Archive for July, 2019

July 31, 2019

Forty Ounce Rosé Plus Gluten-Free Breton Original Crackers

40Forty Ounce Rosé plus gluten-free Breton® Crackers feels like a representative combination for happy hour in my gentrifying neighborhood. About thirteen years ago, I moved into a four-block neutral zone between the Crips and the Bloods located in the historic neighborhood that houses my state’s governor’s mansion. Forty-ounce bottles of malt liquor or beer could be purchased a block away. A decent bottle of wine and upscale crackers required driving several miles.

After 30 years of “getting better” (but not really), the neighborhood has begun to change. I haven’t had a break-in or drive-by shooting at my home in about three years. Many young couples with small children live nearby. It’s only a few blocks to new green-built urban farmhouses and shipping container homes. A distillery and craft-beer maker have relocated within walking distance. We have a farmer’s market, performance venue, restaurants, two bakeries, a creamery, local retail, and a museum.

Many of my neighbors sit on the front porch in the evening. There’s almost always a light breeze. A generous pour of chilled Forty Ounce Rosé in my glass makes for a refreshing accompaniment to relaxing on the porch.

Forty Ounce Rosé is a French wine that is handmade using traditional sustainable farming and vinification methods. It includes a blend of grapes from Muscadet and Touraine:53% Gamay, 33% Merlot, 10% Cabernet Franc, 4% Pineau d’Aunis and contains 12.5% alcohol. The amusing bottle holds 33.82 fluid ounces (a liter) rather than an actual forty ounces.

I often find rosé either too sweet or too tart. I like a balance somewhere in between. I don’t expect the fullness of a red, but I want some body to the wine. Forty Ounce Rosé fills the bill.

Rosés have been back in vogue for a few years, but in my city it can still be a struggle to find a satisfactory bottle. My friends and I recently resorted to having the liquor store order a case of Forty Ounce that we can split. Perhaps if we order often enough, they’ll opt to stock it on the shelf.
breton
Eventually, we get hungry while sitting on the porch. This week I decided to add Breton Original gluten-free crackers to my snack choices. I must confess, it’s been so long since I’ve had the original crackers containing gluten, I can’t remember what they taste like so I can’t give you that comparison. I’ll just have to describe my current experience.

The initial taste is slightly sweet and not unpleasant. The texture is not crisp and crunchy like Schär Table Crackers or crisp then somewhat flaky like Glutino Premium Rounds. These are softer with a texture similar to that of a graham cracker. At the end of the bite, there’s an aftertaste I don’t like. I’m not sure if it comes from the flax seeds or added flavoring.

I tried these crackers alongside chicken salad and tuna salad. This is not the cracker I would choose for either in the future. Perhaps I would serve Breton Original gluten-free crackers with a soft cheese.

It’s possible herbed chévre would mitigate the aftertaste. A smear of cream cheese topped with apricot jelly or olives might also work. Overall, I see these as a specialty cracker, not one to keep on hand.

In addition to snacks, porch sitting is often filled with fanciful contemplation. I’m sure the world’s problems have been solved several times over on porch stoops. Perhaps if conference rooms were filled with rustling leaves, beautiful blooms, a pleasant breeze, warbling birds, diverse and cordial neighbors in comfortable clothes, and plenty of wine meetings would inspire change and improvement in our institutions.

At least we know we can inspire change from our porches with Forty Ounce Rosé and Breton crackers in hand.

http://www.fortyouncewines.com/#wines

http://www.fortyouncewines.com/#wines/rosé

https://www.darefoods.com/ca_en/brand/breton/1

http://www.cooking2thrive.com/blog/well-preserved/

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

July 22, 2019

Braise then Graze

This year, I’ve been known to braise then graze. Most often, I bake fish; broil or bake beef and pork; and bake or boil chicken, but my favorite preparation may be to braise! Earlier this year, I braised some steak I dredged in gluten-free flour and cooked with a flavorful broth. The result inadvertently mimicked my grandmother’s beef and noodles. In fact, my sister, who thought this was a deliberate replication said, “You nailed it! You can fix this for my birthday,” when she sampled the dish. I confessed it was a happy accident.

