Metaphyseal extensions of hypertrophied chondrocytes in abused infants indicate healing fractures.

We examined histologically 40 bones from 11 infants aged < 1 year who died with evidence of infant abuse. Twenty-three bones had fractures, and 15 of these contained conspicuous metaphyseal extensions of hypertrophied chondrocytes (EHC) which were highly associated with healing fracture sites. These data indicate that such lesions are common in fractures related to child abuse, are easily identified, and are indicative of healing fractures. The presence of this lesion has significant implications for those who assess skeletal injury in abused infants because the determination of infant abuse often relies on establishing a pattern of skeletal trauma. Quantitation of the growth rate of individual physes in this age group may eventually permit assessment of the minimum age of these skeletal injuries.

Circadian dysregulation in abused individuals: a proposed theoretical model for practice and research.

Trauma in the form of physical and sexual abuse remains a major issue confronting health professionals and society today. Despite the identification of large numbers of children at risk, no studies exist on the association between childhood abuse and the development of acute and long-term disruption of sleep/wake patterns. Furthermore, identification of the most effective nursing interventions to restore healthy sleep rhythms is sorely lacking. As a basic human process, sleep follows a circadian pattern, effecting sleep onset and stages. This article explores a possible model to link the sleep disruption seen in abuse children with circadian and rhythmic theories.

From abuse to violence: psychophysiological consequences of maltreatment.

This paper reviews the psychophysiological literature related to violent behaviors. It explores the interactions of environmental influences, pain, stressors, hormones, and neurotransmitters. It presents ways in which maltreatment in the form of abuse or neglect exacerbates preexisting psychobiological vulnerabilities. It proposes that whatever forces increase impulsivity and irritability, engender hypervigilence and paranoia, diminish judgment and verbal competence, and curtail the recognition of pain in the self and others, will enhance violence, and presents evidence that maltreatment has all of these effects.

Low dopamine-beta-hydroxylase: a biological sequela of abuse and neglect?

Twenty-one psychiatrically hospitalized boys were studied while off psychoactive medication to determine if conduct disorder, solitary type, and abuse or neglect experiences correlated with low levels of dopamine-beta-hydroxylase (DBH) activity. Preliminary results supported earlier findings that undersocialized types of conduct disorder in boys were correlated with low DBH activity. Possible or definite neglect or abuse before 36 months of age was correlated with low DBH activity. Abuse or neglect was not correlated with low DBH activity when time of occurrence was not specified. Low serum DBH may be a biological sequela of seriously disrupted attachment.

[Water deprivation. An uncommon form of child abuse]. / Privation d'eau. Une forme inhabituelle de maltraitance.

The authors report a case of hypernatremic dehydration following chronic water deprivation and very likely salt load as a form of child abuse in a 2 11/12 year-old girl. This uncommon picture often expresses a severely disturbed relationship between parents and child which has to be considered in the family management.

Assessing child abuse: the TRIADS checklist.

Although all types of abuse injure children, psychological abuse is most elusive and damaging on many levels, particularly levels of attachment, affective development, and the evolution of empathetic capacities that allow a child to receive and transmit, in an appropriate manner, emotional information between people. Some think that this type of psychological abuse coupled with neglect and perhaps early physical abuse impairs the child's total capacity to respond emotionally (Brothers, 1989). Essentially, empathy is a matter of a complex informational processing activity. Alexithymia, an inability to perceive the emotions of others, has been linked in primate studies to deprivation (Sackette, 1966). This awareness of the impact of environmental factors on the development of critical emotional and ultimately interpersonal regulating mechanisms underscores the need to attend to all aspects of child abuse.

Effect of medical and social risk factors on outcome of prematurity and very low birth weight.

A cohort of 129 infants with birth weights less than or equal to 1250 gm was followed for more than 4 1/2 years (mean +/- SD: 60 +/- 10 months) to determine the independent effects of two medical risk factors--intracranial hemorrhage and severe chronic lung disease--and a parenting risk factor (abuse or neglect) on neurodevelopmental outcome. In infants without any intracranial hemorrhage or parenting risk factors, severe chronic lung disease was not related to neurologic or cognitive outcome. Infants with increasing grades of intracranial hemorrhage had increasing rates of neurologic and cognitive abnormalities. However, the factor associated with the highest incidence of later abnormality was the parenting risk factor. We conclude that infants with medical risk factors may have additional social risk factors, and that both of these influences must be considered in an examination of the long-term sequelae of neonatal complications.