January 24, 2018
One of the big safety tips parents and educators tell their children is that no one should look at or touch your private parts unless a medical provider needs to examine you during a checkup. Most of us have learned this since we were very little. This is a great lesson, but what is a parent to do when their child’s medical provider becomes the perpetrator of sexual assault? While this seems inconceivable on so many levels, this is exactly what we are seeing play out with the heart wrenching victim statements from the sentencing hearing of Larry Nassar, the former USA Gymnastics doctor who has pled guilty to criminal sexual assault and possession of child pornography.
This is truly a difficult topic for parents to stomach. It is terrible to think about medical providers using their authority and trust to harm patients, especially children. I am heartbroken hearing the testimonies of the girls that Nassar harmed. What he did was unspeakably evil. But I think we need to learn as much as possible from the Larry Nassar case. The more victim impact statements I read, the more I realize that there are some important take-aways regarding child safety and the medical provider-patient relationship that parents need to know. Sadly, Larry Nassar isn’t the only predator who has used his position as a healthcare professional to assault patients.
We need our children empowered to identify and speak out against any type of harassment or abuse from anyone, including (God-forbid) their medical providers. As a pediatric nurse practitioner, here are a few important strategies for empowering yourself as a parent and your children.
The mother of one of Larry Nassar’s 12-year old victims described instances in which she received unacceptable answers to her questions, specifically noting that Nassar “answered in a way that made me feel stupid for asking” when she questioned him not wearing gloves while treating her daughter. He again gave her a condescending answer when she expressed uneasiness about some of the positions into which he was maneuvering her daughter during the treatment. Nassar then repositioned himself between the mother and her daughter, blocking her view, and continued his “treatment” which we now know was actually sexual assault.
As a parent, you should be asking questions. Before any exam, test, or treatment, ask your child’s healthcare provider to explain what they are going to do and why. You should also empower your child to ask their own questions. Your child’s healthcare provider should take the time to answer any question you or your child have before, during, and after the procedure. If your child’s healthcare provider doesn’t fully answer your questions, that should be an immediate red flag to you.
A healthcare provider should always ask your child for permission before they touch them and they should be clear how and where they are going to touch them, especially if the exam or procedure involves a sensitive or private area of your child’s body. From the time parents bring me their newborns, I am constantly explaining what I am doing and why during an exam. By the time a child is about 2 or 3, I start directing my explanation directly to my patient. Some parents are a little surprised that I start doing this from such a young age. It is important to realize that it doesn’t matter if my young patient doesn’t fully understand what I am saying yet, they need to have an active role in their examination. I don’t think that can ever start too early.
When a healthcare provider explains what he or she is doing and asks for permission, it helps to teach children consent from a very young age. Also, it’s generally a good conversation starter for parents on this topic. Parents should be reinforcing the same messages of child safety and consent at home. This is what I say when a sensitive or private area on a child needs to be examined (with slight modifications based on a child’s age and development):
“I need to take a quick look at your ____ to make sure your body is growing and developing just the way it is supposed to. I am your pediatric nurse practitioner but I am only allowed to do this if it is okay with you, and because your parent is here with you.”
At this point, I pause to make sure further examination is okay with both child and parent, and then I use that moment as an opportunity to go into further education. I reinforce to my patient that no one is ever supposed to touch their private areas, and if someone ever does, they need to tell their parents immediately. Again, you can never start too early in teaching your children this very important message. Begin teaching these messages early at home and work with a healthcare provider that reinforces this at their medical office.
Any time your child has an appointment with a doctor, nurse practitioner, gynecologist, dietitian, physical therapist, or any other healthcare provider, a parent should be present.
This is easy when your kids are little, as you are expected to be there to answer questions for your child during the exam, but it’s important to continue this practice as much as you possibly can as they get older. Have open conversations with your child about why you are going into the exam room with them.
In a perfect world, you will always be the one taking your child to their medical appointments, but in the case of an emergency, they could find themselves in an ER or urgent care without you. Additionally, when your child becomes a young adult (around 16 years and older) this subject can become a little grayer for parents to navigate. Many young adults prefer to be examined without their parent present for confidentiality or privacy reasons. There are certain instances when this is understandable.
My guidance for parents would be this: teach your children about consent, inappropriate touch, and the power to say no from as young an age as possible, so this becomes ingrained in who they are.
Talk to your child about when it would be appropriate for a healthcare professional to treat them without you there. Let them know it’s okay to ask — or demand, if necessary — that a nurse or other medical professional sit in the room with them during the exam. If they are asked to remove their garments, they should be left alone in the room to do so and be provided with a gown or other covering to wear during the exam.
Most children have been taught to listen to, and obey, medical providers. Empower your children to say no or stop an exam if a healthcare provider does anything that makes them feel uncomfortable or seems different from the medical exams they have experienced in the past with you present. Let them know that you will always be on their side, and they will not get in trouble for refusing medical treatment in this situation.
But what if being in the room with your child isn’t enough? One thing that stood out to me when I read many of the statements made by parents of Larry Nassar’s victims was how often parents were in the exam room when abuse occurred.
As a parent, you should be an active participant in any exam or treatment your child receives. Your presence and involvement is protective and supportive. Healthcare providers should welcome your engagement.
Larry Nassar used his position and authority as not only a medical professional but also an Olympic doctor to intimidate parents and patients. If at any time during a visit to your child’s pediatric healthcare provider you or your child feel uncomfortable about anything that is happening, end the visit immediately. Go with your gut. Don’t let impressive credentials overshadow your instincts.
While I hope this would never happen to any child, the reality is that this is happening far too often. Education and empowerment are key to prevention. Start talking to your children about this when they are young and keep talking about it as they grow older.
One of the most important things you can do to protect your child is keep the lines of communication open. If your child says someone or something made them feel uncomfortable, take their feelings seriously. Talk about the situation. If they have been sexually assaulted, either by a healthcare provider or any other person, let them know that you believe them and it was not their fault. Immediately call the police and file a report. If your child was assaulted by a healthcare provider, you should also report the assault to the state medical board immediately.
If you suspect that a child is being abused, or if you are a child or teen who is being abused, you can call the National Child Abuse Hotline 1-800-4-A-CHILD. You can also speak to someone safe by calling RAINN’s National Sexual Assault Hotline at 800.656.HOPE.
Author: Dani Stringer, MSN, CPNP, PMHS – founder of KidNurse and MomNurse Academy