Incidence of child neglect and child abuse in the region of Copenhagen

The aim of the study was to evaluate the incidence of physical violence, neglect and sexual abuse against children as reported to the local authorities, in the county of Copenhagen during the year 1993. A questionnaire was mailed to the local authorities in the 18 districts in the county and to 18 schools and 18 general practitioners (GP's). They were asked whether, and how many new, verified and suspected cases of physical, emotional and sexual abuse had come to their attention in 1993. A total of 300 cases of child abuse were identified in the area with a total population of 675.000 i.e. a total incidence of 2.7 cases per 1000 children aged 0-17 years (2.7%), with 0.7% for physical violence, 0.5% for sexual abuse and 1.5% for emotional neglect. Some 180 cases were considered verified and 120 cases were suspected. A considerable variation between the different districts was noted, i.e. the local incidence varied from 0-5.4%. A statistically significant inverse correlation between the average local tax-income and the incidence of child abuse and neglect was found. There were several examples of schools having knowledge of more cases than the local authorities. Very few cases came to be attention of the GP.     

Measurement of tibial torsion

AIM OF STUDY: To investigate the Singaporean doctor's and lawyer's definition of child abuse and neglect, their attitudes towards reporting and their manner of handling suspected cases. METHODS: A self-addressed questionnaire survey was carried out in a population of hospital doctors, family physicians and lawyers. A total of 368 respondents participated in the survey. RESULTS: Most respondents had similar parenting attitudes. The majority felt that child abuse occurred sporadically but 25% of family physicians felt it seldom occurred. Thirty-eight per cent of family physicians had a personal definition of child abuse compared to less than a third of hospital doctors. There was a high consensus among all 3 groups concerning 21 behaviours studied. In all 3 groups, more than 80% agreed that having sex, burning child, tying child and not protecting the child from sexual advances were both unacceptable and abusive. More than 80% of respondents felt that some form of compulsory reporting is necessary in Singapore. Doctors preferred to refer cases of physical abuse to the hospital while lawyers preferred the police. All agreed that sexual abuse is a matter for the police. Respondents were more likely to act in cases of physical abuse and sexual abuse than for cases of emotional abuse and neglect. CONCLUSIONS: There is a need to formalise definitions of child abuse in our society. More education and training in the understanding and handling of child abuse by doctors and lawyers may be necessary.     

Child hearsay statutes: At once over-inclusive and under-inclusive.

Special child hearsay statutes allow for the admissibility of demonstrably reliable but otherwise inadmissible children's hearsay. These statutes were among other child witness innovations that proliferated in the 1980s and 1990s to redress the proof problems that arise in child sexual abuse prosecutions. The author argues that the special child hearsay statutes are at once over-inclusive and under-inclusive: over-inclusive in that child sexual abuse prosecutions typically include the testimony of the child witness and multiple hearsay witnesses; and under-inclusive in that they allow for the admissibility of children's hearsay in child abuse cases but may require the child declarant to be the child victim, excluding the hearsay statements of other child witnesses, and typically do not apply to the hearsay statements of children who witness crimes other than child abuse, like domestic violence. She proposes reforms to remedy these deficiencies in the special child hearsay statutes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrasting perspectives on the nature of sexual assault provided by a service for sexual assault victims and by the law courts.

Examined data on 1,236 cases responded to during a 5-yr period by a sexual assault service (SSAV) and 116 cases during the same period that appeared before the courts, 58 of them involving abuse of children under 16 yrs old. Large numbers of adult women had been sexually assaulted while persuing normal heterosexual social activities, and children had been abused primarily in their own home by family members. The profiles of victims in the court cases reflected the more traditional views of sexual assault that still appear to hold sway in the legal system. In the courts, adult female victims tended to have been violently assaulted by disturbed men, and child victims tended to be those who were abused outside the family. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Circumstances surrounding the occurrence of child maltreatment.

Examined circumstances surrounding the occurrence of child maltreatment for 825 physical abuse incidents, 188 emotional cruelty incidents, 799 occurrences of neglect, 766 severe but nonabusive physical discipline incidents, and 366 incidents of mild and nonabusive discipline. These incidents occurred in 328 families, which included all the families cited for child abuse over a 10-yr period in a 2-county area of eastern Pennsylvania. The age of all children for whom accidents were recorded ranged from birth through 17 yrs. Results show that physical abuse tended to be associated with child behaviors; emotional cruelty was associated with adult conflict that enlarged to involve the child; and neglect was characterized by failure of parents to assume parental responsibilities. Interpretation of the findings focused on the role of the parent–child interaction in physical abuse, the role of adult interactions in emotional cruelty, and the inadequacy of parental motivation and child-rearing skills in neglect. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of individuals' characteristics and experiences on their definitions of child maltreatment

