Non-accidental Injury Research Articles

The socio-economic status of families experiencing the sudden unexpected death of an infant – Is it possibly related to a higher rate of non-natural deaths among them

Low socio-economic status is recognized as one of the risk factors for SIDS. In this study we have pointed out the similarities between families that have SIDS cases and families in which infant non-accidental injury has been proven, as well as the differences between them and the general population. This study was conducted in Montenegro, comparing 30 cases of SIDS with 25 cases of known infanticides and with a control group (60 cases) consisting of live newborns and their mothers from the general population, randomly selected from hospital-born newborns without exclusion criteria. We combined and compared the infant characteristics and mother characteristics between the above cases. There were significant similarities between the SIDS group and the infanticide group in terms of the following characteristics: the education level of the mothers (p = 0.086); maternal employment (p = 0.278); and place of residence (p = 0.269); while there were differences between the two groups regarding hospital birth (p = 0.027) and marital status (p = 0.011). The SIDS and infanticide groups, combined, had higher incidences of: out-of-hospital deliveries (p < 0.001); uneducated mothers (p < 0.001); unemployed mothers (p < 0.001); low socio-economic status (p < 0.001); and cases outside of marriage (p < 0.001), compared to the control groups. This study indicated a possible higher incidence of non-natural death among SIDS cases, as reflected by low socio-economic status and linked attributes, which is explained by their similarities with the infanticide groups and differences with the control groups.

612 Non-burn Injuries in the Emergency Department as Indicators for Future Burn Abuse

Abstract Introduction Thermal burns are a common form of child abuse. They account for up to 20% of all abuse cases reported and are a significant cause of morbidity and mortality. It is imperative that healthcare professionals maintain a high degree of vigilance recognizing signs of abuse, however subtle they may be. This is necessary to protect these vulnerable patients and prevent further injury. Our study seeks to identify predictors of future abuse in patients presenting to the emergency department. This might allow us to identify at risk patients and employ earlier interventions to prevent future harm. Methods A retrospective data review was conducted on all pediatric patients admitted to our burn center between 2008–2018 who were also suspected victims of abuse. Data collected included patient demographics, length of stay, size of the burn, type, degree and location of burn, number of previous emergency room visits, and patterns of injury during previous emergency room visits. Abuse was suspected and investigated if the history was inconsistent with the injury or if it changed, if there was an unreasonable delay in seeking medical care. or if the patient was discharged to an alternative caregiver. Data was analyzed with SPSS Statistics version 10. Results Out of the 5915 total burn admissions between 2008–2018, abuse was suspected and investigated in 297 cases and confirmed in 131 of those suspected. Patients admitted for suspicious burn injuries had an average of 1.82 (SD=3.15, Min=0, Max=25) previous ED visits. Of these patients, 93.6% had medical insurance, 80.5% had a primary care physician, and 72.7% were up to date with their immunizations. The majority presented with 2nd degree burns (86.5%) and the most common mechanism of injury was scald (60.1%). Pediatric patients with confirmed abusive burn injuries had longer hospital length of stay (9.23 days vs. 3.90 days, p&amp;lt; 0.001), and had greater total body surfaced area burned (9.24% vs 4.71%, p=0.001). Significant indicators of abuse included burn injuries to the bilateral lower extremities (thigh and legs) (p&amp;lt; 0.001), bilateral feet (p=0.030), buttocks (p=0.047), and genitalia (p=0.018), as well as signs of abusive non-burn injuries during previous emergency room visits (p=0.005). Conclusions Non-accidental burns should be highly suspected in children presenting with injuries to the bilateral lower extremities, bilateral feet, buttocks, or genitalia, or those with a history of previous non-burn injuries suspicious of abuse. Furthermore, patients with non-accidental burn injuries had more extensive burns and longer lengths of stay in the hospital.

