More on the Childhood and Teenage Years

Childhood and teen care are those two topics that have a way of impacting individuals working in the health care field.  Some parts of the health care field deal with these two topics as everyday events, to others it comes into one’s professional life as an unforgettable single event noted within the clinical setting, such as a child coming into the emergency room after suffering some severe punishment or with symptoms and clinical findings suggesting that some form of abuse has been taking place.

Traditionally, the reaction of society to these two topics has always been mixed in recent decades.  The rights of a child or teen when it comes to such things as receiving health care or being able to go to school without having to meet minimal immunization requirements seem to be a common argument that on occasion pops up in the news.  Some people feel they have a right to not expose their child to the practice of immunizing so early in life due to feared side effects of this process, without knowing the long term results of a child possibly developing another condition due to this lack of preventive treatment.

Childhood behaviors, or should I say misbehaviors due to some sort of psychological or psychiatric history is another major topic for modern news items pertaining to the rights of a child, regardless of his or her behaviors.  A child doesn’t just grow up learning the science of pyrolatry or weaponry without attaching a certain set of personal and social values and beliefs about each of these.  The child-aged criminal doesn’t grow up as a criminal, he/she grows up learning those acts which later in life become qualified as being criminal in nature.  Between the pre-knowing and criminal stages in life, social and family behaviors provide the stimuli and input needed to nuture this knowledge and these events and convert them and the child into the personality he/she becomes.  You can hand a child a gun as a very young baby, but it is the environment that you help to form, the social interactions that you allow to take place, and the reactions to these stimuli that you allow to take palce as a parent, that ultimately cause that individual to make the choices needed towards engaging in mental and physical disease behaviors, or lack the incentive needed for those first activities to occur.

There are these ways in which child mistreatment, abuse, and neglect are noted in the medical documents.  There are also all of these unique codes that exist that tell us a little more about the population at large when it comes to abuse.  Some of these codes measure the parental behaviors and attitudes about childrend, others document the misbehaviors adults engage in which in turn impact their children.

One of the problems with evaluating codes in the medical records is the incomplete nature of these documents.  Believe it or not, not every code is in fact entered, due mostly to the absence of this code being expressed by the primary care giver providing the written record on a patient.  People tend to code for some ICDs and Vcodes more than others.  For example, the physician may rarely fogot to code for something like asthma, diabetes, smoking or drinking, but rarely think about also inquiring into personal histories pertaining to other subjects indirectly related to these, like wearing a seat belt, smoking during pregnancy, or engaging in illegal drug use.  Some clinicians are devoted to such sensitive topics, others just set them aside for the time being due to time constraints.  For this reason, it helps to group codes together that tell us something about character and personality, like grouping together all of the misuse/abuse/illegal use codes for drugs to measure the full extent of drug abuse, or to add smoking and drinking to this to add the possibility of measuring chemical exposure in general on behalf of a fetus during pregnancy.

Likewise, child abuse, which is codes in any of four major forms, may be more often seen as the lesser forms (neglect) than the very serious forms that also tend to require reporting and very aggressive follow-ups, such as child sexual abuse.  We cannot expect to find much coding indicating “poverty” or “homelessness”, although the latter is more likely to be entered given the right situations than the former.  We can however search for other signs of poverty such a poor nutritional state or malnutrition, and even certain ICDs related to long term chronic diseases states linked to this health problem, such as scurvy, beri beri and rickets.

Poverty can also result in receiving inadequate care, so care related events normally available to individuals with health coverage can be reviewed, in particular timeliness of specific long term care visits such as visits linked to immunization programs and wellness care programs, those related to allergy and asthma care, and those related to long term follow-ups on lifelong disease conditions in need of on-going monitoring such as MS and epilepsy.

With all of the above examples in mind, the following are examples of how to group the ICD, v and e codes in order to engage in some sort of grouped data analysis for measuring the efficacy and adequacy of large scale preventive care programs:

Chemical Exposure

  • Fetal exposure to narcotics
  • Fetal exposure to cocaine
  • Narcotic Drug abuse during the months of pregnancy
  • Cocaine abuse during the months of pregnancy
  • Crack Baby Syndrome

[EXAMPLE]

Poverty and Health

We can add these to the arsenal of coding useful for evaluating the quality of life of a child, which normally includes as well such topics as

  • Poverty
  • Unhealthy living conditions
  • Lack of adequate schooling
  • Poor nutrition or malnutrition [Example]
  • Ability or inability for a child to receive full immunizations [Example]
  • Refusal by a parent to provide a child with a particular immunization due to concerns for side effects such as ADHD
  • Refusal by a parent to have his/her child udnergo any immunization process at all due to religious or philosophical beliefs

Safe Parenting

These we can then add to a list of very traditional public health concerns related to those  topics most likely to make the news, such measurable behaviors as

  • Shaken Baby Syndrome
  • Battered Child Syndrome
  • Desertion of Newborn
  • Elbow Dislocations
  • Arm Fractures

[Examples]

These in turn do have a physical condition that at times can be linked to them.  Most physical injuries related to the above are hard to determines links for regarding neglect and abuse.  One dislocation, the dislocation of the elbow, requires such physical events to occur, that most of the time, one can only conclude that these events must have had something to do with some form of parental or babysitter mishandling of a child by the arm, be it accidental or deliberate in nature.

Psychological/Physical Care Quality

Other events, mostly behavior and action realted in origin, lack the physically dangerous mishandling of someone, and instead engage in behavioral and psychological manipulation processes, events such as

  • Child Neglect
  • Physical Child Abuse
  • Psychological Child Abuse
  • Sexual Child Abuse

[Example]

Childhood Suicide

Another topic not always thought of as being linked to abuse and the quality of life for a child pertains to suicide.  Suicide attempts made by children between 0 and 12, and 13 and 17 can be evaluated.  The type of suicide attempted relative to age is an important indicator of the mental health of children and young adults.

Conclusion

All of the above types of human behaviors can be evaluated and mapped, and regions where more of one kind of event than another can be determined.  We expect to see some kind of uniform population density related behavior to the various aspects of child abuse and mistreatment, and the impacts these have in turn on the child’s behaviors, ability to socialize, ability to learn and know the need to avoid such things as crime and drug experimentation or abuse.   Very few of these parential goals set are ever reached in most places, at least for those where people live a life where they must interact with each other on a daily basis.  As for those living in some sort of empty, non-communal, almost anti-social life setting, abuse still happens, only the events are different and the types of misbehaviors and long term outcomes on life these misbehaviors can have differs.

The smaller, less focused upon topics are presented here for this type of review.  We already know a lot about the major indicators of child mishandling, abuse, improper raising, etc., what we don’t ever hear much about are those less frequent behaviors and conditions that can also be evaluated at some large scale regional and population level.  The grid method is therefore applied to this topic in order to see what kinds of behaviors and regional differences exist.

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