Prosecuting cases of abusive head trauma in Switzerland: a descriptive study of the impact of medical documentation and delay of reporting on judicial outcome.

Abusive head trauma (AHT) is a criminal offence that is prosecuted ex officio, following report to the police from physicians or child protection services. The aim of this study was to assess whether the judicial outcome (dismissal vs indictment) was influenced by the quality of the medical documentation and/or the time span between AHT diagnosis and reporting child abuse to the police. The cohort was divided in two groups: 13/23 dismissals (57%) and 10/23 indictments (43%). The diagnostic probability of the AHT cases was certain for both groups. Nonetheless, in fraction of dismissed cases, alternative explanations for the observed lesions seemed plausible to the public prosecutor. Legal files of only 3/12 dismissed cases had a forensic report, while 6/10 cases that were indicted included a forensic report. Further, the legal file of several dismissed cases entirely lacked medical documentation (3/12), which was not the cases for indicted cases. The period between AHT diagnosis and reporting to the police was not different for dismissals (29 ± 19 days) and indictments (7 ± 4 days) (p = 0.32). Physicians filed reports more rapidly (6 ± 1 days) compared to childhood protection service (70 ± 46 days) (p = 0.01) and that may increase the rate of indictments (9/18) compared to reporting via the childhood protection service (1/5). Despite diagnostic certainty, other causes for the lesions were considered as plausible alternative explanations to judicial professionals in several dismissed cases. These seemed to have less medical documentation and forensic evaluations. In addition, more rapid reporting to the police by physicians seems to increase the likelihood of indictments.

[Pediatrics. Consultation in pediatric for children exposed to domestic violence]. / Pédiatrie. Consultation en pédiatrie pour les enfants victimes de violence conjugale.

Exposure to domestic violence affects a significant number of minors and is recognized as psychological abuse of children, with harmful consequences for their health in the absence of protection. The identification of such situations by professionals remains a major challenge, given the culture of secrecy that often prevails in such circumstances. When the situation of children or adolescents exposed to domestic violence is known, it is essential to set up an assessment. A brief intervention led by psychologists has recently been developed within the CHUV's Pediatrics Department. Considering the family context and the type of violence, this service assesses the needs of minors and guides them, placing them at the heart of the support process.

L'exposition à la violence conjugale concerne un nombre important de mineurs et est reconnue comme une maltraitance psychologique envers les enfants, avec des conséquences néfastes pour leur santé en l'absence de protection. Le repérage de ces situations par des professionnels demeure un défi majeur en raison de la culture du secret qui règne souvent dans ces circonstances. Lorsque la situation d'enfants ou d'adolescents exposés à la violence conjugale est connue du médecin, il est essentiel de mettre en place une évaluation. Une intervention brève conduite par des psychologues a récemment été développée au sein du Service de pédiatrie du CHUV. Tenant compte du contexte familial et du type de violences, cette prestation met l'accent sur l'évaluation des besoins des mineurs et sur leur orientation, en les plaçant au centre de la démarche de soutien.

[SECURE: a tool for assessing minors who are victims of domestic violence]. / SECURE : un outil pour évaluer les mineurs victimes de violences conjugales.

Growing up in a climate of domestic violence can have serious repercussions on the health and development of minors. The Child Abuse and Neglect Team (CAN Team) specializes in detecting and analyzing this type of violence. Based on the literature, a tool for structuring the clinical assessment of the child's situation has been created, considering the context of the violence and the risk and protective factors. The tool is described in this article, which offers recommendations for primary care physicians in assessing the danger to a child or adolescent's development.

Grandir dans un climat de violences conjugales peut avoir de graves répercussions sur la santé et le développement des mineurs. Le CAN Team (Child Abuse and Neglect Team), groupe hospitalier de protection de l'enfant, est spécialisé dans la détection et l'analyse de ce type de violences. Sur la base de la littérature, un outil permettant de structurer l'évaluation clinique de la situation de l'enfant a été élaboré, en tenant compte du contexte de violences et des facteurs de risque et de protection. Cet instrument est décrit dans cet article qui propose des recommandations aux médecins de premier recours pour apprécier le danger pesant sur l'évolution de l'enfant ou de l'adolescent.