One of the benefits of braising is the tenderness of the meat when it’s done. My grandmother used a pressure cooker to achieve this effect. Pressure cookers scare me. I always visualize food on the ceiling that has spewed through the valve at the top. I think I’ll stick with braising.
ribs
The other day, I had some country style pork ribs on hand and lots of rain outside. I wasn’t willing to fight the elements to use the grill so I decided to braise the ribs. I can’t say this was a well-thought plan. It is more aptly described as a few decisions based on convenience. I threw some balsamic vinegar, tamari, and a splash of olive oil in an enameled cast iron pot and added a little sugar. The mixture tasted pleasantly salty with a subtle tang.

I placed the pot over medium heat and allowed it to come to a boil while I stirred until the sugar melted. I then placed each rib, unseasoned, into the liquid and immediately turned it so that both sides were coated. Once all of the ribs were in place, I added a large stem of fresh mint leaves for an aromatic top note.

As I began the braising, I had the thought that the flavor profile would have been a good choice for lamb. I wasn’t sure how it would play with pork, but I always throw things together and hope for the best. Usually, it works out.

Braising can be done in the oven or on top of the stove. I used the top of the stove. The idea is to keep the heat low and cook for a long time. I placed the covered pot over a very low flame and set the timer for an hour. Once the hour had passed, I turned the ribs again, sprinkled in a little cayenne, mignonette pepper, and garlic powder for good measure, gave it a stir and continued to cook for another hour.

The results fall off the bone as expected with this cooking technique. The color is dark, almost black, and the flavor rich. There’s plenty of salt from the tamari. There’s no noticeable sweetness, but the sugar has helped create the illusion of caramelization that makes the burned edges of barbecue so appealing.

The flavor is not wholly familiar. It’s lacking any mustard or tomato base that would be typically associated with country style ribs. And of course there’s no smokiness. Nonetheless, the ribs are satisfying and delicious.

I’ll make these ribs again to nail down the actual measurements for a recipe, then we’ll test that recipe a few times to make any needed changes before it is approved for publication. All Cooking2Thrive original recipes are tested a minimum of three times. Some are tested many more.

Once the recipe is perfected, all you’ll have to do is follow the instructions to braise then graze!
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July 15, 2019

Childhood Is the Time to Feel Carefree

Children benefit from boundaries, routine, and rules, but with adults shouldering life’s burdens, childhood is the time to feel carefree. Unscheduled time to lie in the grass and watch the clouds, dig in the dirt, collect rocks, catch grasshoppers, play in the water, ride bikes, play chase, and giggle, giggle, giggle fills with joy the few years kids have before responsibilities loom. Feeling the security that all needs will be met allows children to relax and play without worry.
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Carefree is a feeling that may be rare or missing from a childhood filled with adverse experiences. This understandably affects how those children view the world when they reach adulthood.

If you’ve never experienced a feeling of burden-less security, you cannot return to that feeling as a motivator when times are tough. If your environment has never felt safe, you cannot fully relax. When a period of calm is the regular prelude to disaster, “good” times bring a feeling of impending doom. When parents or caregivers did not protect and provide, you will not trust others or institutions to protect and provide.

Adverse childhood experiences (ACEs) can create a winding road to thriving as an adult. Yes, sometimes it may feel like a spiral! Last week when I said we’d come back to the ways the ACEs study plays in the real world, I wasn’t kidding. I took a quick version of the test. I score a 4 which puts me in the high-risk category.

This came as no surprise. As of this moment, I am healthy and medication free. But I do have celiac disease which is an autoimmune disorder that must be managed. I also have emotional flashbacks and certain triggers that cause me intestinal distress, plus elevated heart rate and blood pressure. These events have become less frequent and more controllable through practicing yoga. The closest diagnosis I have found for my symptoms is complex PTSD which is not a recognized diagnosis at all.

What you call how I feel is not as important to me as having techniques to move from distress to balance and slowly, but surely healing all of those old wounds so that the triggers have nothing to trigger. I’ve made great progress along this road.

I mention this to let you know I have firsthand experience with the wounds created by adverse childhood experiences. I know how it feels to move through life braced for attack. I have often felt defective and unloveable. What I believe about myself intellectually simply can’t be squared with how I feel inside.

There is what feels like a never-ending well of sadness & grief within my solar plexus. I am not depressed, but I find it difficult to access joy. And I cannot remember ever feeling carefree!
sad
I come from a family that is well-respected in the community. A college board room bears my father’s name and a Nature Conservancy pavilion, my mother’s. My grandfather was a Shriner and county judge. Both he and my father were business owners and deacons in a Southern Baptist Church.

