Baren JM, Mace SE, Hendry PL. Children's mental health emergencies-part 3: special situations: child maltreatment, violence, and response to disasters.. Pediatric Emergency Care. 2008; 24 (8) : 569-77.
Keywords: Adolescent, Child, Child Abuse/*psychology, Child, Preschool, *Disasters, Emergencies, Emergency Service, Hospital, Humans, Mass Casualty Incidents/psychology, Mental Disorders/*psychology, Residence Characteristics, Schools, Triage, Violence/*psychology
OBJECTIVE: Children may be exposed to or even be the victims of a violent …
OBJECTIVE: Children may be exposed to or even be the victims of a violent situation, or a disaster, and the likelihood of a child's exposure to a violent situation or a disaster is increasing. METHODS: A review of the literature was done to address key mental health issues occurring with child maltreatment, violence in the home, community, in the emergency department, and disasters. RESULTS: Although pediatric mental health issues regarding violence, disasters, and child maltreatment have often been overlooked or unrecognized, the consequences for the child in such situations can be devastating. However, recognition and appropriate treatment can favorably impact the child's recovery from exposure to such violent events or disasters. CONCLUSIONS: Recognition and early intervention to address the mental health issues of children in violent situations or disasters can help ameliorate the negative psychological sequelae of such events. The importance of providing mental health and social services to children exposed to disasters was recognized by the Pediatric Institute of Medicine Report.
Friedrich WN, Fisher J, Broughton D, Houston M, Shafran CR. Normative sexual behavior in children: a contemporary sample.. Pediatrics. 1998; 101 (4) : E9.
Keywords: Age Factors, Child, *Child Behavior/ethnology, Child Day Care Centers, Child, Preschool, Domestic Violence, Family/psychology, Family Relations, Female, Humans, Male, Reference Values, Sex Factors, *Sexual Behavior/ethnology/statistics & numerical data, S
OBJECTIVE: Sexual behavior in children can cause uncertainty in the clinician …
OBJECTIVE: Sexual behavior in children can cause uncertainty in the clinician because of the relationship between sexual abuse and sexual behavior. Consequently, it is important to understand normative childhood sexual behavior. DESIGN: Sexual behavior in 1114 2- to 12-year-old children was rated by primary female caregivers. These children were screened for the absence of sexual abuse. A 38-item scale assessing a broad range of sexual behavior (Child Sexual Behavior Inventory, Third Version) was administered along with the Child Behavior Checklist and a questionnaire assessing family stress, family sexuality, social maturity of the child, maternal attitudes regarding child sexuality, and hours in day care. RESULTS: Sexual behavior was related to the child's age, maternal education, family sexuality, family stress, family violence, and hours/week in day care. Frequencies of sexual behaviors for 2- to 5-, 6- to 9-, and 10- to 12-year-old boys and girls are presented. CONCLUSIONS: A broad range of sexual behaviors are exhibited by children who there is no reason to believe have been sexually abused. Their relative frequency is similar to two earlier studies, and this reinforces the validity of these results.
Gold MA. Emergency Contraception.. Adolescent Medicine (Philadelphia, Pa.). 1997; 8 (3) : 455-462.
Emergency contraception uses oral contraceptives or postcoital insertion of an …
Emergency contraception uses oral contraceptives or postcoital insertion of an intrauterine device (IUD) to prevent pregnancy after an episode of unprotected intercourse. This chapter reviews the available data on the efficacy of emergency contraceptive pills (ECPs), indications and contraindications, availability, safety, and potential side effects. It also addresses the controversial issues that arise from equating ECPs with abortion, as well as the effects of ECPs on contraceptive practices of adolescents.
Hibbard RA. Triage and referrals for child sexual abuse medical examinations from the sociolegal system.. Child Abuse & Neglect. 1998; 22 (6) : 503-13.
Keywords: Child, Child Abuse, Sexual/*diagnosis/*legislation & jurisprudence, Child, Preschool, Humans, *Referral and Consultation, *Triage, United States
Johnson KL, Brown ECB, Feldman KW, Qu P, Lindberg DM. Child Abuse Pediatricians Assess a Low Likelihood of Abuse in Half of 2890 Physical Abuse Consults.. Child maltreatment. 2022; 27 (2) : 202-208.
