High Risk For Physical Abuse Research Articles

Knowing Your Patient Population: Techniques to Capture Infants at High Risk for Physical Abuse in a Trauma Registry

BackgroundPhysical abuse is a major public health concern and a leading cause of morbidity and mortality in infants. Clinical decision tools derived from trauma registries can facilitate timely risk-stratification. The Trauma Quality Improvement Program (TQIP) database does not report age for children <1 year who are at highest risk for abuse. We report a method to capture these infants despite the missing age. MethodsPatients ≤17 years were identified from TQIP (2017–2019). The primary outcomes included injuries resulting from confirmed or suspected child abuse captured by diagnosis codes or report/investigation of physical abuse, or different caregiver at discharge available in TQIP. We used two methods to select infants within TQIP. In the first, World Health Organization (WHO) growth standards for stature or length-for-age and weight-for-age were selected to capture children younger than 1 year. In the second, a K-means machine learning algorithm was used to cluster patients by weight and height. We compared outcome and injury data with and without patients <1 year. ResultsUsing the WHO growth standard 19,916 children <1 year were identified. A total of 20,513 patients had a report of physical abuse filed, and 9393 were infants <1 year. Increased age-adjusted odds ratios [95% CI] were seen for fractures of the upper limb (1.28 [1.22–1.34]), vertebrae (1.89 [1.68–2.13]), ribs (5.2 [4.8–5.63]), and spinal cord (3.39 [2.85–4.02]) and head injuries (1.55 [1.5–1.6]) with infants included. ConclusionsIn a nationwide trauma registry, WHO growth standards can be used to capture patients under one year who are more adversely impacted by maltreatment. Type of StudyRetrospective, Cross-sectional. Level of EvidenceLevel III, Diagnostic.

Risk of Injury-Related Readmission Varies by Initial Presenting-Hospital Type Among Children at High Risk for Physical Abuse.

Children experiencing physical abuse may initially present to hospitals with underappreciated minor injuries, only to experience more severe injuries in the future. The objectives of this study were to 1) describe young children presenting with high-risk diagnoses for physical abuse, 2) characterize the hospitals to which they initially presented, and 3) evaluate associations of initial presenting-hospital type with subsequent admission for injury. Patients aged younger than 6 years from the 2009-2014 Florida Agency for Healthcare Administration database with high-risk diagnoses (codes previously associated with >70% risk of child physical abuse) were included. Patients were categorized by the hospital type to which they initially presented: community hospital, adult/combined trauma center, or pediatric trauma center. Primary outcome was subsequent injury-related hospital admission within 1 year. Association of initial presenting-hospital type with outcome was evaluated with multivariable logistic regression, adjusting for demographics, socioeconomic status, preexisting comorbidities, and injury severity. A total of 8626 high-risk children met inclusion criteria. Sixty-eight percent of high-risk children initially presented to community hospitals. At 1 year, 3% of high-risk children had experienced subsequent injury-related admission. On multivariable analysis, initial presentation to a community hospital was associated with higher risk of subsequent injury-related admission (odds ratio, 4.03 vs level 1/pediatric trauma center; 95% confidence interval, 1.83-8.86). Initial presentation to a level 2 adult or combined adult/pediatric trauma center was also associated with higher risk for subsequent injury-related admission (odds ratio, 3.19; 95% confidence interval, 1.40-7.27). Most children at high risk for physical abuse initially present to community hospitals, not dedicated trauma centers. Children initially evaluated in high-level pediatric trauma centers had lower risk of subsequent injury-related admission. This unexplained variability suggests stronger collaboration is needed between community hospitals and regional pediatric trauma centers at the time of initial presentation to recognize and protect vulnerable children.

Effects of maternal adverse child experiences on parental maltreatment of children: An empirical study of mediating factors among Japanese mothers

AbstractDespite increasing research into connections between adverse childhood experiences (ACEs) and health problems, the impact of parental ACEs on parenting practices has not been sufficiently clear. The objective of the study was to consider whether the association between maternal ACEs and child maltreatment is affected by three mediating factors: socio‐economic status (SES), social support and maternal psychological distress in adulthood. The Kochi Child Health Impact of Living Difficulty (K‐CHILD) study (2016) provided the data for this study. Mothers who had children in the first, fifth, eighth and eleventh grade and who lived in the Kochi Prefecture of Japan participated. A pool of 11,954 completed child and caregiver questionnaires was used for analysis. We found that a large number of maternal ACEs was connected to higher risk of physical abuse, psychological abuse and neglect. Maternal psychological distress had the greatest mediating effect. Maternal ACEs can be a risk factor for maltreatment of children. This study suggests that care for mothers with psychological distress will be a key intervention to break the cycle of childhood adversity.

Where are all the males? Gender-specific typologies of childhood adversity based on a large community sample.