I was ranked #3 in my graduating class, was Junior Class President, a member of the popular girl’s social club, and left high school early with college scholarship in hand. I excelled in that environment as well. I graduated in four years with a grade point of 3.86 in spite of changing schools twice. See any red flags there? Probably not. There were some, but not the kind that tend to register for intervention or assistance.

Hidden abuse and neglect are all around you. The products of abuse and neglect are your friends, neighbors, bosses, co-workers, doctors, nurses, lawyers, judges, psychologists, social workers, teachers, policemen, CEOs, and government officials. Many are living “successful” lives.

Some have healed their wounds. Some contribute to a toxic environment wherever they go. Most likely this is not their intent. They are moving through the world in the best way they know how, but some simply don’t care whether they harm you. Your distress will not even register.

A child with a parent or caregiver who does not see and/or respond to his/her distress, or deliberately creates it, cannot securely bond with that parent or caregiver. “The behaviour of parents, and of anyone else in a care-giving role, is complementary to attachment behaviour. The roles of the caregiver are first to be available and responsive as and when wanted and, secondly, to intervene judiciously should the child or older person who is being cared for be heading for trouble. Not only is it a key role but there is substantial evidence that how it is discharged by a person’s parents determines in great degree whether or not he grows up to be mentally healthy.” – John Bowlby, pioneer of attachment theory, in a 1976 lecture entitled The Making and Breaking of Affectional Bonds. 1

With evidence that adverse childhood experiences affect long-term physical health and contribute to chronic disease plus evidence that ACEs additionally affect mental health, it seems imperative that we develop mindful parenting to enhance secure attachment and minimize childhood trauma. The focus for most existing programs are low income, low education level, and minority populations.
hair pull
What about the middle class and above, educated parents who wound their children within families that escape scrutiny? How do we identify and help those children? How do we re-educate these parents regarding parenting?

I would argue this is as important to health and safety as having babies sleep on their backs, wear helmets when biking, and ride in car seats. I don’t want to suggest that we should individually interfere in families except in extreme cases, but changing the norms regarding healthy parenting is essential. It will require the combined effort of researchers, early childhood experts, mental health and medical professionals, parenting experts, internet influencers, and courageous parents to effect significant change.

I’m ready to get the process started. As parents, we cannot identify areas for improvement without an assessment of the current situation. Following is a list of items for parents to consider when evaluating a family environment.

It will require courage to explore these questions from the point of view of your child’s experience. Please keep in mind that only a clear view of the current situation will be helpful. Viewing a situation like you wish it were or hope it will become will not lead to improvement. The overall goal is to improve the health of our children by reducing adverse childhood experiences.

If you are a parent of thinking of becoming one, ask yourself:

Do I have time to devote to holding, comforting, and connecting with my child each day?
My ex-husband used to say having children was not going to change his life. He was right, it didn’t. But it sure changed mine. If you behave like he did and do not have a partner who sees and/or fills in the gaps, your child will not receive adequate responsive parenting.

Am I reliable?
A child must be able to consistently rely on you to provide and protect. If they cannot, it will affect attachment and trust. Repeated unfulfilled promises are detrimental. When a parent promises to call and does not, it hurts. When a parent forgets to show up for a soccer game he/she promised to attend, it hurts. All of us slip from time to time. It is a pattern of unreliability that is harmful.

Do I believe that the highest and best use of my parenting time and energy is to be responsive to my child’s needs?
Children need to feel seen. Children need to know someone will come and comfort them when they are distressed. Children need to feel valued. Children need to know food will be provided when they are hungry. They need to have fluids available when they are thirsty. Children need to have access to a bathroom when they need to go. Children need to feel included as an important part of the family unit.

I know it sounds like I’m just stating the obvious. I know that if you love your children, you most likely believe this is an automatic part of parenting and you may be rolling your eyes. But in my family–the one that looked wonderful on the outside–if I wanted breakfast as a preschooler, I had to fix or find it. If I needed clean clothes, I had to wash them. In first grade, I was expected to wake myself up, get dressed, and get on the school bus without input or even a good morning from the adults in the house. At age six, I still had a potty chair in the laundry room because my father would stay in the only bathroom for an hour at a time and if I knocked on the door, he became enraged and screamed at me to find another place to go. I emptied and cleaned up the potty chair when he finally came out.

