Commonwealth of Pennsylvania

Task Force on Child Protection

Good morning Chairman Heckler and members of the Task Force. I am Maria McColgan,
Director of the Child Protection Program at St. Christopher's Hospital for Children and Associate
Professor of Pediatrics at Drexel University College of Medicine. I am honored to be here today
among many of my esteemed colleagues and humbled by the opportunity to present to you today.
Since completing my pediatric residency at St. Christophers Hospital, I have practiced Child
Abuse Pediatrics and, along with several of the physician colleagues in the room, became one of
the first Board Certified Child Abuse Pediatricians in 2009. In addition to my clinical
responsibilities at St. Christophers, I am also the Pediatric Advisor to Prevent Child Abuse
Pennsylvania, an organization dedicated to the primary prevention of Child abuse and neglect,
under the umbrella of the Pennsylvania Chapter of the American Academy of Pediatrics. I am
proud to also represent these two organizations in my testimony today.
I am hopeful that my testimony will bear witness to the realities of how often and harshly some
of this states children are exposed to child abuse abuse wed all like to believe does not exist,
but as my testimony will confirm is quite real and consequential for the child and society overall.
Over the last two years, Ive been connected with an interdisciplinary coalition known as the
Protect Our Children Committee (POCC). POCC has provided a forum for professionals and
advocates like myself who work in the trenches of child protection and have solid insight of how
things are working in practice, but who are often unconnected to the usual policy generating
tables.
Through POCC, weve been able to share information, expertise and quite frankly frustrations,
realizing there was potential in our collective advocacy. So last year, I joined other doctors,
public and private child welfare workers, legal experts, social workers, childrens advocacy
center and victim services leaders, disability rights advocates, law enforcement, researchers, drug
and alcohol and mental health clinicians in a call for a state level task force on child protection.
We were certain that Pennsylvanias children and families could benefit from a research-driven
and grassroots informed analysis about how Pennsylvania is doing both in preventing child abuse
and implementing core front end child protection policies including defining, reporting,
investigating and assuring a pathway to services for the child and the family.
So I am here today, first, to affirm that this Task Force and each of us can elevate the voice of
very vulnerable children whose voices are muffled if not silenced in the halls of power.
Together we must dedicate ourselves individually and collectively to chart a new course for
Pennsylvanias most vulnerable children and families and recognize our children as our most
valuable and cherished resource.
My testimony today is framed from the perspective of a practicing child abuse pediatrician for
almost 10 years. In that time I have identified and treated thousands of injuries physical and
sexual resulting from some of the most horrific treatment of children that can be imagined.
My perspective is from the medical treatment of the child, I have too often witnessed how the
tragedy is compounded by inadequate state laws that too often exacerbate the vulnerability of a
child, leave the child and family unconnected to services, and complicate the decision-making of
local child welfare workers.

A few weeks ago I was presenting at a conference in Bucks County. A children and youth
services caseworker told me about a child that she was still losing sleep over. The child had a
bruise on his ear, an almost diagnostic sign of inflicted injury, as it is very rare that a child will
accidentally bruise their ear, as it is on the side of the head. She felt the injury was due to an
abusive act and wanted to indicate the case as physical abuse. Ultimately she and her
supervisors decided she was unable to indicate the case as child abuse because the bruise did not
meet the threshold set by Pennsylvania's state law of a severe injury, nor did the injury cause
sufficient pain or impairment. Regrettably we have seen countless cases like this the child who
has marks, bruises, or welts from being hit, spanked, whooped or otherwise physically
disciplined, but state law establishes that the childs injuries were not severe enough to be
determined to be child abuse.
And consider the 2 1/2 year old child who presented to our hospital last year with an
extraordinarily high sodium level. After an exhaustive workup for other medical causes, we
diagnosed her with salt poisoning and physical abuse. Based on the medical diagnosis of child
abuse, the caseworker indicated the case and named the mother as the perpetrator of the child
abuse and the child was placed in foster care. A court, however, overturned the finding of child
abuse saying that the investigation had not proven that the mother was directly responsible for
the abuse in other words the court felt that the perpetrator had been undetermined. Therefore,
the child was returned home with her mother. Several months later the child returned to St.
Christopher's with multiple injuries including an old severe burn that had not received medical
treatment, severe malnutrition, bruises and scars all over her body including bruises on both ears
and a healed laceration behind her ear from being pulled so hard that "her ear almost fell off"
as subsequently reported by her sister.
Consider as well the twins who had subdural hemorrhages, retinal hemorrhages and fractures,
which led to a diagnosis of physical abuse and inflicted traumatic brain injury. The family
members who were indicated appealed and won, because there were 5 different caretakers in the
recent days leading up to finding the injuries, again rendering the case unfounded because the
perpetrator is unknown.
Building the foundation of child protection based on adult-driven versus child-centered policies
is a significant shortcoming in Pennsylvania. I can recount too many cases where there was a
clear medical diagnosis that the child was abused, but the child welfare investigation - driven by
state law and practices - determined that abuse did not occur. In such cases, the childs injuries
that were medically diagnosed as child abuse remain uncounted in official state statistics.
Consider too that in so many of these unfounded cases despite medical diagnosis - critical
pieces of information to better protect this child going forward will not exist, and, where
information might be retained, it likely wont be shared with the next doctor or child welfare
investigator. Where a perpetrator is undetermined but abuse has occurred or in other cases where
the report was unfounded, the records must be destroyed in a certain period of time. Also
Pennsylvania collects and retains no data about a child who may receive General Protective
Services (GPS) services offered since the 1990s to address circumstances where safety
concerns exist but which were deemed to be non-abuse cases. So often, the child of a prior
unfounded report or the recipient of GPS presents again, at a later date, in an emergency

