Child abuse: assessment and intervention

The National Statistics on Child Abuse and Neglect are staggering and rising despite a national objective to decrease domestic violence, of which child abuse is a part. More than 3 million children are abused each year. That figure represents 25 out of every 1,000 children being physically, sexually, or emotionally abused or neglected by their caretakers. It is important to note that 50% of abused children have an abused mother (American Medical Association, 1992). There are immediate as well as long-term sequelae of abuse including emotional and developmental problems, permanent injury, death, and perpetuation of abuse to the next generation. Since fractures are often part of the constellation of injuries seen in the abused child, orthopaedic nurses may encounter these children in a range of settings. Recognizing the signs of abuse is an important step for intervention on behalf of the child.     

Incidence of psychogenic seizures in adults: a population-based study in Iceland

OBJECTIVE: We report an unusual case of penetrating pencil injury in a young child that turned out to be a case of physical abuse. METHOD: This is a case report with review of the literature. RESULTS: A 4-year-old boy was brought by his mother to the accident and emergency department for a penetrating wound of the right hand. He was said to have injured himself during a fall at home while holding a sharpened lead pencil. The pencil broke after penetrating the hypothenar eminence, leaving the graphite tip embedded in the palm. On surgical exploration, a piece of graphite measuring 1.3 cm was removed. The injury was actually inflicted by his mother because he failed to complete his homework properly. Deep penetrating injuries associated with the lead pencil are uncommon events in the medical literature. They are often reported as accidental and usually involve the oropharynx and the orbit. CONCLUSION: Deep penetrating injury with a pencil is unusual in childhood and the public should be made aware of the possibility of nonaccidental injury.     

Theoretical assessment of family-centered care

The purpose of this study was to develop a theoretical concept system to describe family-centred care in a child welfare clinic. A hybrid model was used as a method for concept development. The aim was to test categories which describe family-centred care. The categories were based on the review of the literature and on the analyse based on the interviews of the public health nurses and their client families. The results show that family-centred care at the child welfare clinic can be described by six categories: the life situation and the living conditions of the family, the individuality of the family, the relationship between the family and the public health nurse, nursing actions, the expert knowledge of the public health nurse and her individuality. The results show the different levels of family-centered care. The child, all the members of the family or the whole family system can be chosen as a starting point of nursing. The public health nurses considered that the whole family is the starting point of the family-centered nursing.     

Retinal hemorrhage in the infant as an indication of shaken baby trauma

BACKGROUND: The shaken baby syndrome is a form of child abuse in young children. Typical are intracranial and intraocular bleedings. As external injuries are often missing, the shaken baby syndrome may easily be overlooked. Intraocular bleeding is a major diagnostic sign and can prove the diagnosis, if child abuse is suspected by the paediatrician. Thus critical family situations can be uncovered and long term help can be initiated. PATIENTS: Between 1991 and 1997 seven babies (age two to nine months) with intraocular bleedings were examined. Diagnosis, differential diagnosis and prognosis of the shaken baby syndrome are presented with these children. RESULTS: In two of the seven children a non-accidental trauma and shaken baby syndrome was obvious. In three cases the diagnosis of a shaken baby syndrome was most probable. In one child intraocular bleeding was possibly caused by a fall three months earlier. One child had retinal bleedings after resuscitation. In two cases a vitrectomy was performed. The follow up was two months to six years. In two children intraocular bleeding resolved completely, three children developed mild to severe amblyopia and two children became blind. Vitrectomy could not prevent loss of sight. CONCLUSIONS: Sudden cerebral symptoms or intraocular bleedings in otherwise healthy young children are suspicious for child abuse. A shaken baby syndrome has to be considered. Thus funduscopic examination in mydriasis is obligatory. The prognosis depends on the severeness of ocular hemorrhages and cerebral lesions.     

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.     