OBJECTIVE: This study was designed to explore the extent to which individuals' own characteristics and experiences, particularly those involving child-rearing and child maltreatment, influence their definitions of abuse and neglect. METHOD: An anonymous written questionnaire asking respondents to rate the importance of individual factors to an abuse determination, as well as to rate the likelihood of specific acts incorporated into vignettes to constitute abuse, was administered to participants (n = 323) representing six groups with diverse relationships and experience with children: mental health professionals, legal professionals, medical professionals, preschool and elementary school teachers, parents, and adult nonparents. RESULTS: Parenting experience had only a minimal effect on assessments of abuse, while having encountered a case or suspected case of maltreatment at work predisposed individuals to view more ambiguous acts as less likely to constitute abuse. Nonetheless, this latter group was less receptive to factors offered in mitigation of perpetrator liability. Surprisingly, no effect was detected for individuals themselves identifying as a victim or perpetrator of abuse or neglect. CONCLUSIONS: Although personal experiences with child-rearing and child maltreatment had only a marginal effect on individuals' assessments of abuse and neglect, the role played by professional experiences with such cases should be investigated further as it does appear to impact these determinations. Along with the delineation of key factors discussed in this study, such work can assist in the development of a much needed standard to guide practitioners, particularly in regard to more ambiguous acts which tended to produce more guarded reactions from professionals.     

Managing procedural pain in children with burns. Part 1: Assessment of pain in children

Managing procedural pain in a child involves multiple factors, including how to evaluate the pain. This process is more difficult with children because of differences in cognitive and physical development. A multidimensional model for the assessment of pain in a pediatric burn patient is presented along with recommendations based on various levels of development.     

Heparin, low molecular weight heparin, heparinoid, and antithrombin III therapy of disseminated intravascular coagulation

OBJECTIVE: To determine features of fractures in young children that would be helpful in distinguishing child abuse from unintentional injuries. DESIGN: Case series. SETTING: Pediatric Services of Yale-New Haven (Conn) Hospital (a tertiary care center). PATIENTS: Consecutive children who were less than 3 years of age and who were examined for a fracture from January 1979 through December 1983 were identified from the daily logs of the emergency department or the hospital's child abuse registry. OUTCOME MEASURE: Each case was rated, by means of predefined criteria and a consensus of two clinicians and two pediatric radiologists, on a seven-point scale from "definite child abuse" to "definite unintentional injury." A middle rating of "unknown" was used if there was not enough information to reach a consensus. RESULTS: Of the 253 fractures in 215 children that were identified, we categorized 24.2% as abuse, 8.4% as unknown, and 67.4% as unintentional injuries. Fractures that were considered likely due to abuse were (1) fractures in children whose caretakers reported either a change in the child's behavior, but no accidental event, or a minor fall, but the injury was more severe than expected; (2) fractures of the radius/ulna, tibia/fibula, or femur in children less than 1 year of age; or (3) midshaft or metaphyseal fractures of the humerus. Linear fractures of the parietal bone were the most common skull fractures, whether due to abuse or unintentional injuries. CONCLUSION: In young children with fractures, child abuse is common. By comparing fractures due to abuse and those due to unintentional injuries, we obtained empiric evidence to help clinicians and radiologists correctly examine children with such serious injuries.     

Childhood memory and a history of different forms of abuse.

Awidespread professional and public controversy has recently emerged regarding recovered memories of child sexual abuse, but the prevalence and nature of these memories have received limited empirical examination. This study (N?=?553 nonclinical participants) found that very similar proportions of those with histories of physical, emotional, or sexual abuse reported that they had periods without memory of their abuse (21%, 18%, and 18%, respectively). The responses of approximately one half of these participants suggested that they lacked conscious access to their abuse memories, whereas the responses from the others suggested that they had conscious access to their memories. A great deal of variance was found in the reported quality of general childhood memory and the offset of infantile amnesia, and the findings also suggest that it is normative to recover memories of childhood. Each of these variables was also unrelated to the experience of child abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in abused children with and without disabilities

OBJECTIVE: Two questions were posed: (1) What are the proportions of boys and girls in various categories of substantiated child abuse? (2) Do the gender proportions differ for children with and without disabilities? METHOD: Data collected by previous researchers from a demographically representative sample of U.S. child abuse reporting districts was analyzed. This included 1,249 case files involving 1,834 children. The number of girls and boys who did and did not have disabilities was identified for three age categories and for several categories of abuse. Chi-square analyses were used to determine whether there was a relationship between disability and gender for the various age and abuse categories. RESULTS: More boys were physically abused and neglected, but more girls were sexually abused. Boys with disabilities, however, were over-represented in all categories of abuse. Moreover, gender proportions among abused children with disabilities differed significantly from those found among other abused children. Although slightly more than half of abused children without disabilities were girls, 65% of abused children with disabilities were boys. CONCLUSIONS: Boys represented a significantly larger proportion of physically abused, sexually abused, and neglected children with disabilities than would be expected from their respective proportion of abused and neglected children without disabilities. Several possible explanations for the observed gender and disability status interaction are discussed.     