Rozpoznawanie ofiar przemocy seksualnej wśród dzieci i jej skutki w dorosłym życiu

The problem of child sexual exploitation is a difficult topic in many aspects. The current global situation related to the outbreak of the SARS-CoV-2 pandemic has contributed to reducing the detection of many forms of violence, including those against children. The detection of predisposing factors and alarming symptoms that can increase the vigilance of a pediatrician often involves careful examination and proper conversation with the caregiver, since it is he/she who spends the most time with a small patient and who can provide a lot of information about the behavioral changes of the child over time. However, it is important to be careful when formulating questions because the majority of child abusers are the people from the immediate surroundings of their victims. It is also crucial to be able to notice somatic symptoms and to assess the child's behavior at the doctor's office. Delays in recognizing victims of child abuse as well as time delayed psychological support can entail multiple negative consequences, in particular those related to mental health. Adults abused in their childhood have difficulties in maintaining long-lasting relationships and they struggle more often with eating disorders and mood swings.

Fifteen-minute consultation: The toddler’s fracture

The toddler’s fracture is a distinct entity among tibial shaft fractures. It is defined as a minimally displaced or undisplaced spiral fracture, usually affecting the distal shaft of the tibia,...

Imaging the pediatric retina: An overview.

Recent decade has seen a shift in the causes of childhood blinding diseases from anterior segment to retinal disease in both developed and developing countries. The common retinal disorders are retinopathy of prematurity and vitreoretinal infections in neonates, congenital anomalies in infants, and vascular retinopathies including type 1 diabetes, tumors, and inherited retinal diseases in children (up to 12 years). Retinal imaging helps in diagnosis, management, follow up and prognostication in all these disorders. These imaging modalities include fundus photography, fluorescein angiography, ultrasonography, retinal vascular and structural studies, and electrodiagnosis. Over the decades there has been tremendous advances both in design (compact, multifunctional, tele-consult capable) and technology (wide- and ultra-wide field and noninvasive retinal angiography). These new advances have application in most of the pediatric retinal diseases though at most times the designs of new devices have remained confined to use in adults. Poor patient cooperation and insufficient attention span in children demand careful crafting of the devices. The newer attempts of hand-held retinal diagnostic devices are welcome additions in this direction. While much has been done, there is still much to do in the coming years. One of the compelling and immediate needs is the pediatric version of optical coherence tomography angiography. These needs and demands would increase many folds in future. A sound policy could be the simultaneous development of adult and pediatric version of all ophthalmic diagnostic devices, coupled with capacity building of trained medical personnel.

From Victim to Minister's Advisor: A Personnal View of Child Protection in France.

In France, maltreatment of children, that mean “physical, sexual or emotional maltreatment, or neglect of a child” is a very underestimated phenomenon, yet it is running rampant. The various causes of child abuse are subject to denial, and the ensuing delay of identification of victims is profoundly damaging. As a medical doctor and survivor of child abuse, I have a clear vision of the shortcomings of our child protection system. Non-recognition or late recognition of cases of child abuse is directly related to a lack of knowledge and training on this subject, which leads to weaknesses both in terms of detection and reporting of potential cases. Once the children are identified, they need to receive proper care that should not be limited to the social aspects. Indeed, the victims of abuse suffer from important repercussions on their physical and mental health. Without proper care, their health as adults will be severely impacted. These children require specific care and an adapted health care pack, as well as inclusion in the child protection framework. The task force “Child health in child protection” that I manage has suggested the creation of a standardized healthcare protocol for child victims of abuse, with psychological and medical costs fully covered by the Government, especially regarding clinical psychologists and psycho-motor therapists.

Humeral nutrient artery may mimic non-accidental injury.

Humeral nutrient artery may mimic non-accidental injury.