Follow-up skeletal surveys in suspected child abuse

OBJECTIVE: The purpose of this study was to assess the additional yield of a repeat skeletal survey in identifying and dating skeletal injury for cases in which child abuse was strongly suspected. MATERIALS AND METHODS: Twenty-three infants and toddlers strongly suspected of being physically abused on the basis of findings on the initial skeletal survey, other imaging studies, history, or physical examination underwent a follow-up examination approximately 2 weeks after the initial examination. The high-detail imaging system included a single-emulsion, single-screen combination with a low-absorption carbon-fiber cassette. The skeletal survey protocol entailed tightly collimated anteroposterior views of the appendicular skeleton and anteroposterior and lateral views of the axial skeleton. Between the two studies, all children were in Department of Social Services custody or living in a safe home. RESULTS: The follow-up skeletal survey yielded additional information regarding skeletal injury in 14 (61%) of 23 cases. Follow-up study increased the number of definite fractures detected from 70 to 89 (27%) (p = .005). Most of these additional injuries were classic metaphyseal lesions or rib fractures. In 13 of the 70 fractures previously detected, the follow-up skeletal survey also provided important information about the age of those injuries. CONCLUSION: When child abuse is strongly suspected on the basis of the findings on the initial skeletal survey, other imaging studies, history, or physical examination, a follow-up skeletal survey is recommended to provide a through and accurate assessment of osseous injuries.     

Review of Secondary traumatic stress and the child welfare professional.

Reviews the book, Secondary traumatic stress and the child welfare professional by Josephine G. Pryce, Kimberly K. Shackelford, and David H. Pryce (see record 2007-05981-000). This book offers a complete examination of an important and often overlooked issue in the field of trauma work—secondary traumatic stress (STS). The authors appear to have written this book in response to a relative dearth of literature in this area as it affects child welfare workers. The research summarized and cited in this book is current, making the book timely and well developed. The easy-to-comprehend writing style of the authors flows and allows readers to be easily drawn into the case scenarios provided. Any professional working in child welfare as a caseworker, investigator, or supervisor, will benefit from reading this book. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Child abuse: why should I report it?

In Indiana, dental professionals are mandated by law to report suspected child abuse and neglect to Child Protective Services (CPS) or the law enforcement agency in their county. The penalty for non-reporting is fine and/or jail. This article will give dental professionals information on child abuse injuries that can be identified in the dental office, how to talk to the child and family members regarding suspicions, and how to report those suspicions to your local CPS or law enforcement agency. Dental professionals will receive reassurance and encouragement from this article to report suspected cases of child abuse to CPS or law enforcement. The report is not meant to be punitive, but is intended to get the family connected to services to assist them, the child, and any other children they have or may have in the future, to avoid further abuse, and to attempt to break the cycle of abuse. To report suspicions of child abuse in Indiana, dial: 1-800-800-5556.     

Parental substance abuse as a predictor of child maltreatment re-reports

This longitudinal study of child abuse and neglect cases closed after investigation examined the impact of parental substance abuse on family functioning and on subsequent referrals to child protective services. The findings support the hypothesis that parental substance abuse would have a negative impact on family functioning, which, in turn, would result in a higher rate of re-reports. As expected, substance abuse also had a direct impact on re-reports. It is critical that the child welfare system recognize and respond to parental substance abuse problems in these families through expanded and improved voluntary, and perhaps, mandatory services.     

Childhood sexually transmitted diseases and child sexual abuse: results of a Canadian survey of three professional groups

The purpose of this national survey was to determine the knowledge and attitudes of Canadian health and social services professionals about the occurrence of sexually transmitted diseases (STDs) in children and its implications for child sexual abuse. A mailed questionnaire was sent to a randomly selected sample of 4,500 nurses, physicians, and youth/social workers across the country. Response rates varied from over 60% of nurses and youth/social workers to only 38% of the physicians. Nurses and youth/social workers were younger than physicians, had a proportionately higher number of females within their groups, and more frequently reported that they had or might have been sexually abused as children. Although there was no statistically significant difference among the groups on the composite knowledge score, physicians scored higher than the other two groups on knowledge about STDs, and youth/social workers had the highest knowledge scores about sexual abuse. Some differences in attitudes among the groups were also noted. Overall, the rates of respondents reporting confidence in their ability to treat children with STDs or child sexual abuse were low (26% and 35% respectively). This paper presents the overall results of the survey, and makes recommendations for strategies to enhance professional expertise in the area.     