Before you make excuses for my parents…they weren’t working multiple jobs. My mother was a stay-at-home mom. Our house was not fancy, but it was clean. Mom did her laundry and my dad’s. She did most of the ironing although some of this was subbed out to me beginning when I was about four. Of course, she had to find me before she could delegate. I spent most of my time wandering the farm or sitting in the woods during the day until my dad came home.

The occasional fishing trip, trail ride, and visit to my grandparents did not adequately balance the grim reality of every day. There simply aren’t enough trips to Disneyland to fix a pervasive, everyday problem.

Do I understand the difference between feeling love and behaving in a loving manner?

I’m sure most of my family and our community would tell you my parents loved me. But they often did not behave in a loving manner. Crying was to risk being hit with the razor strop my dad raised in response. Asking for food, comfort, or help was to risk a cruel or dismissive response from my mother.

I felt my father loved me, but was dangerous. I was afraid of him until I left home for college. I still do not feel my mother loved me, or if she did, I’m certain she didn’t like me. A boyfriend once described her behavior toward me as turning up her nose as though I had shit on my shoes and she just couldn’t stand the smell.

The day after my mother died, my sister & I met for breakfast. I looked at her and said, “My first thought this morning was I never have to be a disappointment again.” Her eyebrows raised and she responded, “I thought exactly the same thing!”

Do I have unresolved feelings about my childhood? If so, can I make a realistic assessment regarding how those may impact my parenting? Do I have a plan for resolving those issues?
Given my background, it might seem advisable for me to choose not to have children. That was not the choice I made. Parenting was the hardest thing I’ve ever done because every move had to be mindful. I knew how bad it felt to be treated the way I was treated and I was determined not to do that to my children. That doesn’t mean they weren’t affected by my subconscious struggles or that I did not occasionally do hurtful things. It does mean the environment in our home was vastly different from the one in which I grew up.

When my oldest took a psychology class in college, he called me and said the class had taken an assessment and, other than getting a divorce, he couldn’t think of anything I’d done to screw up him and his brother. I’ll take that and my continuing close relationship with both boys as confirmation that I did an adequate job of breaking the cycle.

Do I have significant emotional resources to support me so that I can hold, comfort, and connect with my child each day?
Some of us have a deep well from which to draw. Others will need more outside support. It is okay to need whatever you need and to ask for help.

Can I put my feelings aside when appropriate in order to make decisions that will benefit my child?
If your ex-husband is making your life hell, can you keep all negative thoughts, feelings, and judgments to yourself in order to continue to encourage his relationship with his children? Can you handle being alone on Christmas without making your kids feel bad when it’s his year to have them? Can you be cordial to his wife and supportive of the rules in their household?

Do I feel safe in my home?
If not, neither will your child. One of the duties of parenting is to protect. Are there changes you can make to protect yourself and your child?

Do I feel competent to make good decisions?
If not, your child may feel a need to parent you. This is an undue burden.

Do I, or does my partner, create chaos in my home?
Chaos undermines a child’s feeling of security.

Am I flexible?
Life is unpredictable. Flexibility is a sign of mental health and maturity. It is important to live by guidelines that allow for adjustment to changing circumstances.

Do my partner and I have the same parenting objectives?
If partners do not share the same values, conflict will result. Minor conflicts and/or the ability to resolve conflicts can mitigate their effects. Ongoing conflict can feel dangerous to a child.

Are my partner and I able to work as a team?
Consistent expectations, boundaries, and consequences contribute to security. If partners do not work as a team, one may undermine what the other one is doing. This can have significant consequences.

There’s a couple in my circle of friends whose teenage son was arrested last fall for shooting up the cars at a friend’s house. Some of the bullets hit the house which was occupied by the parents at the time. This is a serious crime and the teen was at risk of being charged as an adult. The threat of prison was real.

The gunman attended a private school until high school. His parents are intelligent, good people. They have been married for over 20 years. They have long-term friendships. The father has worked for the same company for over 20 years. They have only moved once in that time frame.

The mom also has MS that has gradually placed more and more household burden on the father. As became clear in court, when dad would lay down the law, mom would go behind his back and release the son from imposed consequences. Dad was sometimes unaware until too late and sometimes too worn out for the fight. Or maybe he didn’t want to fight with his weakened wife who could no longer drive, lift a pan in the kitchen, or manage the laundry.