Keywords: Child, *Child Abuse/diagnosis, Humans, Pediatricians, *Physical Abuse, Referral and Consultation, Retrospective Studies
The aim of this study was to examine the frequency with which child abuse …
The aim of this study was to examine the frequency with which child abuse pediatricians (CAPs) assess consultations as low versus high likelihood of abuse. In this retrospective secondary analysis of data from the Examining Siblings to Recognize Abuse (ExSTRA) study, the likelihood of abuse score for 2890 consultations at 20 medical centers was collected. Descriptive statistics were used to examine the percentage of cases representing low versus high likelihood of abuse (i.e., score of 1-4 vs. 5-7 on a 7-point scale). Linear and logistic regression analyses were used to examine score variability between medical centers. Overall, fifty-three percent of cases were assessed as low likelihood of abuse, suggesting that CAPs were equally as likely to assess a high versus low likelihood of abuse. The percentage of cases representing low likelihood of abuse differed significantly (P < .001) between medical centers after controlling for patient age, sex, race/ethnicity, twin/triplet status, injury types, and injury severity. The variability between CAP assessments at different medical centers is discussed, along with potential contributors to this variability and directions for future work.
Kellogg ND, Parra JM, Menard S. Children with anogenital symptoms and signs referred for sexual abuse evaluations.. Archives of Pediatrics & Adolescent Medicine. 1998; 152 (7) : 634-41.
Keywords: Adolescent, Anus Diseases/etiology, Child, Child Abuse, Sexual/*diagnosis, Child, Preschool, Diagnosis, Differential, Female, Genital Diseases, Female/etiology, Humans, Infant, Lichen Sclerosus et Atrophicus/diagnosis, Male, Odds Ratio, Urinary Tract I
OBJECTIVE: To determine whether children referred to a sexual abuse clinic …
OBJECTIVE: To determine whether children referred to a sexual abuse clinic because of anogenital symptoms or signs have examination findings that are suggestive of or probable or definitive for sexual abuse. DESIGN: Case series of 157 patients. SETTING: Child and adolescent ambulatory care sexual abuse clinic. RESULTS: A medical records review of 3660 cases was done; 157 cases were identified for study. Most (75%) referrals were from medical clinics. Of 184 complaints, the most common presenting symptom or sign was anogenital bleeding or bruising (29.3%), followed by irritation or redness (21.7%), abnormal anogenital anatomy (20.7%), vaginal discharge (18.4%), lesions (6.5%), and "other" symptoms or signs (3.3%). We used a standardized classification system and determined that 25 patients (15%) had examination findings in the sexual abuse clinic that were suggestive of or probable or definitive for sexual abuse. Although 85 patients had examination findings that corroborated the presenting symptom(s), 70 had nonspecific examination findings or a diagnosis other than sexual abuse. Seventy-two patients had normal examination findings. Only patients with the presenting symptom of lesions had an increased likelihood of a sexual abuse diagnosis. Common examination findings included anogenital erythema, enhanced vascularity of the hymen or vestibule in prepubertal girls, labial adhesions, and culture-negative vaginitis. CONCLUSIONS: Few children are referred for sexual abuse evaluations based on physical signs or symptoms alone. Children with anogenital symptoms but without a disclosure or suspicion of sexual abuse are unlikely to have examination findings suggestive of abuse. The evaluation of children with anogenital symptoms and signs should include a consideration of alternative conditions and causes not directly related to sexual abuse.
Kondis JS, Muenzer J, Luhmann JD. Missed Fractures in Infants Presenting to the Emergency Department With Fussiness.. Pediatric Emergency Care. 2017; 33 (8) : 538-543.
Keywords: Child Abuse/*diagnosis/prevention & control/statistics & numerical data, Delayed Diagnosis/*statistics & numerical data, Diagnostic Errors/*statistics & numerical data, Emergency Service, Hospital/statistics & numerical data, Fractures, Bone/*diagnosis
OBJECTIVES: The aim of this study was to evaluate incidence of prior fussy …
OBJECTIVES: The aim of this study was to evaluate incidence of prior fussy emergency visits in infants with subsequently diagnosed fractures suggestive of abuse. METHODS: This was a retrospective chart review of infants younger than 6 months who presented to the pediatric emergency department (ED) between January 1, 2006, and December 31, 2011. Inclusion criteria included age 0 to 6 months, discharge diagnosis including "fracture," "broken" (or break), or "trauma" or any child abuse diagnosis or chief complaint of "fussy" or "crying" as documented in the electronic medical record by the triage nurse. RESULTS: Three thousand seven hundred thirty-two charts were reviewed, and 279 infants with fractures were identified. Eighteen (6.5%) of 279 infants had a prior ED visit for fussiness without an obvious source. Of these, 2 had a witnessed event causing their fracture, and therefore the fracture was not considered concerning for abuse. The remaining 16 had fractures concerning for abuse. Mean age was 2.5 (SD, 1.2) months. Fifteen (83%) of 18 infants were 3 months or younger at the time of the fussy visit. The mean interval between the first and second ED visits was 27 days (median, 20 days). Thirty-nine percent were evaluated by a pediatric emergency medicine-trained physician during their initial fussy visit, whereas 78% were evaluated by pediatric emergency medicine-trained physician during their subsequent visit. Most common injuries were multiple types of fractures followed by extremity and rib fractures. CONCLUSIONS: Fractures concerning for child abuse are an important cause of unexplained fussiness in infants presenting to the pediatric ED. A high index of suspicion is essential for prompt diagnosis and likely prevention of other abuse.