The complexities of eliciting and assessing children's statements.

The authors agree with the main elements of M. Bruck and S. J. Ceci's (see record 1996-09956-001) amicus curiae brief for the case of State v. Michaels, but they believe that 4 specific aspects of child sexual abuse investigations deserve a more constructive emphasis. Research has tended to concentrate on the suggestibility of children and neglected other topics that may be of great utility to those who investigate suspected cases of child sexual abuse. More attention should have been paid in the brief to the complexities of assessment and the special characteristics of the Wee Care case. Too much emphasis has been placed on children and not nearly enough attention on remedial actions to minimize the problems associated with suggestion. Finally, research shows that it may be possible to develop reliable and valid techniques to assess child sexual abuse allegations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Scalp autografts and hair transfer to the face in the burned child

Hair transfer from split-thickness skin grafts harvested from the scalp is not a widely reported problem. The authors present their experience with hair transfer from scalp autografts in a pediatric burn population, with particular emphasis on hair transfer to the face. They retrospectively reviewed 3307 acute and reconstructive pediatric burn admissions over a 4-year period at a single institution and identified 109 cases in which the scalp had been used as a donor site and in which the patient survived the acute burn period. Data from 73 male and 36 female patients were analyzed with respect to age, race, sex, percent total body surface area burned, graft thickness, number of scalp harvests and time between harvests, and presence of donor site alopecia. Eighteen of the 109 patients had noticeable hair growth from their scalp grafts (17 percent). Fourteen of 18 cases of hair growth involved face or neck grafts (13 percent); the remaining 4 patients had hair growth elsewhere on the body. There was no difference between the two groups (hair growth versus no hair growth) when compared by age, sex, or graft thickness. There was a correlation between larger burn size and greater incidence of hair growth. Those who had multiple harvests of the same scalp donor site were more than twice as likely to have hair transfer (9 of 34 versus 9 of 75 patients), although time between harvests was not a significant variable. Caucasian children represented 77 percent of the study population yet 100 percent of the cases of problem hair growth. Thirty-three percent of the hair growth group (6 of 18 patients) and 4 percent of the remaining patients (4 of 91) had some degree of donor site alopecia. The scalp is a reliable and valuable donor site for skin grafting in children, particularly for facial burns. The authors note a moderate incidence of hair transfer (17 percent) and propose both suggestions for prevention and recommendations for management.     

Confirmation of childhood abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specified

The diagnostic validity of multiple personality disorder (MPD) and its association to trauma have been questioned because corroboration of child abuse in studies of patients with MPD is scant. The purpose of this study was to determine on a retrospective basis whether external corroboration of child abuse could be found in a group of patients with MPD and dissociative disorder not otherwise specified. A group of child and adolescent psychiatric inpatients and outpatients was chosen because of the extensive number of collateral records collected on them in a tertiary care setting. This group was also chosen because of the intense interest paid by child protective services and courts to child abuse during the past 15 years. This retrospective chart review confirmed child abuse in eight of nine patients with MPD and in all 12 cases of dissociative disorder not otherwise specified. This study provides further evidence of the association of severe dissociative disorders with trauma, particularly child abuse. Future studies should be prospective and blinded to avoid the possibility of investigator bias, and should include a control group for comparison of base rate of child abuse.     

Resident documentation of diagnostic impression in sexual abuse evaluations

In sexual abuse evaluations, the documentation of the examiner's diagnostic impression is essential. If the diagnostic impression is not documented, the examiner will have to rely on memory rather than the medical record when called to testify. The purpose of this study was to determine whether pediatric residents adequately document their diagnostic impression in child sexual abuse evaluations. We performed a three-year retrospective chart review from patients 0-17 years of age who were evaluated at our emergency room for suspected sexual abuse. We reviewed 1,487 charts for historical information, physical findings, and diagnostic impression. Physical findings were categorized as normal, nonspecific, suggestive, or indicative of penetration. In 77% of cases (N = 256) with hymenal findings indicative of penetration and 84% of cases (N = 31) with vaginal findings indicative of penetration, residents recorded no impression or a nonspecific impression. Results were similar for vulvar and rectal findings indicative of penetration. Residents fail to document an adequate interpretation of their physical examinations in sexual abuse evaluations.     