department or with a new pediatrician because so often these children do not have medical
homes. The treating physicians and the child welfare workers seeing the child this time often
will not have all the facts, and are left with the impression that this is the first time a child has
experienced injuries that could be abuse related.
The final case I will present here today is certainly far from the last example of cases that I have
been involved with where Pennsylvanias definition of child abuse was confusing and not
sufficiently protective of the child.
Recently, I cared for a 7-week-old infant who was brought to the Emergency Department
because he wasnt moving his arm. He was noted to have a fracture of the humerus, the bone of
the upper arm. On further workup we found other fractures, a bruise and a healing laceration in
his mouth. The medical diagnosis was clearly inflicted injury. In family court, the defense
attorney argued that this case, although likely inflicted injury, does not rise to the level of our
states definition of abuse because it did not lead to impairment of the child. He argued, How
could the child be impaired because he was only 7 weeks old and couldnt even hold a bottle
yet. Therefore this child could not be considered impaired as a result of this injury.
Remarkably the judge agreed and ruled that this was not child abuse and ordered that the child be
returned home. We all appreciate and want to find the appropriate balance in safeguarding the
rights of parents with protecting children, but this case and the high bar to determine a child has
been abused illustrates, to me, that weve not yet struck the right balance. Even in this case of a
clear medical diagnosis of abuse, our states law raised enough confusion to rule against a legal
definition of child abuse.
Another element of our state definition of child abuse relates to the inclusion of severe pain.
As a physician I am a mandated reporter and so I often find myself making a call to ChildLine to
report child abuse. And during the course of my report and the later investigation, I will be
repeatedly asked Did the child suffer severe pain? This question is fraught with problems.
Pain is subjective, meaning that an injury that one person might rate as causing severe 10 out of
10 pain, another person might rate the pain from a similar injury as a moderate 6 or 7.
With children, this becomes even more difficult. I cannot determine with any certainty the level
of pain a 7 week old, a 13 month old or often times even an older child is experiencing. For
example, is a child who has bruises on her buttocks that make it uncomfortable to sit suffering
severe pain? Or how about the infant with a femur fracture? When no one is touching or
moving an injured child, they can fall asleep, but that does not mean they are not experiencing
pain. Nor does it mean that they have not suffered an abusive injury.
As this Pennsylvania and much of our country turned its attention to reporting child abuse in the
wake of the Jerry Sandusky and Penn State scandal, we will fail our children again if we ignore
that reporting is impacted by how we define abuse and what happens after a report of concern for
a child has been filed.
Pennsylvanias definition, particularly the provisions related to severe pain, impacts the
likelihood of medical providers to report cases of suspected abuse and neglect to Childline. We

are piloting a new program called Family Safe Zone at St. Christophers Hospital for Children,
the goal of which is to change attitudes toward corporal punishment and increase bystander
willingness to intervene on behalf of a child. During a meeting, one of our social workers noted
her responsibility to report suspected child abuse. She voiced her frustrations with ChildLine
stating: Their mindset is so toward the severe that you have to fight and beg, even as a medical
provider, to get them to accept the case.
I can go on for hours with similar cases in which Pennsylvania state law created such difficult
restrictions that an injury must cause severe injury or impairment of the child to be deemed a
case of abuse or neglect. I want to assure you this is not a Philadelphia specific challenge,
because all of the other counties are operating under the same limiting law. I have consulted on
similar types of cases I illustrated today from across the Commonwealth, and in fact, most of the
cases I presented were from counties surrounding Philadelphia.
Linked to the definition - and influencing our adult versus child approach to child protection - is
the role and nature of the state child abuse registry. Persons named as perpetrators of child abuse
will have their status known when they apply to work or volunteer with children. This registry
serves a critical role as it provides potential employers or community-based volunteer
organizations with information to better protect our children. It is, however, time to evaluate the
role of the registry in terms of who is on the registry, for how long and the mechanics of its
operation, particularly the appeal process for having ones name removed.
In a Commonwealth that has set the bar very high as to what injuries can be inflicted on a child
and not be deemed child abuse, I have been repeatedly cautioned to set my expectations for
change low. I have been told that it is too controversial to bring up any discussion of corporal
punishment. Im reminded often that Pennsylvania is a more conservative state and that we are
remiss to intervene in a parent or caregivers ability and right to discipline their child with
physical interventions.
With all due respect, I believe that it is not only time to begin this discussion, but it is long
overdue. We must talk about what is appropriate and acceptable discipline and what is
unreasonable punishment. In a talk by Dr. Sandy Bloom of Drexel University School of Public
Health, I saw and remain influenced and inspired by the following slide:
Hitting and Adult = Assault
Hitting and Animal = Cruelty
Hitting a Child = Discipline?
I am not considering that we debate the appropriateness of a simple swat to a toddlers hand to
caution them from touching a hot stove, or a tug on the arm to prevent a child from running into
the street. However, I am suggesting that we begin to discuss moderate to severe forms of
physical punishment.
We need to ask the question, when is it ever acceptable to hit a child? Should it be legal to hit an
infant or toddler, who does not yet have the understanding of why they are being hit and are too
vulnerable to physically defend themselves from excessive corporal punishment?
When, if ever is it acceptable to spank a child, and for what reason?

