The medical assessment of fractures in suspected child maltreatment: Infants and young children with skeletal injury.

Fractures are common injuries in childhood. While most fractures are caused by accidental trauma, inflicted trauma (maltreatment) is a serious and potentially unrecognized cause of fractures, particularly in infants and young children. This practice point identifies the clinical features that prompt concern for inflicted skeletal injury and outlines a management approach based on current literature and published guidelines, including the clinician's duty to report suspicion of child abuse to child welfare authorities. This document does not address isolated skull fractures.

Sleep problems over a year in sexually abused preschoolers.

OBJECTIVES: The aim of the present study was to explore sleep problems in sexually abused preschoolers over a year. METHODS: The sample consisted of 224 abused children and 83 nonabused children aged 3 to 6 years old at enrolment into the study (T1), and 85 abused children and 73 nonabused children at the second evaluation, approximately 1 year later (T2). Sleep problems were assessed using parental reports on the Child Behavior Checklist - Preschool Version. RESULTS: Multivariate analysis of covariance revealed that sexually abused preschoolers presented higher scores of sleep problems than nonabused children on all items related to sleep problems at T1. Results from a regression analysis revealed that sexual abuse remained associated with higher levels of sleep problems after controlling for sociodemographical variables. At T2, abused preschoolers still presented more sleep problems than nonabused children on all but one of the sleep items. Results from a repeated measure one-way analysis of covariance revealed that abused preschoolers presented higher total sleep scores at both measurement times. Time was not associated with levels of sleep problems and sleep problems did not evolve differently for abused and nonabused children. CONCLUSIONS: Sexually abused preschoolers are at risk of presenting with sleep problems. These results are worrisome given the negative impacts of sleep problems on child development. Research and clinical implications are discussed.

Sleep problems and dissociation in preschool victims of sexual abuse.

OBJECTIVE: Child sexual abuse (CSA) is associated with a host of deleterious impacts, yet little is known about the short-term correlates in children. This study aimed to investigate the association between dissociation and sleep problems in a sample of preschool-age sexual abuse victims while controlling for potentially confounding variables, including gender, age, polytrauma, CSA characteristics, and parental distress. METHOD: The sample consisted of 179 children (ages 3-6 years) and their non-offending parents. Parents completed questionnaires assessing their child's dissociative symptoms and sleep problems as well as their own level of psychological distress. RESULTS: Regression analyses revealed that sleep problems were significantly associated with dissociative symptoms over and above all other control variables (children's gender and age, polytrauma, and parental distress). A longer duration of sexual abuse also predicted greater dissociative symptoms in preschool children. CONCLUSION: Findings highlight the association between sleep problems and dissociation in preschool-age victims of CSA. Further research is needed to understand their impact on children's development to design appropriate treatment and prevention initiatives aimed at fostering resilience in young vulnerable children.

Emotion Regulation in Sexually Abused Preschoolers: The Contribution of Parental Factors.

Child sexual abuse (CSA) is associated with emotion regulation deficits in childhood. Parents play a crucial role in the development of emotion regulation in their children, especially at younger ages. Close to 50% of mothers of sexually abused children report having been sexually victimized themselves as children. They are consequently at risk of experiencing significant distress following the disclosure of sexual abuse of their child. Parents' distress could interfere with their ability to provide support and to foster development of emotion regulation in their children. The aim of the present study was to explore the relationship of parental factors (history of sexual victimization in childhood and the current level of distress) to sexually abused preschoolers' emotion regulation competencies. Emotion regulation was assessed in 153 preschoolers by their parents with the Emotion Regulation Checklist; 75 of these children were abused (14 boys); 78 were not abused (21 boys) and were part of a comparison group. Parents reported their level of distress using the Psychiatric Symptom Index. Results indicated that parental factors contributed to some dimensions of preschoolers' emotion regulation (namely displays of underregulation of emotion) above and beyond children's victimization status and gender (Cohen's ƒ(2) = .15). Identifying parental distress and history of sexual victimization as positively associated with emotional dysregulation in preschool children victims of CSA has important research and clinical implications.

Palmoplantar keratoderma and skin grafting: postsurgical long-term follow-up of two cases with Olmsted syndrome.

Olmsted syndrome is a rare congenital mutilating palmoplantar keratoderma associated with periorificial keratotic plaques. Treatment options include topical keratolytics, systemic retinoids, and debulking procedures. Full-thickness excision of hyperkeratotic plaques followed by skin grafting has been reported in the medical literature, although long-term results have not been evaluated. We present two cases of Olmsted syndrome with severe palmoplantar keratoderma treated with excision and skin grafting, along with long-term clinical results 11 years (patient 1) and 6 years (patient 2) following the initial surgery.

Disclosure of sexual abuse, and personal and familial factors as predictors of post-traumatic stress disorder symptoms in school-aged girls.

OBJECTIVE: The aim of the present study was to analyze predictive factors of post-traumatic stress disorder (PTSD) symptoms in school-aged girls. METHODS: A group (n=67) of seven- to 12 year-old girls consulting a paediatric hospital following disclosure of sexual abuse were compared with a group (n=67) of nonabused girls. The girls answered questionnaires related to PTSD, coping, sense of hope, self-esteem, sibling relationships and perceived social support. Mothers answered questionnaires related to family relationships, family violence, perceived support given and psychological distress. RESULTS: The mean +/- SD age of the girls was 9+/-1.5 years. In the sexual abuse group, single-parent families were more frequent (53.7% versus 32.3%; P<0.01), mothers were less educated (10.8% versus 13.1%; P<0.0001) and socioeconomic level was lower (36.8% versus 47.9%; P<0.0001). A history of sexual abuse in childhood was reported by 50% of mothers of sexually abused children and 37% of mothers of the comparison group children. A higher prevalence of PTSD clinical scores was found for the girls reporting sexual abuse (46.3% versus 18.5%; P<0.001). Regression analyses controlling for parental education level and family structure revealed that group membership (sexual abuse group versus comparison group) was predictive of the level of PTSD symptoms. In addition, the mother's level of support, the child's perception of parental support and the child's reliance on avoidance coping predicted PTSD symptoms. Sense of hope and the child witnessing interparental physical violence were marginally associated with the level of PTSD symptoms. CONCLUSIONS: PTSD was common in the present study's sample of sexually abused girls. Because predictive factors relate to both child-related variables and familial context, interventions for this population should target not only the child, but also the family.