The result is heartbreaking. The daughter attempted suicide two years ago and the son committed a crime that endangered someone else’s life.

Do I consider my willingness to enforce a consequence before I institute one?
If you take away rare concert tickets and then give the tickets back because you feel bad knowing it might be the last chance to see that band in person, you let the child know consequences mean nothing.

If you take away a cell phone for a month, but then give it back in two days because you hadn’t considered that you wanted him/her to have it on a field trip, you teach the child that consequences are questionable.

If you take away TV and it means there are times you cannot watch TV, are you willing to inconvenience yourself in order to enforce the consequence?

Consequences that mean nothing may be worse than no consequences at all. Consequences with no meaning undermine trust.

Am I willing to look like the oddball when it benefits my child?
What works for one child may not work for another. Really knowing your child and being sensitive to the things that distress him/her can put you at odds with daycare workers, teachers, and principals. There is a delicate balance between advocating for your child and undermining authority.

I would not suggest undermining a teacher’s authority on minor issues. If your child comes home every day discouraged or has a real aversion to school that did not exist when in a different classroom, something is amiss. It may be time to visit the classroom, consult with other teachers, or request a classroom change. Your input may not be welcome. Remembering this is not about you, but the well-being of your child and using the strength of your convictions will allow you to be the best advocate.

Am I willing and able to put down the electronic devices and toys to encourage my child’s curiosity, imagination, and sense of adventure?
Non-directed play can build resilience. Knowing that we will not be perfect parents means that one part of our task is to help build resilience in our children.

Curiosity has been shown to field off depression by keeping us engaged in life. Imagination leads to creative solutions to problems. The ability to view changing circumstances as an adventure can bring a positive view of negative events.

Is my ultimate goal to prepare my child to be an adult who is secure, calm, competent, resourceful, compassionate, inspired, loving, flexible, empathetic, law-abiding, and capable of connection?
Most of us would probably say we want our children to be happy and achieve their dreams. Some of us might say we want our children to get the best education or highest paying job. Some of us have more specific achievement goals–go to an ivy league school, play professional sports, have a certain appearance, fit in a certain social circle, become a professional with an MD, JD, or PhD distinction. While there’s nothing wrong with aspiring goals, early pressure to perform can create anxiety.
grass
Which brings us back to feeling carefree. Children can only feel carefree when their needs are met, they trust their protectors, they feel they are loved, expectations of them are realistic, and they know they can rely on the adults in their lives. It is possible to live in a home with plenty of resources and married parents and still not feel carefree.

Take it from me, children long for that feeling! Adults who endured a number of adverse childhood events may experience significant grief and loss during the healing process. Often it feels as though we lost the chance for a childhood.

I used to have a button that said, “It’s never too late to have a happy childhood.” It’s a nice sentiment, a hopeful statement, and possibly an inspiration for some. The statement is sometimes based on the idea that we can reparent ourselves.

I believe we can reframe our experiences and heal, but we never regain our childhood. Once it’s gone, it’s gone. Let’s help our children feel carefree while they are children!

1)https://pdfs.semanticscholar.org/fe8b/82d36a04baa05ea8e66f583935c1e22793cb.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1948879/

https://www.paultough.com/the-books/how-children-succeed/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409906/

July 10, 2019

Adverse Childhood Experiences Can Detrimentally Affect Health

Even when current stress is low, the lingering effects from adverse childhood experiences can detrimentally affect health. We’re often reminded that current or ongoing stress is bad for us, but the stress we experienced long ago can be just as significant. Researchers who conducted The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study concluded: “We found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults”.1
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This week I’m going to give you information about the study. Next week, I’ll talk more about real-life scenarios that are playing out in the statistics. With adverse childhood experiences affecting more than half of us, this is a very big topic. And with the increase in chronic disease, it seems important and timely.

How The Study Came About

As sometimes happens, a doctor set out on one mission only to have his curiosity piqued by something he discovered along the way. This eventually led to the groundbreaking ACE Study. Vincent Felitti, head of Kaiser Permanente’s Department of Preventive Medicine in San Diego, set out to determine why the dropout rate of participants at Kaiser Permanente’s obesity clinic there was about 50% even though all of the dropouts successfully lost weight under the clinic’s program.