Physical abuse of preschoolers: identification and intervention through occupational therapy

Child abuse is a major public health concern in the United States, one that has negative consequences on abused persons' productivity and mental health throughout their lives. Occupational therapists who work with preschool-aged children are in a strategic position to screen for physical abuse and aid in the rehabilitation of children and families engaged in abuse. This article provides a review of the literature and accounts of clinical experience with children and families in a variety of settings. It offers an overview of behavioral risk factors that have been shown to correlate with physical abuse, including how these factors can be observed within the context of an occupational therapy evaluation. Guidelines for interacting with child protective services via reporting suspected cases of child abuse and working collaboratively with such agencies are provided. Strategies for occupational therapy intervention with abused children and their parents are described. These strategies include using activities to facilitate positive parent-child interaction, educating parents regarding child development and management techniques, and facilitating children's psychosocial development.     

Pediatric elbow trauma

Acute pediatric elbow trauma is commonly seen in the emergency department (ED). Reports confirm that, compared to other fractures, children's elbow fractures are commonly misdiagnosed in the ED. In addition, missed orthopedic injuries are one of the leading causes of malpractice claims in emergency medicine. Radiologic diagnosis of these injuries is challenging, as a large portion of the pediatric elbow is composed of radiolucent cartilage. Knowledge of the normal anatomy and ossification centers around the elbow is essential for correct diagnosis. Acute neurovascular injury is frequently associated with these injuries, but is often difficult to assess in an apprehensive child. Immediate orthopedic consultation is indicated for any child with an elbow injury in whom neurologic or vascular compromise is suspected. Consultation should be strongly considered for children with displaced supracondylar fractures and/or significant echymosis and swelling about the cubital fossa.     

"Hidden" laryngeal injuries in homicidal strangulation: how to detect and interpret these findings

These studies were designed to demonstrate that the usual method of laryngeal dissection carries a significant risk of overlooking important laryngeal injuries. Formalin-fixed hyoid-larynx complexes were prepared in a prospective forensic study involving 191 cases of homicidal strangulation, 1984 to 1997. The basic steps of the applied method included: complete resection of the thyroid cartilage, a horizontal incision through the cricoid cartilage before opening the larynx dorsally, inspection of the laryngeal joints, and incisions of the laryngeal muscles. Using this procedure allowed us to detect the following injuries, which otherwise would have been destroyed or overlooked: (a) 17 incomplete fractures restricted to the dorsal surfaces of the thyroid laminae and 10 incomplete or non-dislocated fractures of the cricoid cartilage. In 7 cases, such a "hidden" fracture was the only laryngeal injury resulting from neck compression. (b) Extensive laryngeal muscle hemorrhages, especially of the vocal folds, were found in almost half of all cases, more rarely in strangulation by ligature and more frequently in manual strangulation. Gross hemorrhages were the decisive local laryngeal finding in 19 cases. (c) Laryngeal joint injuries (bleedings) were found in 18% to 52% of the different strangulation types. (d) Hemorrhages of the laryngeal mucosa were common findings that occur in about 60% of all cases; only in rare cases do such bleedings have a special diagnostic value. The quantity and significance of findings obtainable from complete preparation clearly document Camps's demand made in 1976 to dispense with the usual laryngeal dissection technique (dorsal scissor incision through the cricoid cartilage), at least in (questionable) strangulation cases.     

Factors influencing the reporting of father-child sexual abuse: Study of licensed practicing psychologists.

Several studies have indicated that high proportions of practicing psychologists fail to report cases of suspected child sexual abuse despite their knowledge of mandatory reporting laws. We surveyed 279 practicing psychologists from two states, using a set of controlled vignettes. Results indicate that clinicians' decisions to report suspected sexual child abuse are affected by the accused father's admission or denial of abuse and by the clinician's expectation of what effect reporting would have on continued therapy. Results are discussed in the context of previous research and state mandatory reporting laws. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Immunocytochemical localization of aromatase-containing neurons in the rat brain during pre- and postnatal development

This article discusses the existence of both spouse abuse and child abuse within families. Recent research suggests that practitioners have often missed the coexistence of these problems within their caseloads. Practice implications for both domestic violence service providers and child welfare professionals are outlined. Recommendations for changes in assessment procedures, treatment planning, and implementation are made.     