A survey of health care and child protective services provider knowledge regarding the toe tourniquet syndrome

Recent efforts to increase public awareness of child abuse may result in an increased number of inappropriate reports of suspected child abuse. The authors believe that digital hair strangulation should be included among the conditions that may be confused with child abuse. Digital hair strangulation (toe tourniquet syndrome) occurs primarily in infants and is characterized by a constricting band of foreign material that becomes tightly wrapped around a digit or digits (most often the toes). The consensus in the medical literature is that this condition is not the result of intentional injury. As no reference to the toe tourniquet syndrome exists in the child abuse literature, it was hypothesized that child welfare workers would be more likely than physicians and public health nurses to misinterpret this condition as resulting from intentional injury. A survey was conducted to test this hypothesis. Professionals from the fields of medicine, nursing, and child welfare were provided with a history and photographic findings of a child with a typical case of the toe tourniquet syndrome. Participants were surveyed regarding their interpretation of the described injuries. More than 50% of all respondents indicated that they would report this case as suspected abuse. Child welfare workers responded that the injuries were suggestive of abuse (83%), significantly more often than public health nurses did (45%), (chi 2 = 4.55, p = .03).(ABSTRACT TRUNCATED AT 250 WORDS)     

The co-occurrence of spouse and physical child abuse: A review and appraisal.

For more than 20 years, there have been periodic reports in the research literature about the co-occurrence of spouse abuse and physical child abuse. This review compiles and evaluates those reports. Forty-two studies were found that provided some data concerning co-occurrence; 31 of the studies included sufficient detail to be used in this review. The different types of studies are classified and methodological issues are discussed. The base rate of co-occurrence found in representative community samples was about 6%. In clinical samples of either battered women or physically abused children, the percentage of overlap ranged from 20% to 100%. When a conservative definition of child abuse was used, a median co-occurrence rate of 40% was found. Five models depicting the directionality of abuse in violent families are proposed and discussed in relation to the data and theories of violence. Recommendations for methodological improvements and theory-driven studies are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Jurors’ discussions of a defendant’s history of child abuse and alcohol abuse in capital sentencing deliberations.

We tested a novel theoretical model explaining the psychological processes underlying jurors’ discussions about a defendant’s history of child abuse and alcohol abuse in a capital case. We coded the extent to which jurors used child abuse and alcohol abuse as mitigating factors, as aggravating factors, or argued that they should be ignored. Relying on attribution theory, we coded the extent to which jurors rendered controllable or uncontrollable and stable or unstable attributions regarding the defendant’s history of child abuse and alcohol abuse. Jurors were more likely to argue that child abuse and alcohol abuse should not be used as mitigators or to even use them against the defendant as aggravators than they were to use them as mitigators. Jurors made more controllable than uncontrollable attributions regarding child abuse and more stable than unstable attributions regarding both child abuse and alcohol abuse. The more jurors supported the death penalty, the more they argued to discount child abuse and alcohol abuse as mitigators or use them as aggravators and the more controllable and stable attributions they made. Political orientation predicted discussions and attributions about alcohol abuse, but not child abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outcome and cost of child abuse

OBJECTIVE: To compare the cases of child abuse (CA) with other admissions in a pediatric intensive care unit (PICU) for differences in patient-specific health care costs, severity of illness (SI) and mortality, and describe their outcome. METHOD: A retrospective cohort study of all patients admitted to the PICU between January 1991 and August 1994. Discharge diagnosis, age, SI, mortality rate, length of stay, hospitalization charges ($Hosp), and mortality were retrieved. RESULTS: There were 937 admissions; 13 were secondary to CA. Cases of CA represented 1.4% of admissions and 17% of deaths. CA patients had the highest SI (61%), $Hosp ($30,684), daily charges ($5,294) and mortality rates (53%) than any other group. In our patients, SI is a factor that affects charges. Even when compared to a cohort group with SI, child abuse patients had higher daily hospitalization charges (p < .05). The medical bills for the acute care of a CA patient averaged $35,641 per case. Even with these expenditures, 70% died and 60% of the survivors had severe residual morbidity. CONCLUSION: These results confirm that interventional medical care in response to severe CA is very costly and the ultimate outcome is significantly worse than other diseases. Therefore, we believe it is imperative to allocate resources to prevention.