While conducting interviews with people who had left the program, Dr. Felitti discovered that a majority of some 286 people he had spoken to reported sexual abuse as children. Felitti wondered if weight gain was being used to cope with depression, anxiety, and fear. He decided to learn more.

Participants in the Study

With a team, Dr. Felitti and the CDC’s Dr. Robert Anda interviewed 17,337 study participants asking five questions relating to personal trauma and five relating to trauma within the family. About half of the participants were female; 74.8% were white; the average age was 57; 75.2% had attended college; all had jobs and good health care. Each positive response to a question counted as one point. The resulting total is the ACE score.

About two-thirds of participants had experienced at least one adverse childhood event. Of those, 87% (almost 10,000) had experienced more than one. Over 15% of women and 12% of men in this mostly white, middle and upper-middle class, college educated group had experienced more than four.

According to the CDC, rates of child abuse and neglect are five times higher for those who live in families with low socioeconomic status as compared to children in families with higher socioeconomic status. That means the original ACE rates of occurrence may be much higher in some segments of the population.

Questions That Were Asked

The questions asked included physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect, a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment. All of these are major stressors chosen in part because they had been identified in earlier research, but they are not a comprehensive list of adverse childhood experiences.

The study did not address food insecurity, homelessness, loss of a caregiver other than a parent, surviving a severe accident, recurring hospitalization, a medically fragile family member, neighborhood violence, living with a hoarder, drug addiction within the family, involvement with the foster care system, racism, bullying, watching a sibling being abused, witnessing a father being abused by a mother, witnessing a grandmother abusing a father, or involvement with the juvenile justice system. All of these events and others that create toxic stress can increase the risk of long-term health consequences.

How Answers Relate to Health Risks

Through 2015, more than 70 publications have expanded on the knowledge gained through The ACE Study and parallel research has shown the effects of traumatic stress on children’s developing brains. In general, an ACE score of 4 or higher increases the likelihood of chronic pulmonary lung disease 390%; hepatitis 240%, depression 460% and attempted suicide 1220%. Yes, you read that right. The risk for attempted suicide increases over 1000 percent.

In addition, children who experience four or more categories of exposure compared to those to have none will have a 4- to 12-fold increased health risk for alcoholism, drug abuse, and depression; a 2- to 4-fold increase in smoking, poor self-rated health, ≥50 sexual intercourse partners and sexually transmitted disease; and a 1.4- to 1.6-fold increase in risk for physical inactivity and severe obesity.

Costs of Adverse Childhood Events

While the greatest cost of ACEs is to the individual and, by extension, the family, societal costs are also great. According to the CDC, “In the United States, the total lifetime economic burden associated with child abuse and neglect was approximately $124 billion in 2008. This economic burden rivals the cost of other high profile public health problems, such as stroke and type 2 diabetes.” And it appears that it contributes to those high profile health costs as well.

There are also intangible costs. ACEs affect our classrooms, our friendships, our marriages, and our ability to work well with others. They can also be self-perpetuating. A child who does not feel valued may not value the lives of others including his/her children. Without intervention or mitigating circumstances, the cycle repeats.

Addressing the Problem

The CDC has developed a technical package that identifies a number of strategies to help communities prevent and reduce child abuse. They include strengthening economic support, providing quality child care & early education, enhancing parenting skills, intervening to lessen harm & future risk, and changing social norms.

We Have a Long Way to Go

At this moment, I cannot stop thinking about the two-month-old child living in Missouri who is being kept at home by a total stranger while her parents vacation in the Caribbean. There is significant risk in this scenario. Yes, the caregiver works for a service and, in theory, has been vetted by the employer, but the parents will not meet him/her in advance.

On top of this, the mother’s housekeeper has observed this baby being repeatedly left alone in bed in her room all day other than feeding time. When she cries, she is not talked to, picked up, or comforted. It’s easy to say: she’s too little to know the difference; kids are resilient; she won’t remember; I’m sure they usually pick her up; her parents have plenty of money so she’ll be fine…. But taken together these are red flags that are significant and indicative of insidious neglect that often flies under the radar.

My cousin who is a psychologist relayed the story of this baby to me a few weeks ago. She and the mother are friends who share both a yoga class and a housekeeper. She is concerned, but there is a stable home; the baby is changed, fed, bathed, and dressed in cute clothes; and she sees the pediatrician as scheduled. There is simply no documentable problem.