인지행동치료 기반 부모훈련 프로그램이 아동학대 가해 부모의 부모양육태도, 부모 자녀간 의사소통 유형, 정서조절곤란에 미치는 영향

인지행동치료 기반 부모훈련 프로그램이 아동학대 가해 부모의 부모양육태도, 부모 자녀간 의사소통 유형, 정서조절곤란에 미치는 영향

Neurodevelopmental assessment at one year of age predicts neuropsychological performance at six years in a cohort of West African Children

ABSTRACT Rural children from Benin, west Africa were evaluated with the Mullen Scales of Early Learning (MSEL) at one year of age and then at six years with the Kaufman Assessment Battery for Children (KABC-II), the visual computerized Tests of Variables of Attention (TOVA), and the Bruininks-Oseretsky Test (BOT-2) of motor proficiency (N = 568). Although both the MSEL and KABC-II were available to the assessors in French, instructions to the mother/child were in local language of Fon. Mothers were evaluated with the Edinburgh Postpartum Depression Scale (EPDS), Caldwell HOME Scale, educational level and literacy, and a Socio-Economic Scale – also in their local language (Fon). After adjusting for maternal factors, MSEL cognitive composite was correlated with KABC-II with moderate effect sizes, but not with TOVA scores. Overall eta-squared effect for the multivariate models were moderately to strongly correlated (.07 to .37). Neurodevelopmental assessments in early childhood adapted cross-culturally are predictive of school-age neuropsychological cognitive ability.

Nigerian radiographers and non-accidental injury in children

ABSTRACT Background: It is not uncommon to hit children in Nigeria, hence there is an increased possibility of encountering children with non-accidental injury (NAI). Radiographers are one of the first-line caregivers in a hospital setting, hence it is important that they are able to identify and act appropriately in cases of suspected NAI in children Objective: The objective of this study was to establish Nigerian radiographers’ awareness and role both before and after identifying NAI in children. Materials and Methods: This was a descriptive cross-sectional survey that assessed radiographers’ awareness and role in identifying NAI in children. A Google Form link was distributed through various Nigerian radiographers’ WhatsApp groups, inviting interested radiographers to participate in the survey. Data were analyzed by using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results were presented by using tables and charts. Results: Ninety-eight radiographers working across the federation participated in the online survey. A total of 53.1% of the respondents clearly understood what NAI meant, whereas 59.2% never participated in the imaging of a child for NAI investigation. Only 12.3% were confident that they were very competent in identifying radiological signs of NAI in children. Conclusion: Although most radiographers understand what NAI means, very few agree that they have been formally trained in pediatric imaging, hence they lack the expertise in acting appropriately in cases of suspected NAI in children. The radiographers strongly believe that they would benefit from proper training to handle cases of NAI in children.

Congenital anomalies in children with postneonatally acquired cerebral palsy: an international data linkage study.

To describe the major congenital anomalies present in children with postneonatally acquired cerebral palsy (CP), and to compare clinical outcomes and cause of postneonatally acquired CP between children with and without anomalies. Data were linked between total population CP and congenital anomaly registers in five European and three Australian regions for children born 1991 to 2009 (n=468 children with postneonatally acquired CP; 255 males, 213 females). Data were pooled and children classified into mutually exclusive categories based on type of congenital anomaly. The proportion of children with congenital anomalies was calculated. Clinical outcomes and cause of postneonatally acquired CP were compared between children with and without anomalies. Major congenital anomalies were reported in 25.6% (95% confidence interval [CI] 21.7-29.9) of children with postneonatally acquired CP. Cardiac anomalies, often severe, were common and present in 14.5% of children with postneonatally acquired CP. Clinical outcomes were not more severe in children with congenital anomalies than those without anomalies. Cause of postneonatally acquired CP differed with the presence of congenital anomalies, with cerebrovascular accidents predominating in the anomaly group. Congenital anomalies were likely associated with cause of postneonatally acquired CP in 77% of children with anomalies. In this large, international study of children with postneonatally acquired CP, congenital anomalies (particularly cardiac anomalies) were common. Future research should determine specific causal pathways to postneonatally acquired CP that include congenital anomalies to identify opportunities for prevention. One-quarter of children with postneonatally acquired cerebral palsy (CP) have a major congenital anomaly. Cardiac anomalies, often severe, are the most common anomalies. Causes of postneonatally acquired CP differ between children with and without congenital anomalies.

