by Tara L. Harris, M.D., M.S., FAAP
In many families, companion animals
play an important role and are considered family members. For children, pets
can serve as playmates and non-judging
confidants, and they can contribute to a
child’s development of self-esteem, feelings of empathy and connection to others. Unfortunately, in the web of family
violence, pets are not immune, and their
abuse can be used to manipulate and harm
other family members.
When a pediatrician is told of threatened harm or abuse of a pet, it may not be
obvious immediately that this is a concern
to prioritize. However, a growing body of
research is revealing the worrisome implications for
children in homes where a pet has been abused.
According to the American Veterinary Medical Association, as many as 70% of families with minors have
pets ( www.avma.org), and multiple studies of women
receiving services for domestic violence (DV) have
shown a similar pattern of pet ownership. Research
in recent decades has revealed that the multiple forms
of family violence (partner violence, child abuse, elder
abuse) often co-occur; more recently documented is
that companion animal abuse also is a component
of this dynamic. Up to half to three-quarters of DV
victims in shelters report that their abusive partner has
harmed or killed one or more of their pets.
Abuse of pets raises concern for the children in
these households for several reasons. First, witnessing the abuse of a beloved pet is emotionally distressing for the child. It also models a pattern of behavior
that clearly is detrimental to healthy development.
In addition, abusers’ unrealistic expectations of
pets may lead to abusive incidents such as beating a
young puppy for urinating on the floor. This is espe-
cially worrisome since unrealistic developmental ex-
pectations also are a common trigger for child abuse
(e.g., shaking injuries in crying infants and abuse of
toddlers associated with toilet-training accidents).
Even when household violence is not directed
at children, they may sustain injuries if caught in
the “cross-fire.” In most homes where a pet is being
abused, the children report intervening or attempting to intervene to protect their pet (McDonald SE,
Collins EA. Child Abuse Negl. 2015;50:116-127).
The length of time children remain in these dangerous, sometimes deadly, environments may be
prolonged by the presence of pets; concerns about
the pets’ safety leads many victims to delay leaving
their abusive homes.
Abusers whose violence includes abuse of family
pets have been shown to be more controlling and to
employ more dangerous forms of violence (e.g., rape
and stalking) than abusers who do not abuse pets
(Simmons CA, Lehmann PL. J Interpers Violence.
What pediatricians can do
For the reasons discussed here, pediatricians must
be concerned for their patients’ safety when they
have reason to believe a family pet has been abused
or killed. Following are steps they can take to help
protect their patients.
• Develop a protocol for how and when to make
a report if abuse of a pet is disclosed.
• Advocate for local DV shelters to allow pets or
develop foster programs to remove this barrier
to leaving dangerous homes.
• Encourage local child protective service and
animal humane organizations to work collaboratively to ensure that when a home is known
to be affected by violence that the safety of all
dependents is addressed.
• Offer trainings for animal control officers on
recognizing red flags for child abuse, and participate in development of guidelines for when they
should involve child protective services.
• Advocate for legislation to add penalties if animal
cruelty is inflicted in the presence of a child and/
or for child maltreatment that includes actual or
threatened harm to a child’s pet to acknowledge
that such animal abuse is emotionally abusive
to the child.
Pediatricians have long understood that to advocate for their patients’ health and safety, they must
advocate for the health and safety of the entire family. For many families, that includes their pets.
Dr. Harris is a member of the AAP Section on Child Abuse and Neglect.
by Nanette B. Silverberg, M.D., FAAD, FAAP,
and Sharon Jacob, M.D., FAAD, FAAP
The skin, once thought to be immunologically
sequestered from the body, is now deemed to be an
integral part of a multisystem inflammatory axis.
Atopic dermatitis (AD) and psoriasis, especially
in their most severe forms, have been linked to a
variety of systemic inflammatory disorders and
comorbidities. These comorbidities highlight that
inflammatory skin diseases of childhood are serious
chronic multisystem illnesses and not merely cosmetic conditions.
Atopic dermatitis comorbidities vary by age and
length of illness. Some of the most common co-
morbidities are included in the gold-standard AD
diagnostic criteria by Hanifin and Rajka (Acta Derm
Venereol Suppl (Stockh) 1980;92:44-47). These crite-
ria include pruritus, chronic or recurrent dermatitis,
specific distribution by age (e.g., flexural disease of
childhood) and personal and/or family history of
atopy, i.e., food allergies, asthma and allergic rhi-
noconjunctivitis. Minor features include more than
a dozen comorbid conditions, including ichthyosis
vulgaris; bacterial and viral infections; allergic pre-
disposition with positive immunoglobulin E and
skin prick testing; eye findings such as cataracts; and
excessive skin reactivity to touching foods, pressure
and environmental triggers. These major and minor
criteria actually have been staring us in the face for
almost 40 years with the concept of comorbidities
being part and parcel of the definition of atopic der-
matitis and the atopic diathesis.
Recently, both pediatric psoriasis and atopic dermatitis have been linked to cutaneous infections and
psychosocial disorders such as anxiety, depression
and hyperactivity for the children involved and their
parents. Linkage to cutaneous autoimmunity, including vitiligo and alopecia areata, may be noted
in both sets of diseases.
The most important and well-described series of
comorbidities shared by these two diseases is the association with obesity and the metabolic syndrome
— a cluster of conditions characterized by increased
Pet abuse should raise concerns for physical,
emotional safety of children
A growing body of research is revealing the worrisome implications for children in homes where a pet has been abused.
Atopic dermatitis, psoriasis have similar comorbidities