[Assessment of families in situations of forced migration: Transcultural approaches to identifying and supporting psychological suffering]. / Évaluation des familles en situation de migration forcée: Approches transculturelles pour repérer et accompagner la souffrance psychologique.

With current migratory movements, the population is becoming increasingly mixed, and consultations are receiving more migrants. The paediatrician or general practitioner is often the front-line health professional who has to assess how to welcome a newcomer family, investigate their life history, discuss mental health with them and sometimes overcome the negative prejudices that some cultures and people may have about psychiatry. Identifying worrying symptoms is an important first step in the overall assessment. It is then essential to support these families while working on protective factors and offering support for parenthood. Finally, working with the network will be key to ensuring continuity of care and the most appropriate support for the migrant's needs.

Avec les mouvements migratoires actuels, la population devient de plus en plus métissée et les consultations accueillent davantage de migrants. Le pédiatre ou le généraliste est souvent le professionnel de santé en première ligne qui doit évaluer la façon d'accueillir une famille primo-arrivante, d'investiguer leur histoire de vie, de parler de santé mentale avec eux et parfois de contourner les préjugés négatifs que certaines cultures et personnes pourraient avoir sur la psychiatrie. Le repérage des symptômes inquiétants est une première étape importante lors de l'évaluation globale. Il est fondamental ensuite d'accompagner ces familles tout en travaillant sur les facteurs protecteurs et en proposant un soutien à la parentalité. Enfin, le travail avec le réseau sera déterminant pour assurer la continuité des soins et un accompagnement le plus adapté au besoin du migrant.

Paediatric refugees from Ukraine: guidance for health care providers.

BACKGROUND: With the invasion of Ukraine by the Russian Army in February 2022, refugees, the majority of whom are women and children, started fleeing the war to neighbouring countries. Even before the current escalation, the conflict in the eastern part of Ukraine has led to the internal displacement of more than 200,000 children, and many others have experienced attacks, e.g. on schools. This inevitably leads to limitations in health care delivery. During transit, overcrowding, poor shelter and vulnerability may further put refugees at increased risk for infectious diseases. This consensus document aims to provide information and guidance regarding health issues that paediatricians and general practitioners may face when caring for Ukrainian children. METHODS: Members of the Migrant Health Reference Group of Paediatrics Switzerland and the Paediatric Infectious Disease Group in Switzerland developed this recommendation between March and April 2022 in a modified Delphi process. RESULTS: A total of 50 recommendations were agreed on with a ≥80% consensus. These include the following topics: i) general aspects, including interpreter services, urgent health needs, personal history and general check-ups; ii) mental health, including how to search for signs of psychological distress without going into traumatic details; iii) vaccinations, including recommendations for evaluation and catch-up; iv) screening for tuberculosis, human immunodeficiency virus, and hepatitis B and C; and v) providing age-appropriate preventive and health service information. CONCLUSION: This document provides current evidence and guidance when caring for paediatric refugees from Ukraine. The recommendations focus on Switzerland but may well be used in other countries. These are based on current evidence and may need to be adapted to individual situations and once further evidence becomes available.

[Mobbing amongst students : from detection to care : How to work together ?] / Harcèlement-intimidation entre élèves - De la détection à la prise en charge : comment travailler ensemble ?

Mobbing amongst students represent a worrying public health issue. The role of doctors, whether in the hospital or in the office, is decisive in the early detection of suffering related to a context of violence at school. The CAN Team offers support to professionals confronted with these situations in order to improve the collaboration of adults, professionals or parents, who accompany these young people. Since 2015, the canton of Vaud has been deploying a comprehensive system in schools to prevent and deal with mobbing amongst students. A communication procedure between the CAN Team and the schools has been set up in order to offer a coherent care for all children and adolescents in the canton.