And most importantly, is it ever okay to hit any child with an implement such a broom, an
extension cord or even a belt?
To find the answers, we have to look carefully at the data, as we now have a wealth of medical
and psychological studies that show the effects of physical punishment. Several studies have
looked at the frequency of hitting children.
Seventeen percent of mothers reported spanking an infant under 13 months old in
the past week
26% of mothers reported hitting their 3 year old children greater than 2 times in
the past month
35% of parents have spanked their 4-5 year old children in the past week
And 80% of all children were by the time they reached 5th grade.
And we now know that physical punishment, including spanking can lead to toxic stress that can
lead to detrimental changes in the developing brain.
In this study, subjects who were victims of physical punishment were noted to have significant
reductions in gray matter of the brain.
And in various studies, Children who experience physical punishment are at higher risk for:
Behavioral problems and delinquent behaviors
Low self-esteem
Depression
Substance abuse
Poorer quality of relationship with parents
Physical abuse of ones own spouse and children as an adult
Spanking is also shown to lead to increased risk of physical aggression, anti-social behaviors,
conduct problems and internalizing behaviors among children.
Therefore, the American Academy of Pediatrics strongly opposes striking a child for any reason.
As a result of what these studies have taught me and from my experience of treating children
who have been injured by a disciplining parent, I encourage all parents to abandon all forms of
hitting and to use other forms of positive parenting, which are proven to be more effective and
lead to healthier outcomes. As a doctor and as a parent of young children myself, I invite
discussion and work with parents who insist that they need to use hitting to punish their child. I
ask that they consider the alternatives, but if they will not abandon the use of physical discipline,
I recommend that they only hit with their open hand so that they too can feel the amount of pain
they are inflicting on the child.
There are now 29 countries that prohibit corporal punishment of children, even in the home. In
the US, there are no federal or state laws prohibiting physical punishment in the home, and in
fact, only 28 states and the District of Columbia prohibit physical punishment in public schools.
Legislation on use of physical punishment in other settings caring for children varies state to

state. We should look at the effects of the prohibitions in other countries, and other states to help
guide us as we decide what the right legislation is for Pennsylvania.
As a lifelong Pennsylvania, I am disheartened at the fact that Pennsylvania was the last state in
the country to become compliant with the federal Child Abuse Prevention and Treatment Act
(CAPTA). It took until 2006 to achieve this compliance. I would love to be able to say that I
live in a state that is a leader in Child Protection. That I live in a state where children are not
only protected, but revered and held on a pedestal and recognized as our most valuable resource.
I want to live in a state where it doesn't matter if your race or color is, it doesn't matter what your
religion or political party, it is never ok to injure a child. I want to live in a state that values
prevention, not only because it is economically beneficial, but because it is the right thing to do
and the best chance for ensuring that all children are raised in nurturing environments that allow
them to live up to their potential.
Well, now, I am 7 pages in, and I havent even touched on sexual abuse, neglect or school abuse.
But the themes are the same. Why should the threshold be severe neglect? Why do not routinely
believe a child who says they were sexually or physically abused? Why isnt abuse of a child in
a school setting considered a case of child abuse and investigated in a similar manner? It is very
frustrating as a medical provider to repeatedly refer cases to ChildLine, only to find out they will
not be investigated as a Child Protective Services (CPS) report, and are sometimes not even
accepted for general Protective Services (GPS).
I also want to take a quick moment to focus on prevention. Of course the very wise Benjamin
Franklin stated that an ounce of prevention is worth a pound of cure. Well, with child abuse and
neglect, an ounce of prevention is worth more like a hundred billion dollars worth of a cure.
Recent estimates of direct and indirect costs of child maltreatment range between $104 and $124
billion dollars per year in the United States. We need to shift our focus from intervening after
damage has been done to prevention before it occurs. We must send a message to all
Pennsylvanians that Prevention IS Possible and each and every one of us has a role to play.
Honored members of the Task Force, thank you again for the opportunity to present my
testimony today. I hope that as you consider these complex issues, you will remember some of
the children that we have discussed and know that the work you are doing will help to improve
their future.

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