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Lynn Sheets, MD, medical director of child advocacy and protective services at Children’s Hospital of Wisconsin

New infant abuse prevention bill based on work of Children's Hospital of Wisconsin doctor

This story was featured in the Milwaukee Journal Sentinel.

U.S. Senator Tammy Baldwin announced a new bill on April 3 that would help reduce cases of infant abuse in the United States. This bill — the Early Detection to Stop Infant Abuse and Prevent Fatalities Act — is inspired by and based on the work of Lynn Sheets, MD, medical director of child advocacy and protective services at Children’s Hospital of Wisconsin. Dr. Sheets, who is a national leader in child abuse prevention, has been working with Senator Baldwin for the last several months on crafting the bill.

This bill would:

  • Develop, implement or expand training to assist medical professionals in identifying and responding to injuries that suggest potential abuse in infants

  • Develop protocols and policies that improve communication and coordination between mandatory reporters and child protective services

  • Raise awareness about the significance and identification of such injuries among health professionals, professionals caring for children, child protective services staff and the public.

In 2012, Dr. Sheets led a clinical study to determine what percent of abused, pre-walking infants had a history of poorly explained, relatively minor visible injuries. Although the association between bruising in young infants and subsequent more serious abuse was well established, Dr. Sheets sought to determine exactly how many infants evaluated for abuse had a previous history of medically minor, suspicious injuries, which Dr. Sheets termed “sentinel injuries.”

Dr. Sheets examined the cases of 401 infants under 1 year of age from over a 10-year span. She determined that as many as 30 percent of abused infants had a history of sentinel injuries. In 2013, her findings were published in Pediatrics, the official journal of the American Academy of Pediatrics.

Education and awareness is Dr. Sheets’ mission. Such injuries in infants are commonly overlooked by medical providers, caregivers and child welfare professionals because they seem trivial. Without early intervention, physical abuse can escalate, resulting in severe injuries or even fatalities.

Dr. Sheets’ message is simple: “Small infants should not have bruises.” Bruising on babies before they start to attempt walking should raise concerns for physical abuse or, more rarely, a bleeding disorder. Early intervention can mean the difference between life and death.

The Early Detection to Stop Infant Abuse and Prevent Fatalities Act amends the Child Abuse Prevention and Treatment Act (CAPTA) to develop new and expanded trainings and best practices to support medical and child welfare professionals in identifying and responding to signs of potential abuse in infants under 7 months. The bill has bipartisan support in both the House and Senate, with U.S. Senator Bill Cassidy, MD, of Louisiana, and U.S. Representatives Kim Schrier, MD, of Washington and Steve Stivers of Ohio joining Baldwin as co-sponsors.

“We must do everything we can to help prevent child abuse and protect the most vulnerable in our country,” said Baldwin in a press release announcing the bill. “This commonsense proposal will make sure that medical providers and child welfare professionals have the tools they need to recognize early warning signs of abuse in infants, so they can step in and save lives.”

The bill also has the support from a number of local and national children’s health organizations, including the Children’s Hospital Association and the American Academy of Pediatrics.

“As pediatricians, our number one priority is to keep children healthy and safe. There is clear evidence that certain injuries can be signs of potential child abuse, and require a thorough evaluation. When these injuries go unrecognized, it can lead to tragic consequences for children who are victims of abuse,” said Kyle Yasuda, MD, FAAP, president, American Academy of Pediatrics, when the bill was announced. “The Early Detection to Stop Infant Abuse and Prevent Fatalities Act supports evidence-based approaches to improve our ability to identify these injuries and protect children from harm. The AAP applauds Senator Baldwin, Senator Cassidy, Representative Schrier, and Representative Stivers for their bipartisan leadership in sponsoring this important legislation, and we urge Congress to advance this policy without delay.”

According to the National Child Abuse and Neglect Data System, an estimated 1,720 children died from abuse or neglect in the United States in fiscal year 2017. Seventy-two percent of child fatalities involved children younger than 3, and 50 percent involved infants younger than 1 year old. Multiple studies have found that relatively minor, visible injuries in young infants, including bruising and intraoral injuries, are often indicators of abuse. Such injuries in infants are commonly overlooked by medical providers, caregivers and child welfare professionals because they seem trivial. Without early intervention, physical abuse can escalate, resulting in severe injuries or even fatalities.

The bill’s sponsors will be working to get the legislation incorporated into the reauthorization of CAPTA, which Congress is set to consider later this year.