Outcomes related to burn-related child abuse: a case series

Nationally, approximately 10% of child abuse cases involve burning, and up to 20% of pediatric burn admissions involve abuse or neglect. Historically, these cases have been more difficult to prosecute than nonburn cases for multiple reasons. Between 1995 and 1999, there were 285 pediatric (under 18) patients admitted to the Spectrum Health Regional Burn Center. Of these cases, 18 of the alleged perpetrators were legally investigated for suspicion of child abuse, and 7 received punitive sentences. We found that men tended to be prosecuted and convicted more often than women and that cases involving multiple instances of injury tended to be prosecuted more frequently. Similarly, we found that cases involving more severe injuries tended to be prosecuted more successfully. There are many psychological and social factors involved in handling burn abuse cases. However, by successful prosecution of these crimes, victims tend to fare better both socially and psychologically.     

Variations in perceptions of child neglect

This study explored the perceptions of the seriousness of specific components of neglect held by mothers from three cultural groups and held by public child welfare workers in two different roles in the Chicago area. It then compared the perceptions of the mothers to those of the workers. The findings suggest that members of minority groups perceive some types of child neglect as more serious than do their Caucasian counterparts, that investigative workers see most types of child neglect as more serious than do service workers, and that workers see all types of child neglect as less serious than do the mothers. Comparisons revealed that various groups perceive the dimensions of neglect differently in terms of their potential harm to the child.     

Child maltreatment polyvictimization: Rates and short-term effects on adjustment in a representative Hong Kong sample.

Objective: This article examines the unique effects of multiple forms of victimization, namely child abuse and neglect (CAN) and exposure to parental intimate partner violence (IPV), on children's self-blame, feelings of being threatened, self-esteem, and ability to control anger. Method: The cross-sectional study recruited a population-based sample of 2,062 children aged 12–17 years in Hong Kong. Structured questionnaires were used to collect data from the children. The prevalence rate of the co-occurrence of exposure to IPV and CAN in the Chinese population, and the unique impacts of exposure to IPV and CAN on children were examined. Results: The results show that 13.1% of the children had experienced CAN, and 6.5% had witnessed parental IPV. Among those families characterized by IPV, 61.1% were involved in child abuse in the preceding year of the study. Participants who had experienced both CAN and exposure to parental IPV reported lower levels of self-esteem and higher rates of being aggressive and violent, and feeling threatened. These children also reported the highest levels of feeling that their well-being was threatened and of blaming themselves for parental violence and parental discipline. Conclusions: The findings reemphasize the important need for public policy on child and youth victimization that encourages social workers and Child Protective Services to screen for child polyvictimization in cases of suspected/reported child abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical decision making and mandatory reporting in cases of suspected child abuse

This article presents a unique approach to analyzing the issue of mandatory reporting suspected child abuse from an ethical decision-making perspective with a nursing model. Sometimes nurses confront this problem in their own families or in their neighborhoods or social groups. Clearly, deciding to intervene is a challenging and difficult process. Yet reporting is mandated by law. A model of ethical decision-making may guide the clinician in this process.     

The phenotype enhancement method identifies the Xcp outer membrane secretion machinery from Pseudomonas alcaligenes as a bottleneck for lipase production

Contemporary social issues typically spring from historical roots, and, as this article points out, that is particularly true of the effort to find a balanced, fair, and helpful way of responding to child abuse and neglect. This article examines how today's child protective services system evolved from a past of almshouses, orphan trains, anticruelty societies, and legislation establishing the protection of children as a government function. The author finds that the history of child protection in the United States is marked by a continuing, unresolved tension between the aim of rescuing children from abusive homes and that of strengthening the care their families can provide. Against that backdrop, this article explains the structure of the typical child protective services (CPS) agency (the unit within a broader public child welfare department that focuses on abuse and neglect) and outlines the roles in child protection that are played by the police, the courts, private and public social service agencies, and the community at large. According to the author's analysis, the fundamental challenges facing CPS can be captured in two questions regarding appropriate boundaries for the agency: Which situations require the agency's intervention? And how can the broader resources of the community be mobilized in the effort to protect children?