By: Rupali Chadha, M.D.

Featuring Dr. Chadha’s article from The Physician Outlook.

Several months into a global pandemic, the stress, financial and emotional, has begun to weigh on us all. Most adults have decent coping skills to manage added stress and even adults, in many cases, are unraveling. Alcohol sales are up a staggering 300% and liquor stores have been deemed an “essential business.” Most adults are joking about the Covid 15 or 19 pounds they have packed on. And many relationships are stressed either due to distance or not enough space. Still, as adults, we can have more insight, skills and fortitude to deal with the additional stress in a pandemic. 

But what to say of children? The added stresses and possible trauma to children may be the most unfortunate unseen devastation of a pandemic, especially with closed schools and activities. Children are now engaged in most states in distance learning and are cut off from other non-family adults and children entirely. Even more heartbreaking is that not only do children lack the adult coping mechanisms to manage stress, they can therefore also more easily become victims.

About a month ago, I was approached by an ex Pharma executive turned community activist who told me of the work she was doing to bring about healing for children and how her work had become more challenging in the midst of a pandemic. I was surprised to meet her in happenstance, but not surprised to hear about what was happening. Children of abuse or who grow up in environments where there is domestic violence, are losing their only grip on hope: schools. Until March, a teacher or school counselor or coach, all who are mandated reporters, could intervene if a child was suffering from physical or emotional trauma. Or even perhaps another parent in the carpool or a church pastor may have noticed, then intervened. As more and more of our daily routines and lives suffer, the less and less likely it is that these children are seen at all.  

Kristie Bruce-Lane, a mother and career woman, but more importantly a very compassionate community organizer, who founded the Thumbprint Project Foundation in San Diego, CA, explained the pressing need for a docu-series to highlight the issue of childhood abuse and domestic violence especially during these times of Covid. “As a foundation we decided to produce the docu-series ahead of schedule due to the impact the pandemic is having on the children who come from “unsafe homes” where there is an undercurrent of domestic violence. These children are trapped behind closed doors, caught in the cross-fire, with no voice and no outlets. Contact with healthcare workers, teachers, coaches, and family members have been severed due to the stay at home orders. Developmentally, some are unable to voice their fears when they are scared. Some do not even know how to use a phone to call for help. They are not passive witnesses to the abuse - they see and hear everything!” And furthermore, they may directly be victims of actual abuse themselves. 

Asked why the name “thumbprint,” Bruce-Lane explained, “There is acknowledgment that a child who is exposed to domestic violence abuse, both physical and verbal, during their upbringing will suffer developmental and psychological damage. Exposure to violence in the home negatively wires and encodes the child’s developing brain (negative neural pathways are formed), forming a ‘thumbprint.’ This ‘thumbprint’ shapes a child’s behaviors, sense of self, and how they view others. If not addressed, these negative behaviors will assimilate into their lives and will perpetuate. The generational cycle persists.”  

In fact this is precisely why so many physicians too are concerned and we have seen this in history before. After World War II, many war torn areas of Europe had school closures as well.  Children had lost access to in person learning, and without the internet, all learning in many cases. The generational effect of that was seen in wages (the only thing measurable and only calculated outcome at that time) for those children for decades to come. While there was no data on childhood abuse or witnessing domestic violence, there was likely an effect. And like now, many of our most vulnerable children lost their one square meal a day, lunch, which was given at school. Lest history repeat itself, knowing these risks of not just an educational deficiency, but the effects of neglect, poverty and violence, must be accounted for or will leave a lasting thumbprint again.  

Physical injuries of course heal in time but the after effects to the development and resiliency of the child often do not. Children who are not directly abused, but the witness to domestic violence, have lasting scars too. Childhood domestic violence has a lifetime effect emotionally and an economical impact on our communities in addition to contributing to our homelessness crisis. Bruce-Lane commented, “When I find myself driving in cities across our nation and I see a homeless person living on the streets of our communities, I often ask myself ‘what happened to that person and was a factor in them choosing that path of life on the streets?’ Because no one really choosesthat life, no one says when they are a child the thing they dream about the most is living on the street.” There is a recognized hopelessness due to trauma that these individuals suffer. After layers of trauma, it becomes difficult to unravel later in life. Many times the link between the trauma then and the outcomes now are substance abuse and mental illness, both which can thrive in survivors of childhood abuse. 

So what can we do in a pandemic to identify and heal these children? Children are not only not seen in schools by coaches and teachers, but regular in person visits for wellness checks and even emergency rooms too are avoided so that doctors miss many of these little victims, unless the injuries are physical and severe. Awareness is the first step! It is important for stressed couples to know that there are resources if their homes are turning or are violent. For doctors it is important for us to be aware of this hidden pandemic. We ought to assess for abuse at every telehealth visit as well. We can be more aware of the added challenge that now it is even harder than before to talk to a child alone; to build that bond on a computer. 

Additionally we can take advantage of community resources like Bruce-Lane has helped build.  

As the President and Founder of The Thumbprint Project Foundation, she offers this, “These kids are our kids…..they are our community’s kids. When they suffer we all suffer. When disaster strikes like a death due to the child being caught in the cross-fire, we mourn as a community. These kids touch so many other lives - family, teachers, and coaches, and they are our future generation. If they end up going down the wrong path, we go with them as a community.” And there are likely groups like this in every city and state and as doctors we can find them and work with them, especially those of us in the fields of pediatrics, psychiatry and emergency medicine.  

Thumbprint - Childhood Domestic Violence - The Hidden Public Crisis was released on September 16, ahead of Domestic Violence month in October. It is available on both Vodcast and Podcast.