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.

Physical abuse of children: an update.

Now, more than ever, physicians must be willing to suspect child abuse and report their concerns. New information from the past decade warns us that reports of violence against children continue to increase. We are learning that MRI imaging of the head may, in some cases, help date subdural hematomas, but long-term developmental follow-up studies of "shaken" infants are lacking. Intentional thoracic and abdominal injuries carry a high mortality. Finally, new information in the field of child abuse-in particular, physical abuse-is slow to come. Lack of funding for basic medical child abuse research and lack of trained researchers in the field are the two most important barriers. Preventive intervention at the community and family level needs to be supported by both the pediatrician and the local and national government leaders. As the U.S. Advisory Board on Child Abuse and Neglect says, "We need to make it as easy for parents to pick up the telephone and get help before they abuse their child as it is now for their neighbor or physician to pick up the telephone and report them after it has happened." Child health practitioners may be in the best position to implement such a policy.

Physical abuse of children: an update.

Now, more than ever, physicians must be willing to suspect child abuse and report their concerns. New information from the past decade warns us that reports of violence against children continue to increase. We are learning that MRI imaging of the head may, in some cases, help date subdural hematomas, but long-term developmental follow-up studies of "shaken" infants are lacking. Intentional thoracic and abdominal injuries carry a high mortality. Finally, new information in the field of child abuse--in particular, physical abuse--is slow to come. Lack of funding for basic medical child abuse research and lack of trained researchers in the field are the two most important barriers. Preventive intervention at the community and family level needs to be supported by both the pediatrician and the local and national government leaders. As the U.S. Advisory Board on Child Abuse and Neglect says, "We need to make it as easy for parents to pick up the telephone and get help before they abuse their child as it is now for their neighbor or physician to pick up the telephone and report them after it has happened." Child health practitioners may be in the best position to implement such a policy.

Parietal pseudofracture and spontaneous intracranial hemorrhage suggesting nonaccidental trauma: report of 2 cases.

Massive intracranial hemorrhage, no history of trauma and radiographic findings that were initially interpreted as linear parietal fractures raised the possibility of nonaccidental trauma in 2 infants. Both had severe coagulopathy, 1 due to hemorrhagic disease of the newborn (vitamin K deficiency) and the other due to disseminated herpes simplex virus infection. Both infants died. At autopsy, the parietal bone abnormalities were not fractures, but proved to be an anomalous suture in 1 and a connective tissue fissure in the other.

Tuboovarian abscess and peritonitis caused by Streptococcus pneumoniae serotype 1 in young girls.

Streptococcus pneumoniae is a frequent bacterial cause of pneumonia, bacteremia, meningitis, and otitis media in infants and children. Primary pneumococcal peritonitis, however, is rare in children and is usually associated with an underlying medical condition (such as nephrotic syndrome) or with upper genital tract disease in females, Pneumococcal upper genital tract infections in the premenarchal child are extremely unusual. Epidemiologic reviews of pneumococcal serotypes causing infection in children have indicated that serotype 1 is an uncommon pathogen of pelvic disease in children. We describe three children who presented with abdominal pain and a toxic appearance; appendicitis was initially suspected in all three children, but peritonitis due to S pneumoniae serotype 1 was subsequently diagnosed in all three. Each child had a tuboovarian abscess that was demonstrated radiographically. Two children had complicated courses, but all ultimately recovered. The epidemiology and possible tropism of serotype 1 isolates for the female upper genital tract are discussed.