Les phénomènes de harcèlement-intimidation entre élèves représentent un problème de santé publique préoccupant. Le rôle des médecins, que ce soit à l'hôpital ou au cabinet, est déterminant dans la détection précoce d'une souffrance en lien avec un contexte de violences à l'école. Le CAN Team (Child Abuse and Neglect Team) offre un soutien aux professionnel-le-s confron­té-e-s à ces situations afin d'améliorer la collaboration des adultes, professionnel-le-s ou parents, qui accompagnent ces jeunes. Le canton de Vaud déploie depuis 2015 dans les écoles un dispositif complet afin de prévenir et prendre en charge les phénomènes de harcèlement-intimidation entre élèves. Une procédure de communication entre le CAN Team et les écoles a été mise sur pied en vue d'offrir une prise en charge cohérente pour l'ensemble des enfants et des adolescent-e-s du canton.

[COVID-19: does the end of semi-confinement match with the beginning of the revelations of child abuse ?] / COVID-19: la fin du semi-confinement rime-t-elle avec le début des révélations de mauvais traitements envers les enfants ?

During the semi-confinement period linked to the COVID-19 pandemic, the CHUV's Child Abuse and Neglect Team observed a decrease in cases of child abuse. Has confinement made it easier for families to avoid violence or, on the contrary, to hide it? Within the framework of this second hypothesis, we propose that the relaxation of the measures be an opportunity for professionals to explore in families the possible occurrence of domestic abuse.

Au CHUV, durant la période de semi-confinement liée à la pandémie Coronavirus Disease 2019, le Child Abuse and Neglect Team a observé une baisse des cas de maltraitance. Le confinement a-t-il permis aux familles d'avoir moins recours à la violence ou, au contraire, de la cacher ? Dans le cadre de cette seconde hypothèse, nous proposons que l'assouplissement des mesures soit une opportunité pour les professionnels d'explorer dans les familles la possible survenue de maltraitances intrafamiliales.

[Abuse and non-accidental violence in the adolescent athlete†: how to detect and assess†?] / Maltraitance du jeune sportif†: la détecter et l'évaluer.

Youth sports participation is often perceived as a positive contributor to physical and psychological development. However, we must acknowledge that sometimes the sports environment can be plagued by events of abuse and non-accidental violence of different types. A global and systemic approach will allow the limitation of these catastrophic events in young athletes' lives. Healthcare professionals must be able and knowledgeable to identify abuse correctly and in a timely fashion, to report it and to manage applying interdisciplinary principles. Their role is paramount in the education of all stakeholders, helping to raise awareness around abuse in adolescent athletes. Sporting organizations must apply existing recommendations from health and sporting authorities to guarantee the welfare of the adolescents they welcome in their world.

L'activité sportive contribue au bon développement physique et psychologique des adolescents. Nous devons néanmoins constater que les pratiques y sont parfois néfastes et recèlent des éléments de maltraitance ou de violence non accidentelle. Seule une approche globale et systémique pourra permettre de limiter la survenue de ces événements extrêmement délétères pour la santé des jeunes athlètes. Les professionnels de la santé doivent identifier la maltraitance, la signaler et la prendre en charge en équipe interdisciplinaire. L'éducation et la sensibilisation de tous les acteurs sont les mesures indispensables de départ, puis les organisations sportives doivent de leur côté appliquer les recommandations existantes pour garantir le bien-être des adolescent·e·s qu'ils accueillent.

[Lost in transition: crossed looks on the 18-25 years old]. / Lost in transition :regards croisés sur les 18-25 ans.

Social determinants have an impact on patients' access to care and on their health at any age. Young adults are a population at risk of being affected in their health because of a lack of social protection or unavailability of healthcare system adapted to their specific needs. Primary healthcare providers need to identify that window of social vulnerability in order to avoid a discontinuation in healthcare and to prevent biopsychosocial co-morbidity leading to ongoing consequences on their health.

