasound is good for imaging interfaces between water and soft tissue or between soft tissues of different densities. Bone blocks sound waves very well so there would not be any ability to penetrate or distinguish subtle differences in bone density or breaks.

Ultrasound is less invasive than radiographs as this technology uses sound waves. CAT scans use radiation. NMR are safer than CAT scans or radiographs as they are not dependent on the projection of radiation.

I will disagree with you in your assessment comparing loss of civil rights via the Bush administration versus child abuse protection law. You may believe the anti terrorist laws restricting civil rights would not be passed given more time to think about it but I do not. I believe we are seeing an increasing trend in this country to think it is OK to put the rights of the state (the majority) over the rights of the individual. Squashing rights is OK as long as it is in an issue a person supports or if the squashing is not being done to ones self. Some groups want to squash parental rights, some want to squash people who are foreigners. It is a trend which worry's me. If the country is not willing to draw the line at any loss of freedom where will the line be moved next? Big brother is getting bigger all the time.

OK I'm sorry, but I'm one of three brothers. I can tell you that we broke so many bones and had so many stitches before we were 9 y/o that my parents probably got a frequent visitor discount at the hospital.

It was just part of being a kid then. And all the accidents were just that, accidents. Or maybe it was just me and my clumsy brothers.

Seems to me parents are more afraid then ever to discipline their own children in fear of CPS causing major trouble.

Out of curiosity, anyone here know what qualifications a social worker in CPS needs?

Gray Seal --

I understand your concern because these things can be taken too far by authorities. I'd feel differently if you said you were the one that was watching the child when this happened because you would KNOW that it was an accident. However, it was grandmother and you can't KNOW for sure what really happened because you weren't there.

Even though you completely trust the grandmother, it's the fact that you can't really KNOW for sure that makes it less of an unreasonable risk to have x-rays done.

I hope "Gray Squeal" is doing better!

That is terrible! These doctors have no business doing this! I know that you didn't abuse your child, but even if they are supposed to investigate, leave that to the police, not X-rays! I hope "Gray Squeal" gets better soon.

CP

This degree of paranoia would not be a good thing. The amount of interaction I have with her is a much better gauge than a full body x-ray.



Bachelor Degree. Intensive background check and intensive training.

1. The police investigate reported crimes. Children tend not to report abuse. And if the provider calls the police about their suspicion, the first thing the cops will ask is... more x-rays.

2. Health care workers are often better positioned than anyone in our society to discover child abuse. The signs of abuse are rarely obvious.

In my personal life I work under the assumption of goodwill. I am going to assume that others are ethical and have goodwill towards me. I prefer to think that if someone acts snappy, they are having a bad day, they are not out to get me. It would be nice to live in a society where everything reflected this attitude, but we do not. People DO hurt each other. People DO commit crimes against others. So there are many things we do in order to protect ourselves and each other. We do these things to ensure that someone who DOES intend harm doesn't get a chance to carry it out. We don't assume people are guilty, we are using astute security measures.

Metal detectors at airports.
ID and passport checking at borders.
Metal detectors at court houses.
Drug testing for airline pilots.
Checking IDs when writing a check.

When a provider sees a nine-month-old for a fractured femur, the largest bone in the body and one of the harder ones to break, and hears that they fell off the table, they are going to investigate further. They aren't assuming guilt by doing so, they are being critical and thorough in order to rule out abuse.

The other thing is that if a baby fell off a table and broke her femur, even if the abuse question were never raised or thought about, the provider might want further radiographs to determine if any other damage was done.

There is a point I wish to expound upon a bit more. American society is becoming increasingly distrustful and suspicious. We do not expect the best from people, we expect the worst. The building of walls within the country will be walling us in, not walling others out. You will not be safer. You will not be better protected. We will lose freedom.

The root of this social change is the good old rat race mentality caused by overpopulation. This is my observation. I have seen enough of humans and others species to see patterns which leads me to this conclusion. Sure, terrorism is a recent contributor to this view of others. It is not the root cause. Some in this country were primed to respond in the overreactive manner they have.

We should not shrug our shoulders and accept this mentality to the degree we make it law. As we slip further into a country which is more authoritative, there will be a real reason to fear. It will be fear of the government. This fear could be a domino effect. It is a game we should not be playing.

It is best to stop little things. Stopping big things is much harder to do.

This law is not necessary. If a doctor suspects child abuse, then let the doctor decide what investigations are appropriate, and let the law fully authorize him to do them, but don't use the law to force the doctor to investigate when his professional opinion is that there's nothing to investigate.