The relationship of the development of motor skills and socioeconomic status of family with BMI of children with autism disorder

Background and Study Aim. This study aims to examine the relationship between the development of motor skills and the socio-economic status of families with body mass index (BMI) of children with autism disorder.&#x0D; Material and Methods. To this end, 68 children with autism at the age range of 6-13 years old were selected for the study. Their parents completed Family Socioeconomic Status Questionnaire. The motor skills level of children was measured by the Movement Assessment Battery for Children (MABC). The height and weight of children were measured to calculate their BMI. &#x0D; Results. The results of the Pearson correlation test showed that there is a significant and negative relationship between the development of motor skills and the socioeconomic status of families with BMI of children with autism. The results of the linear regression test also indicated that motor development and family socioeconomic status are predictors of BMI in people with autism (P&lt;0.05). &#x0D; Conclusions. It is concluded that the socioeconomic status of the family and the motor development of children with autism are the determinants of their overweight and obesity and these factors should be considered in the interventions for children and families.

Tea or Thrush?: A Case of Nonaccidental Oral Injury in an Infant

AbstractA 5-month-old girl child patient presented to the emergency department for oral thrush and poor feeding but instead demonstrated concern for abuse after physical exam, as findings were consistent with oral injury. Correct identification of the oral findings as traumatic necessitated navigating language and cultural issues before the mechanism of injury and abuse determination could be made. Exploring the involvement of other caregivers was a crucial piece for investigation of the clinical scenario. The incidence of child abuse and pediatric oral injuries concerning for abuse were reviewed in this case report.

Management of Duodeno-Jejunal Flexure Transection after Blunt Trauma - A Modified Approach.

Background: Small bowel injuries are infrequent after blunt trauma and typically affect fixed segment. Untimely management of such injuries, results in high-output entero-cutaneous fistula which increases morbidity and mortality. Treatment of duodeno-jejunal flexure transection has been traditionally done by pyloric exclusion with gastrojejunostomy, but more recent evidence suggests that end-to-end anastomosis or primary closure may be equally effective in which duodeno-jejunal anastomosis is protected via an external tube duodenostomy. Objective: The objective of the study is to provide a modification to the technique of management of duodeno-jejunal flexure injury, avoiding external tube duodenostomy. Material and Methods: Patients admitted from July 1, 2015 to June 1, 2018 were identified and examined for duodeno-jejunal flexure transection. Non-accidental injury cases were excluded. Results: In the study period, a total of 10 patients were admitted with duodeno-jejunal flexure transection. All cases were admitted 24 hours after the injury and presented with shock. After fluid resuscitation and investigations, they were taken for urgent laparotomy. The whole of duodenum was mobilised, the transected ends were debrided and end-to-end duodenojejunal anastomosis was performed in two-layer fashion. An 18-French Nasojejunal (NJ) tube was placed beyond the anastomosis, and an 18-French nasogastric (NG) tube was placed in the stomach for gastric decompression. A feeding jejunostomy was performed in all cases. Both NG and NJ tubes were removed after bowel movements started and FJ was removed on first follow up. There was no incidence of duodenum related complications, and all were doing well on follow up. Discussion and conclusion: Placing the nasojejunal and nasogastric tube eliminates the need for duodenostomy and gastrostomy, respectively. This method protects the duodeno-jejunal anastomosis and decreases the incidence of duodenum-related complications.

Cerebral palsy in Canadian Indigenous children.

