Mr Staubli, how do you deal with child abuse?
His steps are bouncy. In his spare time, paediatrician Georg Staubli loves to dance rock'n'roll. He takes the many steps up the stairs to his small office with an energetic stride and greets everyone he meets with a friendly smile. On the way up: not a drop of sweat on his forehead.
Mr Staubli, you constantly read about emergency wards being overrun by parents with sick children. Is it the same for you?
In fact, the emergency ward at Zurich Children's Hospital has 500 to 2000 more patients each year than in the previous year. This curve has been rising since 1995.
What could be the reason? Overprotective parents?
There are actually more insecure parents who come to us because their child suddenly has a fever of 40 degrees. But there are also parents who need a certificate for their sick child. Or who want the child to get better immediately so that they can work the next day.
So you and your team treat numerous minor cases.
From a medical point of view, that is the case. My aim is always to keep the child in the emergency ward for as long as necessary and as short a time as possible. After all, it's not the child's fault that it ended up with us.
Is it mainly first-time parents? With each additional child, you supposedly become more relaxed.
It certainly makes a difference whether you already have experience with children. However, I also see many parents who come with their second or third child and say: "My other children never had that!
Paediatricians are in short supply in Swiss cities. That leaves only the hospital at the weekend.
Yes, that's the case. Some paediatricians don't answer their phones after 5 pm on weekdays. Then I can understand why people go straight to hospital out of concern for their child. Parents see that their child has a fever of 40 degrees and want a solution right now. Of course, this has the advantage that the really sick children come to us, but there are also a lot of children who could have waited a day.
They say about you: He is a paediatrician by vocation and passion.
In my view, vocation is absolutely essential. It is necessary in every profession. And if you want to be one of the best, you have to be prepared to go the extra mile. A car mechanic who simply stops repairing a car because he can't find the fault won't become one of the best. He will only become one if he keeps looking until he has actually found the fault. It's no different in medicine.
Why did you become a paediatrician?
I have always enjoyed working in manual labour and therefore worked in adult surgery for a year and a half. This was followed by a year in paediatrics plus a year in paediatric surgery. I considered paediatric surgery as a specialisation, but then realised that training to become a paediatric surgeon in Switzerland takes an extremely long time. I didn't want to be a junior doctor for ten years. So I ended up in emergency medicine.
What makes a good paediatrician?
On the one hand, his expertise. On the other hand, you have to like children and be able to deal with them, even if they are uncooperative or cry, for example. Because you know that this can be an expression of their behaviour. But even more important is the ability to communicate. A paediatrician must be able to deal with parents in particular and understand their worries and fears. If you don't have this ability, even the best professional expertise is useless.
Keyword empathy?
Yes, we know from adult medicine that less than 50 per cent of patients do what the doctor tells them. So if I want the child to be treated the way I recommend, I have to have the parents on board. Otherwise it won't work.
Children are very loyal to their parents, even when they are beaten.
You are the head of the child protection group. You have to confront the parents on a completely different level.
A lot of abuse happens due to excessive demands. However, confronting the parents is easier for us because we can explain why the child should no longer be beaten and what needs to be done to stop this happening. Cases in which children are beaten for ideological reasons are much more difficult.
Does corporal punishment still exist?
There are not many cases, but these are particularly upsetting. There are parents who use beatings and fear to make their child compliant. There are often ideological convictions behind this, but sometimes there are also pathological personality structures. It is very difficult to make such parents realise that this is not possible. One of our key tasks is to assess whether it is possible for us to find a way to protect the child together with the parents.
Is there one case in particular that you remember?
Yes, I remember a case of a nine-year-old girl who was admitted from school. Her body was covered in bruises and she had clear handprints on her buttocks. When I asked the girl what had happened, she said she had fallen off her bike.
And the parents?
We called them in and asked them: Do you beat your daughter? They denied it until we confronted them with our medical observations. In the end, they admitted: "Yes, we do hit our child from time to time. We couldn't leave her in the care of her parents and had to place her with someone else. I was impressed by the daughter's loyalty to her parents. Even at the age of nine, she couldn't admit that she had been beaten by her parents.
In 2015, the child protection group at Zurich Children's Hospital registered 419 cases of abuse. Are girls affected as often as boys?
When it comes to psychological abuse, the genders are evenly balanced. Girls are sexually abused more, boys are physically abused more than girls. This is the case worldwide.
Why?
On the one hand, probably because boys are livelier and more restless. But perhaps it's also about our understanding of roles. They say you don't hit women. Perhaps many parents think that boys are more likely to be hit. Overall, however, the number of suspected cases has decreased compared to the previous year.
Is that a good sign?
We always record fluctuations. From 2006 to 2015, we registered between 400 and 490 reports of suspected child abuse every year. Last year, 75 per cent of the cases were definitely cases of abuse. In 2.5 per cent of cases, abuse could be ruled out as it subsequently turned out to be an accident.
Can you illustrate this with an example?
