Pediatric nonaccidental abdominal trauma: what the radiologist should know.

Abdominal injury in nonaccidental trauma (NAT) is an increasingly recognized cause of hospitalization in abused children. Abdominal injuries in NAT are often severe and have high rates of surgical intervention. Certain imaging findings in the pediatric abdomen, notably bowel perforation and pancreatic injury, should alert the radiologist to possible abuse and incite close interrogation concerning the reported mechanism of injury. Close inspection of the imaging study is warranted to detect additional injury sites because these injuries rarely occur in isolation. When abdominal injury is suspected in known or speculated NAT, computed tomography (CT) of the abdomen and pelvis with intravenous contrast material is recommended for diagnostic and forensic evaluation. Although the rate of bowel injury is disproportionately high in NAT, solid organs, including the liver, pancreas, and spleen, are most often injured. Adrenal and renal trauma is less frequent in NAT and is generally seen with multiple other injuries. Hypoperfusion complex is a constellation of abdominal CT findings that indicates current or impending decompensated shock and is most often due to severe neurologic impairment in NAT. Although abdominal injuries in NAT are relatively uncommon, knowledge of injury patterns and their imaging appearances is important for patient care and protection.

Child abuse and dental neglect: the dental team's role in identification and prevention.

Health, education and social services are placing increasing emphasis on preventing abuse and neglect by early intervention to support families where children and young people may be at risk. Dental hygienist and dental assistants, like all other health professionals, can have a part in recognizing and preventing children from those who would cause them harm. They should be aware of the warning signs, recognizing what to consider as abuse or dental neglect and know how to deal with these young patients, and to fulfil their legal and ethical obligation to report suspected cases. The purpose of this report is to review the oral and dental aspects of child abuse and dental neglect thus helping the dental team in detecting such conditions. In particular, this report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, early childhood caries and diseases that may be indicative of child abuse or neglect. Emphasis is placed on an appropriate protocol to follow in the dental practice to best treat and protect children who may have suffered abuse, helping the team in the diagnosis and documentation.

[Risk assessment of neglect and maltreatment in infants and toddlers. Chances of early preventive intervention]. / Risikoeinschätzung bei Vernachlässigung und Kindeswohlgefährdung im Säuglings--und Kleinkindalter--Chancen früher beziehungsorientierter Diagnostik.

The German child protection system lacks of interdisciplinary and standardized procedures for screening and diagnosing child maltreatment as well as for service delivery. Evidence based assessments of risk-screening in combination with consensus-based models for risk-judgement seem to predict the best possible results. A central part of determining whether an infant is at risk is to evaluate various domains of parental competencies and skills. In particular assessment procedures based on attachment research have proven to be practically and methodologically relevant. These include interactive and video-based observational methods as well as parental representations as sources of information for risk assessment. Attachment based intervention and treatment programs are effective, especially with regard to enhancing paternal sensitive behavior. However, these programs need to be adapted to delivery for specific risk groups. Overall an interdisciplinary approach with regard to the programs as well as to the training of the professionals has to be taken into account.

Shaken baby syndrome.

Shaken baby syndrome (SBS) is a violent act of abuse that can cause myriad neurologic, cognitive, and other functional deficits. In the most serious cases, death can result. Health care practitioners, child care providers, and parents must be educated on the signs of SBS. Cases should be thoroughly reviewed and prevention strategies developed to prevent future incidents.

[Child abuse syndrome]. / Zespól bitego dziecka.

The aggrievement of children is not only a present day problem. The term: child abuse has appeared in the literature in the mid XIX century. In this paper an attempt has been made to reference this phenomenon in region of Bydgoszcz. There were 2889 cases of children with bodily injuries requiring hospital treatment in the years 1992-1996. 10 cases were victims of long lasting violence in their homes. This paper also presented the basic regulations and pays attention to the requirement of greater engagement of the whole society. A restrictive system of child protection can contribute to a significant decrease in the scale of this phenomenon. Scandinavian countries can be used as an example of such an approach.

Shaking-impact syndrome of infancy.

Shaking-impact syndrome (SIS) is a leading cause of traumatic brain injury in infants and young children. Evaluation of these children requires a detailed history and physical examination as well as documentation of intracranial injury with neuroimaging, a dilated fundoscopic examination, a skeletal survey and other laboratory studies. Debate still exists as to the exact mechanisms of brain injury in these patients. The various contributions of shaking alone, shaking with impact, and apnea are discussed. Differences of injury type and severity between accidental traumatic brain injury and SIS are delineated. The long-term neurodevelopmental outcome for survivors of SIS is generally poor. Because few treatment options are successful in reducing the morbidity and mortality of this syndrome, prevention may be the only reasonable solution.