To determine whether inequities in health outcomes for Indigenous Canadians are also present in cerebral palsy (CP) by comparing CP profiles between Indigenous and non-Indigenous children. Using the Canadian Cerebral Palsy Registry, we conducted a cross-sectional study. CP motor subtype, gross motor severity, comorbidities, perinatal adversity, preterm birth, and parental education were compared between 94 Indigenous (53 males, 41 females) and 1555 non-Indigenous (891 males, 664 females) children (all >5y). Multivariate analysis was done to analyze adverse CP factors, defined as CP gross motor severity and comorbidities. CP etiologies, either prenatal/perinatal or postnatal, were also compared. Indigenous children with CP have higher odds of having low parental education (odds ratio [OR] 6.15, 95% confidence interval [CI] 3.36-11.3) and comorbidities (OR 4.46, 95% CI 1.62-12.3), especially cognitive (OR 4.52, 95% CI 2.27-9.05), communication (OR 2.66, 95% CI 1.54-4.61), and feeding (OR 2.25, 95% CI 1.33-3.83) impairment. Indigenous children also have higher CP gross motor severity (p=0.03). Indigenous children are also more likely to have non-accidental head injury (n=4; OR 8.18, 95% CI 1.86-36.0) as the cause of their postnatal CP. Indigenous populations have worse health outcomes as a result of intergenerational impacts of colonization. Our study shows that Indigenous children with CP have increased comorbidities and higher CP gross motor severity, reinforcing the need for a multidisciplinary approach to management. Furthermore, targeted prevention programs against preventable causes of CP, such as non-accidental head injury, may be beneficial. Indigenous children with cerebral palsy (CP) have more severe motor impairment and more comorbidities. Non-accidental head injury is a significant cause of postnatal CP.

Exergaming for children with probable developmental coordination disorder (p-DCD)/DCD

LANGUAGE NOTE | Document text in English; abstract also in Chinese.&#x0D; The purpose of this study was to examine the effectiveness of exergaming for improving balance, eye–hand coordination (EHC), and exercise enjoyment among children with special educational needs (SEN) and probable developmental coordination disorder (p-DCD). This study adopted a single-group intervention with paired results. Nine primary school students (seven boys and two girls, aged 7–10 years) were recruited and underwent a 3-month exergaming intervention involving three 30-minute sessions per week. Xbox One Kinect was used under the supervision of the researchers and physical education (PE) teachers. Pre- and post-intervention scores were calculated for data analysis. Motor performance was assessed using the Movement Assessment Battery for Children – Second Edition Test. The participants’ gaming experiences were captured using Fun Toolkit. The Wilcoxon signed-rank test showed significant improvements in balance and EHC, but no significant differences in enjoyment scores. The findings indicated a positive impact of exergaming on primary school students with SEN and motor problems. The outcomes indicate that exergaming is an effective strategy for improving motor skills in children with SEN and p-DCD/DCD. Therefore, exergaming could be incorporated into PE curricula to motivate students to participate in physical activities in order to improve their physical health and well-being.&#x0D; 本研究探討虛擬遊戲對改善有特殊教育需要（SEN）和（潛在）發育協調障礙的兒童的平衡、眼手協調和享受運動的功效。九名小學生參加為期三個月，每週三次30分鐘的訓練。訓練前後的遊戲分數、運動表現和遊戲體驗都被分析。研究結果顯示平衡力和眼手協調顯著地改善，但享受度沒有明顯差異。這說明虛擬遊戲對有SEN和動作協調問題的小學生有積極影響，改善運動技能。因此，將這納入體育課程，可鼓勵學生參加體能活動，改善身心健康。

Physical development in the early years: the impact of a daily movement programme on young children’s physical development

ABSTRACT Poor physical development in young children has been shown to impact readiness for school, behaviour, social development and academic achievement. This research sought to explore whether a physical intervention programme (Movement for Learning) can improve children’s physical development. The Movement Assessment Battery for Children (2nd edition, MABC-2) was used to assess 108 children (aged 4–5) from three schools in the UK at the start and end of the Reception Year (4–5 years). A monitoring and evaluation survey was completed by 37 teachers which highlighted ways in which the programme had impacted children. Univariate ANOVA using change scores showed significant changes in favour of the intervention group who had undertaken the movement programme.