Methodological issues have been identified when quantifying exposure to adversity and abuse. To address a single type may obscure covarying effects. To sum multiple exposures gives equal weight to each. Latent class analysis (LCA) addresses this by identifying homogenous subpopulations. Most studies using LCA have pooled gender data in spite of evidence that the nature and frequency of exposure differs by gender. Males report more interpersonal abuse, females report more of other exposures, particularly sexual. This study aimed to identify if stratifying data by gender resulted in different profiles of adversity/abuse Participants and setting: The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) wave II, a large community-based survey, nationally representative of the US population. This study used 14 indicators of childhood adversity as the basis for LCA. The number and nature of classes differed by gender. The best solution for females was 4-class: a low risk class; a class at higher risk of sexual abuse; a class at higher risk of physical abuse; a class at higher risk of combined physical and sexual abuse. The best solution for males had only 3-classes; a low risk class, a class at higher risk of sexual abuse; a class at higher risk of physical abuse. The combined dataset resulted in a solution similar to the female solution. The importance of developing models for males and females separately was evidenced by the male and female classes being differentially associated with mental health variables.

When Bigger Is Better: Household Size, Abuse Injuries, Neglect, and Family Response in Novosibirsk, Russia.

Although previous research has demonstrated larger households to be at higher risk of physical abuse and neglect of children, we argue that unilateral conceptualization of larger households as a risk factor is inappropriate. Application of resource dilution theory must capture the possibility that larger families may have more members with both the agency and will to intervene against child maltreatment. We hypothesized a negative interaction between household size and protective informal social control by family members in predicting abuse injuries and neglect. A three-stage probability proportional to size cluster sample representative of Novosibirsk, Russia, was collected from 306 cohabiting couples. One parent in each household was interviewed. A focal child was selected using most recent birthday. When responses limited to families with minor children (below age 18) were selected, 172 families remained in the data. Physical abuse and neglect were measured using the Conflict Tactics Scales (CTS). Protective informal social control by family members was measured using the Informal Social Control of Child Maltreatment (ISC_CM) Scale. Models were tested using random effects regression and logistic regression. Nearly 7% of focal children were injured in the last year, 10% were neglected. Consistent with previous research, protective informal social control was associated with lower odds of injury and fewer instances of neglect. The significant negative interaction between household size and protective control is consistent with the idea that larger households may be protective when adult family members intervene against maltreatment to protect children. Replication and further investigation of protective ISC_CM in Western populations is much needed. Future research should not conceptualize or measure household size as a unilateral risk factor.

Cognitive and behavioral risk factors for child physical abuse among Chinese children: a multiple-informant study.

BackgroundIt has been well established that child physical abuse is a risk factor for cognitive deficits and behavioral problems. However, the possible link between cognitive deficits and behavioral problems placing children at a higher risk of physical abuse has been overlooked. Using a prospective design, the present study aims to examine whether previously measured cognition indicated by intelligence quotient (IQ), including performance IQ (PIQ) and verbal IQ (VIQ), and behavioral problems reported by multiple informants (i.e. mothers, teachers, and children) predict later child physical abuse (which may include minor and severe forms of abuse inflicted separately by mothers and fathers) in Chinese children.MethodsA school-based survey was conducted to collect data from 265 Chinese children (52.8 % boys, mean age 13.71 ± 0.60 years) in the Wave II of China Jintan Cohort study. When they were in the last year of elementary school, children completed the Chinese version of the Wechsler intelligence scale for children-revised that measured VIQ and PIQ during 2010–2012 when their behaviors were self-assessed. Mothers and teachers of these children used the Chinese versions of the youth self report, the child behavior checklist and the teacher report form, respectively, to assess the children’s behaviors. These children reported minor and severe physical abuse experiences in the previous 12 months from mothers and fathers separately using the Chinese version of parent–child conflict tactics scale in 2013 when children were in grades 7 and 8 of middle school.ResultsThe present study found that after controlling for the sociodemographic and other cognitive and/or behavior variables, high scores of child externalizing behavior rated by their mothers or teachers were associated with increased risks of experiencing maternal and paternal severe physical abuse, while a high score of self-reported externalizing behavior was associated with a decreased risk of paternal severe physical abuse. A high score of mother-rated internalizing behavior was associated with a decreased risk of maternal severe physical abuse. VIQ was associated with maternal minor physical abuse with small effect size. PIQ was not associated with any forms of physical abuse after adjusting for child behavior and sociodemographic variables.ConclusionsIn this community sample of Chinese children, externalizing behavior perceived by mothers and teachers is linked to children being at risk for physical abuse, while internalizing behavior perceived by mothers is associated with a decreased risk of maternal physical abuse. Findings suggest that educating parents and teachers to appropriately perceive children’s externalizing behavior may help prevent the occurrence of physical abuse.Electronic supplementary materialThe online version of this article (doi:10.1186/s13034-016-0124-5) contains supplementary material, which is available to authorized users.

Commentary on “A Critical Review of the Classic Metaphyseal Lesion: Traumatic or Metabolic?”

