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“When I came in here, I felt like my body was a big bag of heavy rocks. Now I’m leaving and I think what I did is I’m leaving those rocks here.”

That’s what a 7-year-old boy told First Step Resource Center care coordinator MC Jenni about how he changed since he first walked through First Step’s doors. He’s one of hundreds of survivors of child sexual abuse in Missoula County.

Last year, First Step worked with 429 children, 301 of whom were from Missoula County.

Jenni spoke at the State of the Young Child event Tuesday at the University of Montana. It’s an annual event that zooms in on the issues facing Missoula children and families today from experts in social work, nursing, nonprofits and marketing – and what steps need to be taken to solve them.

On Tuesday, they tackled child sexual abuse and neonatal abstinence syndrome.

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Child sexual abuse is “likely the most prevalent health problem for kids today,” said Parenting Place executive director Teresa Nygaard.

It’s estimated that one in 10 children will be sexually abused before they turn 18, according to a 2013 Darkness to Light study. The list of potential lasting impacts from child sexual abuse is long and heartbreaking: depression, suicide, substance abuse and more.

Events like State of the Young Child should open up a conversation that’s long been taboo, Nygaard said.

“No matter how many times I say child sexual abuse, I feel a jolt of discomfort and shock,” Jenni said. “In isolation, ‘child’ is a wonderful word. ‘Sexual’ is a compelling word. And ‘abuse’ by itself doesn’t really bother me. But when we combine all three of those words, my thoughts get knotted up and I feel fear and anger.”

Of the people that First Step serves, 80 percent are children.

Of those children referred for child sexual abuse, the vast majority of the alleged offenders are people the child knows or is related to.

Missoula Mayor John Engen said he’s met far too many “broken souls” in his work. Much of that “breaking happened when they were kids.”

Policies need to be enacted to help parents and children before a crisis occurs, said Missoula County Commissioner Stacy Rye, which she said should include universal prekindergarten, flexible work schedules and high-quality childcare.

The good news, she said, is that Missoula is packed with resources. The job now is to figure out how to use all of those resources to create change and prevent child abuse and neglect.

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Neonatal abstinence syndrome affects babies whose mothers used opioids during pregnancy.

It’s been on the rise for several years across the U.S., from 1.2 per thousand hospital births in 2000 to nearly 5.8 in 2012, according to the National Institute on Drug Abuse. There’s also been an increase in admissions for NAS, from seven per thousand hospital admissions in 2004 to 30 in 2013.

If a mother is using opioids during pregnancy, when the baby is born it’s the same effect as an adult quitting drugs cold turkey. The baby goes through withdrawal, exhibiting high-pitched continuous crying, extreme irritability, tremors, vomiting, diarrhea, seizures or other symptoms. These babies can also have lower birth weights, lower birth lengths, smaller head sizes and higher rates of prematurity.

That’s where professionals in the NICU come in, helping the baby get through withdrawal. Those methods don’t prevent NAS, but they help stabilize the child.

“We don’t, unfortunately, know a lot about how what happens to these kids long-term,” said Community Medical Center neonatologist Dr. Bonnie Stephens. “All of us that work with children know that there is some effect, but unfortunately our ability to measure that effect in (these) populations is difficult.”

There are a number of variables with this population: a mother could use multiple drugs, making it hard to study the effect of one drug on a baby; the doses are variable; often mothers engage in other risky behaviors that can affect the baby; and follow-up isn’t consistent.

While what happens to a child in utero can have damaging effects, Stephens said it’s actually what happens after birth that typically has bigger impacts on a child.

Last fall, an organization formed, Wrapped in Hope, made up of St. Luke Community Healthcare in Polson, Providence St. Joseph Medical Center in Polson, Kalispell Regional Medical Center, CSKT Tribal Health Department and Lake County Public Health. They’re working together on preventing things like NAS through prenatal care.

A laundry list of people can make referrals to Wrapped in Hope, at which point a patient coordinator works with the mother to identify services she needs: Medicaid, addiction therapy, prenatal care, etc.

In 2013, St. Luke and St. Joseph started collecting data on newborns at risk for NAS. That year, 15 to 19 percent were at risk. In 2014, it jumped to 22 percent. Last year it was nearly one-third.

By January and February of this year, at St. Luke alone, nearly half were at risk.

“People who work with kids who are at risk in early childhood, where we’re noticing tons of what (Stephens) just said: kids who are having behavior disorders, kids who have had learning difficulties, kids who were problematic in preschool settings … as the background got explored, the common thread seems to be substance abuse in pregnancy and premature birth,” said St. Luke’s Dr. Cara Harrop.

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