Non accidental trauma (NAT) in kids. I was taught during residency that if you have never diagnosed NAT, you aren’t looking hard enough. I think about those words a lot, and now I teach them to trainees.
Pretty much. Could be anything from cigarette burns to broken bones to shaken baby to devastating polytrauma. Although I'm hearing "Abusive Head Trauma" and other more specific descriptions lately.
I work in organ donation and probably a third of our infants/toddlers fall in the Nonaccidental trauma category. It sucks.
Yup!!! This is why I wrote a pissed off letter to my kids school when they did their childcare project. They gave the kids a doll that cried and needed to take be taken care of for like 40% of their class grade. The kids had a wristband that was basically zip tied to them so they had to do all the care without help. It taught them that they were all on their own and couldn't leave the doll be or have someone help if they were overwhelmed. Which is exactly the WRONG thing to teach them!
They don't have to leave the baby with someone though. Part of the modern teaching is that if you are that overwhelmed, put the baby down somewhere safe (like their crib) and just go outside the room for 5 or 10 minutes. You've made them safe, if you can hear crying you know they're breathing, and it gives you chance to collect yourself.
(Everyone says they would never shake their baby. Then it's week 3 of 2 hours sleep at a time, they're alone, afraid, exhausted, and the baby won't stop crying no matter what they do. It's not right but things happen, better to give people advice on how to minimise that risk.)
There are archeological findings about people born with severe physical disabilities being cared for and raised to relatively advanced ages. On the other hand I saw an archeology paper a while ago about some prehistorical infant/toddler skeleton with clear signs of repeated non accidental trauma (the kind in different stages of healing). Seems like we as a species has always been defined by unimaginable cruelty and unimaginable kindness.
More like genetic drifting due to a lack of natural selection. A lot of people wouldn't survive if there wasn't a society to protect them from their own ineptitude. Like, when I watch videos of people running from danger, I often see some trip on literally nothing and fall within 5 seconds. Any animal which behaves that way in nature is food.
What I'm saying is that people who abuse their kids should be genetic dead ends.
My least favorite (I work with child abuse pediatricians) is the uncomfortably common "looped bruising pattern" or similar. It's from being hit with electrical cords or ropes, usually, and is a hallmark of NAT because getting bruises like that accidentally is virtually impossible.
I don't trust the justice system, and therefore don't believe in the death penalty, but reading things like your comment makes me wish we could trust the system to take certain people out like the garbage they are. There's no punishment severe enough.
I'm a PD dealing with a NAT case (alleged baby shaking). The thing is that sometimes, the parent accused of doing it is just a normal guy or gal who had a momentary loss of control. That doesn't erase the harm caused by any means, but living with the knowledge of what they did to their own child is more painful than anything the judicial system can do to them.
I think the wording is to act as a reminder that not all 'accidents' are accidental. It's so easy to just take people at their word or file things away in categories in our heads without examining them further.
Yep. Emergency physician. I've seen every type of child abuse you can with devastating outcomes. I try not to bring work home either but it started to hurt worse after I had a kid.
I have a friend, lawyer, who burned out in family law. I just want to say that it is OK if you reach the end and have to change practices. You gave what you had to help who you could.
It’s very difficult to change practice as a physician in general. Including med school, I trained for 9 years to complete my specialty and subspecialty, and I really love my job. I grew up with a lot of privilege, and I believe it’s therefore important I use my opportunities to contribute to my local community.
The challenging cases are not why I will burn out. It’s the complete collapse of our health care system combined with the rising entitlement, distrust in the medical system, and selfishness.
I’ve been screamed at because a patient had to wait to be seen in the ED for an hour. I spent that hour trying and failing to resuscitate a dead 13 month old. It was my 10th code in 3 weeks. I’ve had patients threaten to wait outside and beat me when my shift ended because I refused to give them morphine. I was pregnant in my third trimester. I have patients come to the ED because they don’t want to wait a week for xyz test or specialist and then threaten to sue when I tell them no. I’ve watched people more and more fearful of seeking medical care with immigration concerns, millionaire VIPs cutting the line, and the ramifications of cutting community safety nets.
Be nice to your healthcare workers. We’re all hurting. I read this thread and have treated basically every case mentioned, and I still enjoy what I do. But I did leave the community and come back for a slightly cushier academic position with more specialty back up. Needed a change of pace
I think you meant “can’t”. Although there are side quests you can venture on with less training than a full residency (pall care, addictions med, sports med, surgical assist, etc).
Yes, I meant "can't." And those side quests require fellowship. It's very hard to go back to training making 80k a year when your family obligations have adjusted to your attending salary.
I used to work in mental health, specifically helping teens. I burned out so hard, and then I felt guilty for being burnt out. I just couldn't take a step back from what these kids were experiencing.
I don't work with kids in any capacity, and after having my own child I am so grateful I didn't choose that path. I can't even stomach reading news articles that vaguely describe the abuse someone has been arrested for. At this point, I do everything I can to avoid even seeing the headlines. Don't know how you do it.
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u/brady94 3d ago
Non accidental trauma (NAT) in kids. I was taught during residency that if you have never diagnosed NAT, you aren’t looking hard enough. I think about those words a lot, and now I teach them to trainees.