[Problem of violence in family in the opinion of health service workers]. / Problem przemocy w rodzinie w opinii pracowników sluzby zdrowia.

UNLABELLED: Violence in family is an intentional physical abuse of a family member, frequently a child, violating the victim's rights and causing suffering and damages. Helping the child demands integrated efforts of many experts as well as making the society more sensitive to the problems of children. The aim of this work is to present the opinions and social attitudes of Health Service workers concerning the problem of child abuse. The authors have undertaken the problem of abusing children, to become acquainted with opinions of people working with children on different aspects of treating children by their parents. A questionnaire was used to study the interfamily relations and to answer the following questions: should we intervene and help the victims of violence, do we use too severe punishment in Polish families, is child abuse common in Polish families, is beating a child recognized as an educational method. The study group included Health Service workers--nurses and doctors as well as academic teachers and students of the Medical University of Silesia. RESULTS AND CONCLUSIONS: investigations are continued.

The prevention of shaken baby syndrome.

Shaken Baby Syndrome may have life-long consequences, but it can be prevented. It is far too common and usually arises when the parent or caretaker gets angry, frustrated or impatient, but it can also be caused by inappropriate play. There are pathognomonic signs but suspicion must be high to suspect it. Physicians play an important role in diagnosis, management and most importantly, prevention.

Síndrome del niño maltratado: ¿cómo reconocerlo? / Child abuse syndrome: How inspect?

El objetivo del trabajo es detectar las características clínicas radiológicas del paciente que sufre síndrome de niño maltratado (SNM). La respuesta se obtuvo mediante el estudio de 47 pacientes, en el período que se extiende entre junio de 1996 y junio de 1999, que fueron asistidos en el Servicio de Guardia del Hospital de Niños Víctor J. Vilela de la ciudad de Rosario con Síndrome de Niño Maltratado. Este estudio se valió del análisis clínico y radiológico de los pacientes así como de la investigación de su entorno familiar y social. De la evaluación de los pacientes obtuvimos los siguientes datos: el motivo de consulta más frecuente fueron las lesiones de partes blandas (74,5 por ciento), el 25,5 por ciento ingresó por presentar uno o más sitios de fractura, en el 12,8 por ciento se presumió deshonesto, en 18 pacientes la consulta se produjo días o incluso semanas posteriores al trauma, el sitio de fractura más frecuente fue la diáfisis femoral, en contraste con algunos autores que describen el desprendimiento diafisarios como características del síndrome, en menores de 3 años predominaron las lesiones óseas y en los mayores a 3 años las lesiones de partes blandas, en todos los pacientes se descartó la presencia de metabolopatías u osteopatías, sin embargo su diagnóstico no descarta en sí mismo el SNM. Sabemos fehacientemente que la confirmación del maltrato infantil por parte del responsable será negado en forma sistemática. Pero ante la sospecha fundamentada de su existencia es nuestra responsabilidad profundizar en la búsqueda de un diagnóstico cierto para implementar un tratamiento integral físico psíquico que involucre el entorno de la víctima con la intención de evitar así futuras agresiones e incluso muerte

Shaken baby syndrome: identification, intervention, and prevention.

More than 1 million children are severely abused annually. Shaken baby syndrome (SBS), one example of physical abuse, is a leading cause of morbidity and mortality in infants. There is a national annual incidence in the United States of 750 to 3,750 cases of SBS. Shaken baby syndrome is defined as vigorous manual shaking of an infant who is being held by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding with no external signs of head trauma. Shaken baby syndrome should be suspected in infants with a wide spectrum of clinical signs and symptoms. The classic findings of SBS are retinal hemorrhages, usually bilateral, and intracranial injury. One third of the victims of SBS survive with few or no sequelae, one third suffer permanent injury, and one third die. Parental behaviors, environmental factors, and child characteristics all may contribute to a shaking event. The nurse practitioner, in a wide variety of clinical settings, is in a strategic position for the early identification and intervention for families at risk for SBS. Prevention through parent, caregiver, and community-wide education programs is the only option for infants who are at risk for SBS.