Kudze T, Wheeler C. Common pediatric gynecological issues: a review.. Current Opinion in Obstetrics & Gynecology. 2021; 33 (4) : 350-354 Review.
Keywords: Adult, Child, Female, *Gynecology, Humans
PURPOSE OF REVIEW: To provide clinicians with a review of recent research and …
PURPOSE OF REVIEW: To provide clinicians with a review of recent research and methods for evaluation of common pediatric gynecology complaints and problems. RECENT FINDINGS: The examination and history of a pediatric gynecologic patient involve information gathering in order to limit anxiety for the child and optimize the ability to diagnose and treat her. Child abuse recognition is increasing, and its management requires special expertise. The early management of disorders of sexual development (DSDs) has changed with a focus towards early identification and consideration of delayed surgical management. The multidisciplinary evaluation and management of the pelvic mass in the child involves careful preoperative evaluation to allow for conservative management. SUMMARY: Reproductive endocrinology and infertility (REI) providers are often called upon to evaluate children when a pediatric gynecologist is not immediately available. This review highlights valuable information for adult gynecologic providers who may encounter young girls with gynecologic issues in a variety of settings. Having some basic knowledge of the evaluation and management will allow the provider to either manage the child themselves or triage her to the appropriate consultant.
McGuire L, Martin KD, Leventhal JM. Child abuse consultations initiated by child protective services: the role of expert opinions.. Academic Pediatrics. 2011; 11 (6) : 467-73.
Keywords: Academic Medical Centers, Child Abuse/*diagnosis, Child Welfare, Child, Preschool, Connecticut/epidemiology, *Expert Testimony, Female, Humans, Infant, Logistic Models, Male, Pediatrics, Physicians/*statistics & numerical data, Referral and Consultatio
OBJECTIVE: To describe consultations provided by child abuse pediatricians for …
OBJECTIVE: To describe consultations provided by child abuse pediatricians for cases referred by child protective services (CPS); compare the opinions of the likelihood of child maltreatment of the initial physician, CPS, and the child abuse pediatrician; and examine predictors of the experts' opinions. METHODS: Cases were referred by CPS for consultations between March 1, 1998, and June 30, 2005, to 2 child abuse pediatricians at Yale-New Haven Children's Hospital. We abstracted demographic and clinical information and the opinions of the initial physician, CPS, and the child abuse expert, each coded using a 5-point scale from definite maltreatment to definite benign cause (eg, accident). RESULTS: Of 187 cases, 50.3% occurred in children younger than 1 year of age. Children's most serious injuries were fractures (50.8%), burns (16.6%), and bruises/abrasions (15.0%). The child abuse experts' opinions were 47.6% definite or probable maltreatment, 8.6% uncertain, and 43.9% definite or probable benign. Of the 119 cases with opinions from all 3 assessors, the expert agreed with the physician in 57.1% of cases (κ = 0.34) and with CPS in 64.7% (κ = 0.42). The best predictor of the expert's opinion that the injury was due to maltreatment was agreement between the physician and CPS that maltreatment had occurred. CONCLUSIONS: Levels of agreement were fair to poor between the child abuse expert and either the physician or CPS. Child abuse experts' opinions have important value in selected cases to confirm previous assessments by the physician and/or CPS, or to change the opinion of the case.
National Children’s Alliance.. National Standards of Accreditation for Children’s Advocacy Centers. n.d.; 2023 Edition.
Thompson K, Svendsen S. Analysis of Cases Presenting With Concern of Child Abuse or Neglect to a Child Protection Team.. Clinical Pediatrics. 2024; 63 (9) : 1269-1275.
Keywords: Humans, *Child Abuse/statistics & numerical data/diagnosis/prevention & control, Child, Preschool, Child, Female, Male, *Child Protective Services/statistics & numerical data, Infant, Triage/methods, Referral and Consultation/statistics & numerical dat
Limited data are available on cases presenting for triage by child abuse …
Limited data are available on cases presenting for triage by child abuse specialists, particularly data combining patient demographics with presenting concerns and outcomes. This study aims to provide a descriptive analysis of cases presenting to one child abuse medical subspecialty team. Data were collected for all referrals triaged by the Child Protection Program, a child abuse team located within an academic children's medical center. The program triaged a total of 928 cases and completed 345 in-person visits with a medical provider. Nearly, half of all provider visits were for evaluation of children aged 3 years and younger (51%) and for a concern of physical abuse (49%). Of these visits, 26% were determined to be consistent with an accident or medical condition. This descriptive analysis highlights the burden of child abuse cases presenting to one small hospital-based child abuse program, as well as the structural and financial challenges faced by these programs.
