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Upstate fellowship adds experts to underserved field of treating child abuse and neglect

Upstate Golisano Children's Hospital's Child Abuse Pediatrics Fellowship program is helping to fill a vital need in the identification and treatment of suspected victims of child mistreatment.

With only approximately 350 board certified child abuse pediatricians in the country, these doctors are scarce but vital. They have special training, experience, and skills in evaluating children who may be victims of abuse or neglect.

Upstate’s program has already had a significant impact. Having the fellows allowed fellowship program director Alicia Pekarsky, MD, to re-open the Inpatient Child Abuse Pediatrics consult service in October 2020. The team has always seen patients on an outpatient basis, but the inpatient service had been on pause for about eight years due to personnel shortage.

“It is important to offer consultation with a child abuse pediatrician for hospitalized patients because these children tend to have significant injuries such as head or abdominal trauma, fractures or burns,” said Pekarsky, who also serves as the co-medical director at McMahon/Ryan Child Advocacy Center.

“Agencies that are tasked with investigating and creating safety plans need our team's input while the patient is still hospitalized, rather than after they have been discharged.”

In Onondaga County alone, Pekarsky said there are approximately 5,000 reports of suspected child maltreatment involving 9,000 children in Onondaga County called in to the NYS Central Register yearly. Pekarsky said Upstate saw about 150 patients for suspected child abuse in the first year the inpatient clinic reopened.

Upstate’s three-year fellowship program, which accepted its first fellow in 2018, yielded its first placement in Buffalo in December 2021. Iram Ashraf, MD, who finished her fellowship in the fall, is now at the Oishei Children's Hospital in Buffalo as the only child abuse pediatrician on staff.

“The Children’s Hospital of Buffalo has not had a child abuse pediatrician for at least 15 years,” said Pekarsky “It’s a big deal for that catchment area to now have one.”

Pekarsky said some states have only one board certified child abuse pediatrician doctor, and some have none at all. Upstate’s fellowship program is one of only two in New York (the other is Maimonides Medical Center in Brooklyn) and 31 across the country trying to change that. Upstate’s second fellow, Heather Ross, MD, is in her second year and the program is recruiting for one to two more to begin in 2023.

“Child maltreatment is extremely prevalent,” Pekarsky said. “Our program is training physicians to work in a field that is underserved. There are not enough child abuse pediatricians to evaluate the number of children who should have this type of comprehensive evaluation.”

According to the CDC, at least 1 in 7 children have experienced child abuse and/or neglect in the past year in the United States. This is likely a low estimate because many cases are unreported. In 2020, 1,750 children died of abuse and neglect in the United States. Children living in poverty experience more abuse and neglect and Syracuse has one of the highest child poverty rates in the country for large cities. 

Child abuse pediatrics is a subspecialty of pediatrics, and CAP fellowship programs train physicians to diagnose and treat child abuse and neglect. In addition, Upstate’s fellows collaborate with community agencies on child abuse prevention, participate in advocacy projects, train to become expert witnesses in court proceedings and participate in numerous multi-disciplinary teams throughout the hospital's catchment area.

The fellowship is offered in collaboration with the McMahon Ryan Child Advocacy Center in Syracuse, which coordinates advocacy, prevention, investigation, and prosecution as well as treatment services. In addition to responsibilities at Upstate, fellows spend much time at McMahon Ryan performing outpatient evaluations for suspected abuse.

Upstate’s fellowship in child abuse pediatrics is accredited by Accreditation Council for Graduate Medical Education (ACGME). The fellowship typically follows a three-year residency in general pediatrics. 

As part of every evaluation, child abuse pediatricians actively search for medical problems and other explanations for a child’s signs and symptoms. It is not uncommon for these subspecialists to identify an accidental mechanism or a medical mimic, which can explain the findings.

While more child abuse pediatric training programs are needed, so are more candidates for the special fellowship.  

“A lot of programs are small like ours, Pekarsky said. “I am developing a curriculum that would be used by each of the CAP fellowship programs. This will be more efficient for the faculty and enhance connections among the CAP fellows.”

Pekarsky presented this idea at an academic meeting this past April and in August will be presenting an update during the quarterly meeting of CAP program directors. 

Caption: Child Abuse Pediatrics Fellowship Program Director Alicia Pekarsky, MD, left, a pediatrician at Upstate Golisano Children’s Hospital, speaks with Heather Ross, MD, now in her second year of the fellowship.

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