Value of radiologic skeletal survey in assessment of abused children.

The usefulness of the radiologic skeletal survey in the assessment of children who were suspected of being abused or neglected was studied. During a 2 1/2-year period at one pediatric hospital, 331 skeletal surveys were performed to aid in the evaluation of possible child maltreatment. Of the 331 surveys, 38 (11.5%) showed evidence of trauma. But, in 30 of the 38 skeletal surveys, trauma was either previously known or suspected by the examiner. Therefore, in only eight cases did the skeletal survey provide new information that was helpful in the investigation of possible abuse or neglect which would have remained undiscovered without the skeletal survey. The age, sex, and clinical signs of the subjects were analyzed in an attempt to identify factors that might predict skeletal surveys with positive radiologic findings. Consideration is given to the costs and risks of skeletal surveys v potential benefits.

Enuresis: a contrast of attitudes of parents and physicians.

Questionnaires were used to survey 1,435 parents and 446 physicians in order to determine and compare attitudes and beliefs about enuresis. Although both groups thought that bed-wetting is a maturational problem, the parent group thought emotional causes were important and were less likely to accept small bladder size as an etiology. Parents thought that children should be dry at a much younger age than did the physicians (2.75 vs 5.13 years, respectively). Only 63% of parents thought that medical intervention is a good way to deal with a child's bed-wetting, yet 87% of the physicians suggested medical evaluation. A comparison of the various methods used to stop bed-wetting indicated that parents use waking the child, reassurance and talking with the child, restricting fluids, and punishment significantly more often than physicians. Although many physicians prescribe medication, only 6.6% of the parents thought that medicines are a "very good way" to treat enuresis. When developing a treatment plan for a child with enuresis, the physician should recognize the wide differences between parental and physician attitudes toward this common problem of childhood.

The cutaneous manifestations of child abuse and neglect.

The most easily recognizable physical manifestations of child abuse and neglect are seen in the skin. The findings may be the result of intentional trauma, neglect to provide adequate child care, alterations in family dynamics, or the emotional problems secondary to the maltreatment.

Sexual abuse of boys.

In a retrospective review of 145 sexually abused children, 11% were male. The boys were more likely to be assaulted in a public place than were girls, and boys were more prone to physical injury. The relationship of the perpetrator to the child was similar for boys and girls as was the age of the children. This study emphasizes the existence of boys as victims of sexual abuse.

Growth patterns in children hospitalized because of caloric-deprivation failure to thrive.

Infants and children with suspected caloric-deprivation failure to thrive (CDFTT) are commonly hospitalized to confirm the diagnosis. In the hospital, weight gain at an accelerated rate is used as the primary diagnostic criterion. We evaluated how soon patients with CDFTT began to gain weight and if the speed with which the patients started to gain weight was age dependent. Of 476 patients with growth problems, 57 met the criteria for inclusion in the study. We developed the concept of the "growth quotient," which expresses the patient's rate of growth. We found that almost all 57 children started to grow in less than two weeks, and those less than 6 months old usually began to gain weight in only two to three days. Older infants and children with CDFTT often had initial corrective growth rates equal to or greater than those of young infants.

The effects of ampicillin and trimethoprim/sulfamethoxazole on the periurethral flora of children with urinary tract infection.

Ampicillin and trimethoprim/sulfamethoxazole were shown to be of similar efficacy in the treatment of acute urinary tract infection of children. It was of interest to determine the effects of these antimicrobial drugs on the periurethral flora and recurrence rates. To this end, seventeen girls with twenty-two separate infections of the urinary tract were treated randomly with a ten-day course of either ampicillin or trimethoprim/sulfamethoxazole. Cultures of the urine and periurethral area were obtained before, during (third day), and after (seventeenth day) therapy. All Escherichia coli strains were serotyped. Both treatments resulted in the disappearance of the pathogens from the urine by the third day in all cases, and in all but one patient on the seventeenth day. The causative agents persisted more frequently in the periurethral area than in the urine on both the third and seventeenth days in patients treated with either ampicillin or trimethoprim/sulfamethoxazole. The recurrence rates by the seventeenth day were 50% (4/8) in the ampicillin group, and 14% (2/14) in the trimethoprim/sulfamethoxazole group. Although suggestive in favor of the latter treatment, the difference is not statistically significant. In two of the three re-infections in the ampicillin group the microorganisms causing the second attack were present in the periurethral area on the third day. Sixteen of the seventeen girls were studied radiologically; six (37%) had radiologic abnormalities.

Parental perceptions of enuresis. A collaborative study.

Of 1,379 children 4 years of age and older who were patients in nine medical centers across the country, 346 (25.1%) were found to be enuretic. Their parents considered heavy sleeping and emotional problems as the main causes of enuresis in children; physical causes rarely were believed to be important. "Waking up the child" from sleep to urinate and "talking about the problem" were the main methods that parents used to treat enuresis. Very few used medication. Parents with a grade school level of education punish bed-wetting children at twice the rate of high school- and college-educated parents. Physicians need to be more aware that enuresis is an important problem for parents and that there are many widely held beliefs about cause and management.