Risk of postpartum depression and very early child mistreatment among mothers reporting higher autistic traits: Evidence from the Japan Environment and Children's Study

BackgroundLittle is known about how mothers who report higher autistic traits face new parenthood. This study examined the association between antenatal non-clinical autistic traits and the risks of both postpartum depression (PPD) and child mistreatment at one-month postpartum and if these associations were mediated by preexisting social support. MethodsParticipants included 73,532 singleton mothers without histories of psychiatric conditions from the Japan Environment and Children's Study, a nationwide birth cohort. Autistic traits were measured during the second/third trimesters using the short-version of the Autism Quotient-Japanese version. Participants were classified into three groups (i.e., typical-range, moderate-range, and high-range). PPD was measured using the Japanese version of the Edinburgh Postnatal Depression Scale, while participants self-reported experiences of child mistreatment (i.e., hit or shake the child); both assessments were conducted at one-month postpartum. Individual social support was reported during pregnancy. Data analyses were conducted through Poisson regressions. ResultsA total of 7,147 (9.7%) participants reported PPD, while 12,994 (17.7%) reported child mistreatment at one-month postpartum. Autistic traits were associated with increased PPD risk (adjusted-relative risk [aRR] =1.74, 95%CI=1.64–1.84 for moderate-range; aRR=2.33, 2.13–2.55 for high-range) and child mistreatment (aRR=1.19, 1.13–1.24 for moderate-range; aRR=1.39, 1.28–1.50 for high-range) independently of confounders. Social support mediated 26–31% of these associations for moderate/high-range groups (both risks). LimitationsSelf-reported measurements were used. ConclusionsMothers who reported moderate-to-high autistic traits in the general population were vulnerable to PPD and newborn mistreatment at one-month postpartum, which was partially explained by the lack of social support during pregnancy.

The Superstition that Maims the Vulnerable: Establishing the Magnitude of Witchcraft-Driven Mistreatment of Children and Older Women in Ghana

AbstractWitchcraft-triggered violence is widespread in contemporary African societies. This study establishes the magnitude and identifies the principal features, motivations and socio-cultural contexts of witchcraft-driven mistreatment of children and older women in Ghana. It achieves this aim by embarking on an in-depth analysis of cases of witchcraft-related abuse publicised in three renowned local Ghanaian media outlets between 2014 and 2020 and comparing the results with the findings of extant empirical studies. The data support the view that witchcraft-fuelled abuse is endemic in Ghana, and the worst victims are children and older women of low socio-economic background. It demonstrates that the commonest forms of mistreatment and violence resulting from belief in witchcraft are murder and torture (perpetrated with various weapons/tools), forcible confinement and enslavement, neglect and child labour. The most dominant motivations for such violations are the suspicion that the alleged witches are responsible for family or community members’ death or illness and the supposed victims’ economic or financial predicament. The study stresses the need to criminalise witchcraft accusations and bring pastors and traditional spiritualists under closer scrutiny since many witchcraft allegations and the ensuing persecutions are largely encouraged by their dubious activities.

Safeguarding children in trauma and orthopaedics

Safeguarding, the action taken to protect children from harm, is an important aspect of paediatric care. Orthopaedic surgeons are often the first healthcare professionals to suspect physical abuse or non-accidental injury (NAI) on the basis of children presenting with unexplained bony injury. Physical harm from inflicted injury, a concept that most orthopaedic surgeons are familiar with, is not the only cause for a safeguarding referral and a comprehensive assessment may reveal concerns regarding: neglect, emotional abuse or sexual abuse. Clinicians caring for children, have to consider all of these factors as a cause for concern and organize onward referral. This article focuses on inflicted skeletal injury, how to recognize and investigate it. Typical fractures of concern are discussed and illustrated along with consideration of differential diagnoses.