A child who fell off the balcony because his mother went out to smoke in the garden and wasn't paying attention. This is not actually maltreatment.
How difficult is it to prove a suspicion?
It is very difficult with suspected sexual offences. What do we do with a three-year-old girl who says that someone always touches me in the genital area, but we can't find any evidence of it? Did it actually happen or did it happen by chance, for example during nappy changing? We only have the option of documenting this and giving advice to those affected.
What is considered mental abuse?
There is a large grey area between good and clearly harmful parental behaviour. For example, if a child comes to us with a broken leg from a skiing accident and we see that the parents are constantly arguing in front of the child, that's not good for the child, but it's not abuse. I see very clear abuse, for example, when parents blame the child for their accident. Or disregarding the child's privacy.
If a child suddenly has a fever of 40 degrees, parents want a solution right now.
What do you mean?
We have a 17-year-old patient with a rare disease. The mother has now posted her daughter's medical history in detail and with all the photos on her Facebook account without asking her daughter. I don't think that's right. It's not good for the child.
The number of unreported cases of abuse is likely to be even higher.
Yes, of course. The range of what constitutes abuse and where it begins is really wide and also changes over the years. The definitions are not set in stone either.
Where does neglect begin? And what is harassment? A text message, a word, an insult? You mentioned parental overload. Does stress play a role?
Many unpleasant situations are stress-related, at least in cases where things are not running smoothly. For example, job loss or relationship problems can trigger stress. As a result, there is a risk that your own needs take centre stage instead of those of the child and someone loses patience. It is then important to seek help so that abuse does not occur.
To what extent does your work influence your view of humanity?
I can't make the world a better place, but I can try to make the world a better place for the children who come to me.
Do you remember your first case?
A five-year-old girl was beaten to death and pushed down the stairs. Her seven-year-old sister came to me in the emergency department for an examination. She had no signs of physical abuse, but she was spindly. It was clear to me that the parents had starved the girl. After the examination, I took the child to the cafeteria and told her to choose something. The girl said: «Just anything?» I replied: «Yes, take whatever you want.» I have never forgotten the gleam in his eyes.
What did you tell the girl's parents?
My knowledge that they had beaten one child to death and almost starved the other to death triggered such anger in me that I would have loved to lash out at the parents. My boss at the time, Ulrich Lips, took me to one side and told me: "That won't help either the dead or the living girl. We now have to make sure that this child is protected and that this doesn't happen again. It was then that I realised that my emotions had no place here.
How can such bad cases be prevented?
It takes moral courage. If I see a child being beaten on the campsite, I shouldn't look away, but go and offer help. Or at the GP: if you take a baby for a vaccination, a good paediatrician should tell you what the next developmental steps are. For example, that the child could develop three-month colic or is approaching the age of defiance.
Actually a contradiction. Parents have never been so well informed.
There are the over-informed parents who know everything and are often over-worried. On the other hand, there are parents who have never read a guidebook and never will. As a doctor, you then have the task of picking up these parents and informing them.
This can also be interpreted as interference.
In my opinion, there are two views on life. Either you see the family as a closed system in which you don't interfere. Or the opposite: a system in which people look after and care for each other, because people are actually social beings.
Do you also tell your students this?
Yes, but not everyone is of the same opinion. A medical student once came up to me after a lecture and said that if a father beats his child, you shouldn't intervene, it's only the family's business. When I replied: What if he beats the child to death? The young man explained that the father would have to deal with it himself. As you can see: Even among so-called educated people, there are still those who do not recognise the autonomy of the child.
What is your message as a child protector?
Every child must have optimal development. That is his or her right. A child must not be at the mercy of its parents. If the parents cannot look after the child, someone else must do it. Children need someone to look after them.
Do you follow up on the cases of the children you were unable to help?
I find it stressful not knowing what will happen to the child. That's why I often ask. In suspected cases too, we ask how things are going and how the child is developing. But even then we have to hand over responsibility.
What does a child need to thrive?
A child's physical development is normal if you look after it and take care of its health. Not like the parents who were admitted to our hospital with their child. The child had severe burns. Unfortunately, the parents only came to us five days after the accident, when the skin already smelled bad. When I asked them why they were only coming now, they replied that we were all so ill. Caring for a child also means going to hospital even though you are ill yourself. The child's health always comes first, no matter what.
Mental health too? Keyword: cognitive support?
That is also important. But a child is not only happy when it has a school-leaving certificate and can go to university. A child is happy and satisfied when you listen to them and include them. When I hear about children who have to play the violin, do sport and attend a Russian language course, I sometimes wonder whether this is beneficial to their development.
But parenthood is also hard sometimes. You constantly have this fear in your head that you're not doing the right thing ...
Yes, you're right. Parenting is a very difficult thing. I don't have the solution either. I just think that listening to your child and involving them in decisions should be very important. That doesn't mean that you shouldn't set boundaries at all. I would like parents to simply listen to themselves, to their intuition, taking the child into account.