Walker-Descartes I, Mineo M, Condado LV, Agrawal N. Domestic Violence and Its Effects on Women, Children, and Families.. Pediatric Clinics of North America. 2021; 68 (2) : 455-464.
Keywords: Adolescent, Adult, Child, Child Abuse/*psychology, Child, Preschool, Domestic Violence/*psychology, Female, Humans, Infant, Intimate Partner Violence/psychology, Male, Mental Health
Men and women experience severe domestic violence (DV) and intimate partner …
Men and women experience severe domestic violence (DV) and intimate partner violence (IPV); however, women and children remain especially vulnerable. Violence along the DV/IPV continuum has been recognized as a type of child maltreatment and a child's awareness that a caregiver is being harmed or at risk of harm is sufficient to induce harmful sequelae. Consequences of these abusive behaviors are associated with mental and physical health consequences. Health care professionals can screen, identify, and manage this pathology in affected families while educating communities to these pernicious effects.
Webb T, Valvano T, Nugent M, Melzer-Lange M. Child abuse pediatric consults in the pediatric emergency department improve adherence to hospital guidelines.. WMJ : official publication of the State Medical Society of Wisconsin. 2013; 112 (5) : 206-10.
Keywords: Child, Child Abuse/*diagnosis, Child, Preschool, *Emergency Service, Hospital, Female, Guideline Adherence, Humans, Infant, Injury Severity Score, Male, Pediatrics/*standards, Practice Guidelines as Topic, *Referral and Consultation, Retrospective Stud
BACKGROUND: Little data describes the role of child abuse pediatricians in …
BACKGROUND: Little data describes the role of child abuse pediatricians in consultation for physical abuse patients the pediatric emergency department. OBJECTIVES: To compare adherence in the emergency department to hospital physical abuse guidelines and need to return for testing between 2 groups: those receiving a child abuse consultation in the pediatric emergency department vs those who received standard emergency department care with subsequent child abuse review. METHODS: We reviewed 471 records of visits to the pediatric emergency department for physical abuse. Data collected included demographics, studies performed, whether patients need to return after child abuse review, child abuse subpoenas, child abuse testimony in court. RESULTS: Patients who received a child abuse consult in the emergency department or inpatient were more likely to be younger and to have more severe injuries. In cases where a consult was obtained, there was 100% adherence to emergency department clinical guidelines vs 66% when no consult was obtained. In addition, in cases that did not receive a child abuse consult, 8% had to return to the hospital for labs or radiographs after their emergency department visit. CONCLUSIONS: Child abuse consultation in the pediatric emergency department improves compliance with clinical guidelines and decreases the likelihood that patients will need to return for further testing.
Zamalin D, Hamlin I, Shults J, Katherine Henry M, Campbell KA, Anderst JD, Bachim AN, Berger RP, Frasier LD, Harper NS, Letson MM, Melville JD, Lindberg DM, Wood JN. Predictors of Making a Referral to Child Protective Services Prior to Expert Consultation.. Academic Pediatrics. 2024; 24 (1) : 78-86.
Keywords: Child, Humans, *Child Protective Services, *Child Abuse/diagnosis, Child Welfare, Pediatricians, Referral and Consultation
OBJECTIVE: Suspicion for child abuse is influenced by implicit biases. …
OBJECTIVE: Suspicion for child abuse is influenced by implicit biases. Evaluation by a Child Abuse Pediatrician (CAP) may reduce avoidable child protective services (CPS) referrals. Our objective was to investigate the association of patient demographic, social and clinical characteristics with CPS referral before consultation by a CAP (preconsultation referral). METHODS: Children<5years-old undergoing in-person CAP consultation for suspected physical abuse from February 2021 through April 2022 were identified in CAPNET, a multicenter child abuse research network. Marginal standardization implemented with logistic regression analysis examined hospital-level variation and identified demographic, social, and clinical factors associated with preconsultation referral adjusting for CAP's final assessment of abuse likelihood. RESULTS: Among the 61% (1005/1657) of cases with preconsultation referral, the CAP consultant had low concern for abuse in 38% (384/1005). Preconsultation referrals ranged from 25% to 78% of cases across 10 hospitals (P < .001). In multivariable analyses, preconsultation referral was associated with public insurance, caregiver history of CPS involvement, history of intimate partner violence, higher CAP level of concern for abuse, hospital transfer, and near-fatality (all P < .05). The difference in preconsultation referral prevalence for children with public versus private insurance was significant for children with low CAP concern for abuse (52% vs 38%) but not those with higher concern for abuse (73% vs 73%), (P = .023 for interaction of insurance and abuse likelihood category). There were no differences in preconsultation referral based on race or ethnicity. CONCLUSIONS: Biases based on socioeconomic status and social factors may impact decisions to refer to CPS before CAP consultation.
