Perpetrators of abusive head trauma: a comparison of two geographic populations.

BACKGROUND: Abusive head trauma accounts for significant morbidity and mortality in infants. We compared a Southern population of victims with those in a previous study of a Western population, which found that men, particularly fathers and mothers' boyfriends, are the most common perpetrators. METHODS: All cases of child abuse identified in a teaching hospital were prospectively reviewed for cases of abusive head trauma, and the perpetrators were identified. RESULTS: Of the 76 cases of head trauma identified, 27 met the criteria for the study. The demographics of the perpetrators closely match those of the Western group. Men are the predominant perpetrators, with fathers committing 45% and boyfriends 25% of these injuries. CONCLUSIONS: Despite the differences in study design and population demographics, men are the most common perpetrators of abusive head trauma in both populations.

Child abuse and forensic pediatric medicine fellowship curriculum statement.

Physicians have been involved in the diagnosis and treatment of victims of child abuse and neglect for more than 35 years. In the past decade, a cadre of physicians has developed extensive expertise in the field. Now, physicians are requested for expert consultation by medical, investigative, and legal colleagues. As the field advances, it has become necessary to train more physicians in the field of child abuse and forensic pediatrics as well as to standardize the curricula of the existing fellowships. A joint working group of the American Academy of Pediatrics Section on Child Abuse and Neglect and the Forensic Pediatrics Physician Leadership Group convened to develop a curriculum for medical fellowships in child abuse and neglect. The authors present the model curriculum developed by this group.

Abusive head trauma: the relationship of perpetrators to their victims.

OBJECTIVE: Abusive head trauma is the most common cause of morbidity and mortality in physically abused infants. Effective prevention requires the identification of potential perpetrators. No study has specifically addressed the relationship of the perpetrators of abusive head trauma ("shaken baby syndrome") to their victims. The objectives of this study were to identify the abusers and their relationship to victims in these cases. METHODS: We reviewed the medical charts of 151 infants who suffered abusive head trauma to determine the perpetrator of the abuse. Caretakers were classified by level of certainty: confession to the crime, legal actions taken, or strong suspicion by the staff. The relationship of abusers to victims was analyzed. RESULTS: Male victims accounted for 60.3% of the cases. Twenty-three percent of the children died, although death rates for boys and girls did not vary significantly. Male perpetrators outnumbered females 2.2:1, with fathers, step-fathers, and mothers' boyfriends committing over 60% of the crimes. Fathers accounted for 37% of the abusers, followed by boyfriends at 20.5%. Female baby-sitters, at 17.3%, were a large, previously unrecognized group of perpetrators. Mothers were responsible for only 12.6% of our cases. All but one of the confessed abusers were with the child at the time of onset of symptoms. CONCLUSIONS: Our data suggest male caretakers are at greater risk to abuse infants. Baby-sitters are a concerning risk group, because they represent a significant proportion of abusers, and they more easily escape prosecution. In addition, no prevention efforts have been directed at baby-sitters. These statistics could help change the focus of efforts to prevent abusive head trauma.

Syphilis in infants and young children.

Syphilis is a disease very much on the rise in certain populations in this country. It has reached epidemic proportions in some areas. This trend should be a concern to physicians caring for children in the United States. Rates of congenital syphilis are continuing to rise. Certainly, the poor prenatal care received by many women is inhibiting our ability to prevent congenital syphilis. All infants should have a maternal test for syphilis clearly documented before hospital discharge. In the event that maternal history of length of disease or treatment cannot be documented, the infant should be treated with a full course of antibiotics. In addition, all symptomatic infants should be treated and followed to ascertain falling antibody titers. Acquired syphilis should be suspected in any child with either a positive test for syphilis or symptomatic syphilis in whom evidence for congenital syphilis cannot be documented. Sexual abuse must be strongly suspected even in the absence of disclosure, and the case must be reported to local child protective services. Adequate treatment and follow-up must be assured. Clinicians should refamiliarize themselves with the many and varied presentations of syphilis. Many practitioners will be faced with diagnostic and treatment decisions while the infants are still in the newborn nursery. Occasionally, a child will escape diagnosis and present with symptomatic syphilis later. This disease should not be overlooked in the differential diagnoses of many seemingly simple childhood complaints.