I think it is unjust that the law call for a full body x-ray anytime a child come in with a fracture. It seems that if there were a pattern of abuse, the pattern would reveal itself in medical records and frequent visits to the hospital for treatment. While the argument could be made that a child wasn't maybe taken in for previous fractures, I would question, in such a case, what would drive an abusive parent to take their child for medical care on any occasion? And if a child has had a fracture improperly cared for, a trained doctor -- I would think and hope -- should be able to detect misalignment or other signs of a similar nature.
It is a tragedy that children are abused, but if a child has sustained but a single fracture, I don't see that the state has probable cause to investigate the matter or even force the parents to undergo what I can only describe as a self imposed investigation. I say it's well intentioned, but should not be imposed unless there is a pattern revealing itself in the child's medical records.
On a side note, my best wishes go out to Gray Squeal and her parents. I hope she's up and exploring again soon!

I can assure you, as my wife works as a family practitioner, that any old fracture is NOT cause for further investigation. However, as I stated earlier in this thread, the femur is a tough bone to break, even more so for a nine-month old (her bones are more flexible than ours). When I described the situation in this thread to my wife, she concurred 100% that further investigation would be warranted. She is in the business of saving people's lives, and she sees an awful lot of children. For many practitioners, even if there was no legislation to back it up, there is a feeling that you would rather err on the side of potentially making the parents slightly uncomfortable than to presume good will and circumstance, and let abuse slip through your fingers.

Those of us who are innocent may resent the exhaustive searches at airport gates, but we also feel reassured that IF someone with bad intentions tries to board a plane, there is a good chance of stopping them. So we submit willingly. Why should we feel differently about protecting children from abuse? It happens in every town in America. Kids who are abused and sometimes killed, always emotionally wounded, by their parent(s). Though we ourselves are innocent, why should we not willingly submit to this, knowing that it will help to stop abuse in some family?

I'm not implying that they investigate on the basis of "any old fracture," but rather on implications of abuse in a child's medical history. I would also encourage any parent or legal guardian to cooperate with any query of abuse. I still don't feel, however, that the state should become require any investigation of child abuse on a first time fracture, as is the case here.
Without re-reading through the posts, it was my understanding that the cost of the full body x-ray was to fall on Gray Seal. It also sounded as though Gray Seal's only options were to concede or to risk having Gray Squeal taken away by state officials. This to me is ridiculous.
Without probable cause (in this case I suggest a highly suspect medical history), I fail to see how the state should be allowed to legally impose the radiological exam of the child. File it away under illegal search and seizure, perhaps.
While I have other issues with new airport regulations, I am still willing to go along with the "exhaustive searches" at gates. If, however, the airport were to single me out for additional search with little or no probable cause, I would certainly take issue. It is only my personal view, but as I see it, the doctor examines each child brought to them just as each security station of an airport examines the passengers preparing to board. I don't think either the doctor or the personnel at an airport security station should be forced by the state to impose additional searches or anything else on either a parent or passenger unless they have probable cause for doing so.
As remedial as my understanding of the justice system may be, I seem to recall people being presumed innocent until found guilty. While neither the airport of a hospital are courtrooms, this practice of requiring parents to submit the child to a potentially unnecessary procedure seems (to me) to assign a degree of guilt without any rational reason for doing so.

I agree with you, and indeed, the way you describe it is the way in which health care providers tend to handle it. Again, this bears on this specific case: a nine month old, breaking a bone that is very difficult to break. It's not really a matter of "first" fracture. It's more that this would be SOP in a case where such a large and hardy bone is fractured. If gray squeal had been taken in with a fractured wrist, I seriously doubt the same protocol would have been used, unless the doc is seriously paranoid, or unless, as you suggest, there is a chain of suspect injuries.

So I reiterate, I am referring in this thread to a specific type of injury, namely a fractured femur. I am not advocating that there ought to be a presumption of guilt, or that every injury should be looked at with suspicion.

To reply also to Hercules' earlier post:


Yours is an anecdote, firstly, and again, you seem to be generalizing this whole thing. THE FEMUR IS A BIG STRONG BONE AND IT IS DIFFICULT TO FRACTURE. I'm not talking about your everyday, fall out of the tree and break your ulna fracture. I agree with what you're saying about childhood accidents, I'm just stating why a provider would look differently at a femur fracture than, say, a wrist or arm fracture.


As for your "parents are more afraid then ever to discipline their own children in fear of CPS causing major trouble" bit, I don't get it. I have three kids. My wife and I have never spanked them. They have no discipline problems. There has never been a single study that showed corporal punishment does any good.

But even that aside, here is a big difference between spanking and abuse. Has it ever been taken too far? Sure. Every now and then you hear about some case (usually by anecdote) in which some mother spanked her kid in the grocery store and had CPS called on her.

I have an uncle who has worked for CPS in Indiana for 32 years, and, at least in his experience, he said cases like this really don't happen. When CPS is called for an instance like I mentioned above, they will do some pretty extensive legwork. They don't whisk away children at the drop of a hat. When it does happens, it's after a history was found which the public display is merely a facet of.

But when you say parents are afraid to discipline their children, what are you referring to? I don't agree with spanking a child, but I realize it is not abuse. In your mind, how far should parents be allowed to go in punishing a child physically? Uh oh, I feel a new thread coming on... It's late, I'll start one in the morning!