L'impact des déterminants sociaux sur l'accès aux soins des patients et sur leur santé concerne toutes les catégories d'âge. Les jeunes adultes sont une population particulièrement à risque d'être pénalisés dans leur santé par un défaut de protection sociale ou de réseau de soins adapté à leurs besoins spécifiques. Le médecin de premier recours, pédiatre ou généraliste, doit identifier cette fenêtre de vulnérabilité sociale afin d'éviter une rupture de soins et prévenir les comorbidités biopsychosociales ayant des conséquences durables sur la santé.

[Adolescent and physical activity: addi(c)tive excesses]. / Adolescent et sportif: quand les excès s'addi (c) tionnent.

Benefits of physical activity during adolescence have widely been demonstrated. Yet, raising awareness among young athletes and their surrounding about risks associated with too early specialization or energy deficit--with or without eating disorder--is of outmost importance. Such behaviours can affect adolescents' physical or psychological development as well as compromise their athletic career not to mention the potential negative impact on their athletic performance. Primary care practitioners play an important role in early detection and prevention of overuse injuries as well as psychological distress associated with intense physical activity. Such situations need the intervention of an interdisciplinary team in order to prevent long-term complications.

[News in paediatrics]. / Pédiatrie.

Every pediatrician will be confronted with newborns oryoung infants with skin lesions in proximity of the vertebral column. It is important not to miss a spinal dysraphism because of the risk of meningeal infection or of the possible presence of a tethered cord. A practical algorithm is presented. Non-accidental injury in young infants and toddlers is not rare but difficult to detect. Bruises and fractures are highly suspicious for non-accidental injury and should trigger specific investigations. Emergency departments and hospitals are switching from hypotonic to isotonic solutions as maintenance infusions of children. They reduce the risk of hyponatremia without increasing that of hypernatremia, and they should be used preferentially in the majority of pediatric clinical settings.

[Sport medicine consultation for adolescents]. / Pédiatrie. (2.) Consultation de médecine du sport dédiée à l'adolescent.

Sport activity is a determinant of health and well-being for adolescents' psychological and physic development. Early detection of traumatic lesions or pathological condition among sportive adolescent in the light of their developmental stage is of outmost importance and is best done by an interdisciplinary team. This clinical management also aims at preventing consequences of inappropriate training. The CHUV has set-up a specific sports medicine outpatient consultation clinic for adolescents in the order to provide the best integrative management of young athletes.

[The major issues of an "assault and battery" report for an adolescent]. / Constat "de coups et blessures" et enjeux chez l'adolescent mineur.

Adolescents who are confronted to violence rarely consult health services about this problem. Family maltreatment is the origin of most violence against adolescents, but remains very often hidden from the eyes of professionals. The "assault and battery" reports produced by emergency services are largely about community violence situations. The medical consultation following an assault requires a global evaluation of the teenager confronted to violence. This evaluation will have to take into account not only the adolescent's requests (such as confidentiality), but also professional duties to prevent recidivism.

The health status of children without resident permit consulting the Children's Hospital of Lausanne.

OBJECTIVE: To assess social, economic and medical data concerning children without a resident permit taken into care by the Children's Hospital of Lausanne (HEL) in order to evaluate their specific needs. METHODS: Prospective exploratory study by a questionnaire including the socio-demographic, medical and education data of 103 children without a resident permit, who consulted the HEL for the first time between August 2003 and March 2006. These children were then recalled for a second check-up one year later in order to allow a regular monitoring. RESULTS: Eighty-seven percent of the children were native of Latin America, 36% being less than two years old. This population of children lived in precarious conditions with a family income lower than the poverty level (89% of the families with less than 3100 CHF/month). Forty-five percent of the children had a health insurance. The main reasons for consultation were infectious diseases, a check-up requested by the school or a check-up concerning newborn children. Most of them were in good health and the others were affected by illnesses similar to those found in other children of the same age. At least 13% of the children were obese and 27% were overweight. All children who were of educational age went to school during the year after the first check-up and 48% were affiliated to a health insurance. CONCLUSIONS: The majority of the children from Latin America lived in very precarious conditions. Their general health status was good and most of them could benefit from regular check-ups. Prevention, focused on a healthier life style, was particularly important among this population characterised by a high incidence of overweight and obesity.