I’m not sure how to help this baby. My high school friend whose daughter has become addicted to opioids after back surgery struggles to determine how to and how often to step in to help her son-in-law with the grandchildren who live 3 hours away. In the past year, I’ve seen babies removed from parental care while lying in CVICU. They may be legally fostered by a physician, but they are experiencing traumatic procedures in a noisy, unfriendly environment without a consistent caregiver to comfort them. It is heartbreaking.

The only ACE questions I’ve seen in a healthcare setting were on a proposed opioid risk assessment recently reviewed by the PFCC Hospital Advisory Council on which I sit. I cannot recall ever having a physician ask me a question related to ACEs. In spite of the strong relationship between ACEs and health risk, in the 20 years since the original study, we have not managed to incorporate this important piece of patient history into routine preventative care.

It feels like we are spinning our wheels in a place where we have plenty of data to support systematic change, but not the will or courage to implement it. Instead, we continue to spend billions to fight chronic disease without including programs to reduce or mitigate the effects of adverse childhood experiences.

We Can Make a Difference With Simple Changes

We may not be able to prevent every occurrence of child abuse, but we can improve overall community health by including ACE assessment questions in our patient information forms, then providing trauma-informed treatment for those with high ACE scores.

We can lose the us vs them language of mental health care. Saying abuse “changes who you are” is not productive, helpful, or even true. Abuse and neglect change how you respond to the world, but they do not change the person you can get back to with healing. Calling a patient’s response to a wound inflicted by someone else a “disorder” or “mental illness” is uninformed. It makes his/her adaptation for survival (an internally heroic thing) sound like a defect. Many victims already feel defective. Confirming that feeling does significant damage. Detrimental behavior that results from adaptation can still be dealt with, but in a different manner. The ability to reframe past events can make the difference between hope and hopelessness.

We can train all health professionals, social workers, teachers, human services workers, and law enforcement professionals in Mental Health First Aid.

We can focus on mindfulness (shown to change the brains of PTSD patients) in fitness and mental health programs and let weight loss be a side effect.

Gynecological exams can begin with a conversation while the patient is clothed before proceeding to the physical exam. I think this is good policy no matter what the patient’s background, but can be extremely important for some survivors of childhood sex abuse.

Pediatricians can include questions regarding indicators of attachment in well-care exams and instruct parents regarding the importance of bonding.

Breastfeeding education can include information regarding the benefits of holding a child close and looking into his/her eyes while feeding in addition to the health benefits of consuming breast milk.

Parents can be gently reminded that they must comfort, sooth, protect, and respond to their child’s needs before the child can learn to sooth itself. Withdrawing into itself is not the same as self-soothing. It may mean the child is quiet, but it is dysfunction.

We can stop trying to make ourselves feel better by dismissing subtle signs of distress in our grandchildren, nieces, nephews, and students. Acknowledging a problem is the first step toward fixing a problem.

And we must remember that it is extremely stressful to make life and death decisions; to care for ill and dying patients; to go into homes of severely abused children; and to watch an addict relapse. If we expect professionals to approach patients with compassion, we have to provide them adequate emotional support and safe environments in which to voice their feelings.

Compassion is Always Appropriate

More than likely, you interact with multiple people who had adverse childhood experiences on a regular basis. You may not even know who they are. Some of them will suffer health effects. Some of them will not. Some will act out. Some are doing their best just to get through the day. A high ACE score is both an indicator of risk and a call to practice compassion and patience with everyone you encounter-especially the difficult ones. Compassion is a great starting point for improving health.

Stevens, Jane Ellen (8 October 2012). “The Adverse Childhood Experiences Study — the Largest Public Health Study You Never Heard Of”. The Huffington Post.

https://www.ajpmonline.org/article/S0749-3797(98)00017-8/abstract
Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults
The Adverse Childhood Experiences (ACE) Study
Vincent J Felitti MD, FACPA,*’Correspondence information about the author Vincent J Felitti, Robert F Anda MD, MSB, Dale Nordenberg MDC, David F Williamson MS, PhDB, Alison M Spitz MS, MPHB, Valerie Edwards BAB, Mary P Koss PhDD, James S Marks MD, MPHB

https://acestoohigh.com/got-your-ace-score/

https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917040/