Pediatric Abusive Head Trauma: Multicentric Experience in Mexico.

Abusive head trauma (AHT) is one of the most severe forms of child abuse due to its morbidity and mortality. However, AHT is still misdiagnosed in developing countries because of its nonspecific clinical picture and limited knowledge of it on the part of physicians. The aim of this study was to describe some characteristics of children with AHT, their families, and caregivers, as well as the clinical data that could serve as signs for its suspicion and the medical-legal resolution of the cases. Children suspect with AHT in emergency rooms in three Mexican hospitals were included after obtaining informed consent from the parents. All information was obtained from the parents by means of a questionnaire and from different clinical and radiological evaluations of the clinical records of the patients. 15 children, with a median age of 5 months and predominantly males (73.33%), were included in the study. 66% reported a history of irritability periods, and most of the patients (73.33%) had more than one habitual caregiver. The diagnosis of AHT was suspected in only 33.33% on admission in the Emergency Services. Acute symptomatology was present in 53.33%, while less severe symptoms were reported in the rest. Special attention should be paid on babies with history of irritable periods. When a child who is previously healthy and suddenly presents with a seizure or cardiorespiratory dysfunction or brought to the hospital dead, the diagnosis of AHT should be considered as a priority.

Maltrato infantil: su conocimiento, atención y difusión en tres hospitales pediátricos de México / Child abuse: its knowledge, attention and diffusion in three pediatric hospitals in Mexico

Resumen: El maltrato infantil (MI) se ha visualizado en México desde la década de los 60 a través de publicaciones aisladas de casos clínicos donde predominaban las manifestaciones de daño físico o abuso sexual. A partir de la década de los 90, se estableció la Clínica de Atención Integral al Niño Maltrato en el Instituto Nacional de Pediatría (CAINM-INP), cuyo accionar se orientó a la asistencia, docencia e investigación del tema. Este enfoque fue imitado en dos centros hospitalarios del país: en la Clínica para la Atención Integral del Menor Maltratado del Hospital Infantil de Especialidades de Chihuahua y en el Servicio de Pediatría del Hospital General de Mexicali. El objetivo básico de este trabajo fue presentar a la comunidad médica y paramédica, a otros profesionales que interactúan con la población pediátrica y a la sociedad civil los esfuerzos que se han realizado en México para enfrentar esta situación médica-social y legal de una manera lógica, siempre orientada a proteger a las víctimas y a sus familias.

Abstract: Child abuse (CA) was observed in Mexico since the early 60's through isolated publications from clinical cases and where manifestations of physical injury or sexual abuse predominated. Since the 90's, the Clinic for Integral Care of the Abused Child was established at the National Institute of Pediatrics (CAINM-INP, for its Spanish acronym), which actions were addressed to the care, teaching and research on this topic. This approach was replicated in two hospital centers in the country: the Clinic for Integral Care of the Abused Children at Children's Specialty Care Hospital of Chihuahua and the Pediatric Service of the General Hospital of Mexicali. The main objective of this work was to present to the medical community, paramedics, and other professionals who interact with the pediatric population and society, the efforts that have been made in Mexico to address this legal, medical, and social pathology in a logical manner, and always aimed at protecting victims and their families.

[Child abuse: its knowledge, attention and diffusion in three pediatric hospitals in Mexico]. / Maltrato infantil: su conocimiento, atención y difusión en tres hospitales pediátricos de México.

Child abuse (CA) was observed in Mexico since the early 60's through isolated publications from clinical cases and where manifestations of physical injury or sexual abuse predominated. Since the 90's, the Clinic for Integral Care of the Abused Child was established at the National Institute of Pediatrics (CAINM-INP, for its Spanish acronym), which actions were addressed to the care, teaching and research on this topic. This approach was replicated in two hospital centers in the country: the Clinic for Integral Care of the Abused Children at Children's Specialty Care Hospital of Chihuahua and the Pediatric Service of the General Hospital of Mexicali. The main objective of this work was to present to the medical community, paramedics, and other professionals who interact with the pediatric population and society, the efforts that have been made in Mexico to address this legal, medical, and social pathology in a logical manner, and always aimed at protecting victims and their families.