197 Ayoub et al. [1] that classic metaphyseal lesions are not traumatic lesions contradicts published investigations and is made in contrast to the classic discussions of child abuse in publications such as that of John Caffey [5].” Caffey noted these lesions as early as the 3rd (1956) edition of his text, Pediatric X-Ray Diagnosis [5], in which metaphyseal “chip” fractures occurred in the entity he termed “traumatic infantile hyperostosis.” In a 1957 article [6] and the 4th (1961) edition of his text, Pediatric X-Ray Diagnosis [7], Caffey presented a diagram depicting “corner” and “bucket-handle” patterns of metaphyseal injury. In the 6th and subsequent editions of his book, Caffey stated that these injuries were the consequence of the battered child syndrome. Kleinman (Kleinman PK, oral communication, 2013) noted that Frederick Silverman [8] wrote about Caffey’s assertion that these lesions represented inflicted injuries. In 1953, Silverman [9] used the term “metaphyseal lesions,” and stated that these injuries were due to child maltreatment. He continued to do so in the textbook, The Battered Child [10], which led to multiple texts and scientific articles that mentioned similar characteristic inflicted injuries. In 2011, to provide further evidence of the association of classic metaphyseal lesions and abuse, Kleinman et al. [11] identified the absence of metaphyseal abnormalities in 42 low-risk infants versus nine classic metaphyseal lesions in 18 infants who were at high risk for physical abuse, and they found a statistically significant difference (p < 0.0001) between the two groups. According to Dr. Kleinman (Kleinman PK, oral communication, 2013), Ayoub and his coauthors [1] do not justify their stated conclusion that, “Classic metaphyseal lesions are not true fractures but rather a combination of tissue-processing artifacts and misinterpreted findings of healing rickets.” Kleinman and his coinvesCommentary on “A Critical Review of the Classic Metaphyseal Lesion: Traumatic or Metabolic?”

Chronic conditions in children increase the risk for physical abuse – but vary with socio‐economic circumstances

To explore whether children (age 10, 12 and 15 years) with self-reported chronic conditions are at higher risk of physical abuse and/or exposure to intimate-partner violence than other children, while considering the importance of demographic factors. A national cross-sectional study of 2771 pupils in grades 4, 6 and 9 from 44 schools in Sweden (91% response rate). Conflict Tactic Scales were used to measure physical abuse and separate questions measured exposure to intimate-partner violence. A list of 13 diagnoses was used to estimate chronic conditions. Children with chronic conditions had an increased risk for physical abuse (CPA) only (OR 1.67) as well as in combination with exposure to intimate-partner violence (IPV) (OR 2.54), but not to IPV only, compared to children without chronic conditions. Furthermore, when chronic conditions were combined with country of birth other than Sweden and living in low-income areas, the risk for CPA increased even more, indicating interactive effects. A wide range of chronic health conditions in children increased the risk for physical abuse. This indicates that certain factors unite this group of children, irrespective of the type of disability or degree of severity, but where a combination with socio-economic circumstances is of importance.

A CASE OF SHAKEN BABY SYNDROME AFTER DISCHARGE FROM THE NEWBORN INTENSIVE CARE UNIT

Preterm infants may be at higher risk of physical abuse after hospital discharge. Nonaccidental or inflicted head neurotrauma is the most common cause of mortality and morbidity in physical-abuse cases, and shaken baby syndrome (SBS) is the most common form of abuse. In the majority of the cases, parents who shake their infant do not intend to harm the infant. This article presents a report of a former preterm infant who presented to the pediatrician's office with a maternal report of an accidental fall. Shaken baby syndrome was suspected based on bilateral subdural hemorrhages of varying ages, which were inconsistent with the history provided. The differential diagnosis and systematic clinical evaluation for SBS are provided, and medical and nursing management is discussed. Patient care, advocacy, and mandatory reporting are reviewed. The newborn intensive care unit caregivers' role in preventing SBS in this high-risk population, including specific parent teaching and anticipatory guidance, is reviewed with an emphasis on teaching all caregivers about the dangers of shaking an infant.

Children exposed to domestic violence and child abuse: terminology and taxonomy.

Three definitional issues regarding children exposed to domestic violence are examined. First, the multiple ways in which a child can be exposed to violence is discussed. A taxonomy of 10 types of exposure is proposed. Nine key characteristics of domestic violence, as they relate to children and children's exposure, are then outlined. The third issue addressed concerns why children who are exposed to domestic violence can be considered victims of child maltreatment. These children, by nature of their experience in the home, are psychologically maltreated and are also at high risk for physical abuse and some risk for sexual abuse. Empirical questions concerning these definitions and taxonomies and their interrelations are discussed.

Parent-Child Interaction Therapy with a Family at High Risk for Physical Abuse

The use of empirically validated treatments with physically abusive and at-risk families continues to be an issue requiring further clinical and research attention. This single-case study discusses the effectiveness of Parent-Child Interaction Therapy (PCIT) with a mother-child dyad considered to be at high risk for physical abuse. Although PCIT is effective with different populations and in different settings, no study to date has demonstrated the effectiveness of PCIT with physically abusive families or families at risk for physical abuse. Data are presented from behavioral observations and standardized measures. Results suggest that PCIT was effective in reducing the child's behavior problems and the mother's stress, and increasing the number of positive parent-child interactions. Finally, implications for future clinical and research work on physically abusive and at-risk families are discussed.