... Part 1508-Require-ments for full-size baby cribs. Banning of hazardous full-size baby cribs; ... more ... Part 1508-Require-ments for full-size baby cribs. Banning of hazardous full-size baby cribs; Establishment of safety require-ments. Federal Register 38:32129 (November 21), 1973. 4. Dunn SE: Title 16-Commercial Practices. ... Non-full-size baby cribs. Banning of ...
A series of severe child abuse cases in the state, all involving children who were reportedly hom... more A series of severe child abuse cases in the state, all involving children who were reportedly homeschooled, are cause for concern. We review 4 such cases and the regulations regarding homeschooling in the state of North Carolina, exploring potential deficits in the system and suggesting ways of addressing them.
Journal of the Southern Orthopaedic Association, 1998
Statistics show that more than half the victims of child abuse have fractures. The orthopedic sur... more Statistics show that more than half the victims of child abuse have fractures. The orthopedic surgeon will often be the first person to identify a potentially abused child. In a series at Brenner Children's Hospital, 17% of abused children had a fracture as the initial manifestation of child abuse. For protection of the child, it is essential that the orthopedic surgeon recognize the signs of child abuse and make a referral to the appropriate child protection agency. In this review article, we discuss recognition of common types of child abuse and outline appropriate management of child abuse cases.
... ACKNOWLEDGMENTS We are greatly indebted to Dr Jimmy Simon for critical review of the manuscri... more ... ACKNOWLEDGMENTS We are greatly indebted to Dr Jimmy Simon for critical review of the manuscript and Dr Charles Zemp for allow-ing us to share in the care of his patient. REFERENCES EWELL STEVE ROACH, MD Department of Neurology SARA HENDRICKS SINAL ...
ABSTRACT In 1979 more than 54% of women with children less than 18 years old were in the labor fo... more ABSTRACT In 1979 more than 54% of women with children less than 18 years old were in the labor force. The purpose of this study was to study the attitudes of pediatricians toward maternal employment and substitute child care arrangements. To survey their attitudes toward maternal employment and substitute child care, we sent a questionnaire to 476 North Carolina pediatricians. The response rate was 50%. On the issue of maternal employment the attitudes were 46% favorable, 35% neutral, and 19% unfavorable. Corresponding attitudes for substitute child care were 53%, 30%, and 17%.
Foreign body aspiration in children is commonly seen in emergency departments and carries a signi... more Foreign body aspiration in children is commonly seen in emergency departments and carries a significant mortality. Abusive foreign body suffocation is not well described. We present a case-series of four infants who presented with aspiration of a baby wipe. Each child was found to be a victim of child physical abuse with substantial morbidity and mortality associated with the aspiration of the wipe and associated injuries. We recommend that infants who present with a baby wipe aspiration should be considered as likely victims of child abuse and physicians should evaluate each infant for associated injuries of the oropharynx, skin, skeleton, and head.
This is a literature review of religion-associated medical neglect of children. It attempts to do... more This is a literature review of religion-associated medical neglect of children. It attempts to document the most common denominations involved in religion-associated medical neglect. There is a discussion of the history of religious exemptions to medical care and health risks to children as a result of religious exemption. Suggestions are made for the clinician regarding recognition and management of religion-associated medical neglect in children.
Juvenile dermatomyositis/polymyositis (DMS/PM) are childhood inflammatory myopathies that normall... more Juvenile dermatomyositis/polymyositis (DMS/PM) are childhood inflammatory myopathies that normally affect children between 2 and 15 years of age. The disease is manifested as severe proximal muscle weakness and, in JDMS, as a characteristic cutaneous eruption. It is difficult to predict the course of the disease. This study is aimed at objectively assessing the long-term morbidity of dermatomyositis/polymyositis in children. Twelve cases of JDMS/PM identified through chart review were evaluated by physical and dermatologic examination, muscle testing, ultrasonography, and magnetic resonance imaging (MRI). The patient population included 6 male and 6 female patients with a mean age of 18.8 years (standard deviation 12.4). The mean age at onset of JDMS/PM was 5.8 years (SD 2.8), and the mean time from onset of symptoms to beginning of the study was 10.1 years (SD 9.3). The mean duration of corticosteroid therapy was 53.1 months (SD 40.5), with patients reporting an average of 1.7 relapses (SD 1.5). Patients compared their own activity level with that of healthy control subjects, and on a scale of 1 to 5 with 5 being normal, their mean score was 3.9 (SD 0.9). Fifty-eight percent of the patients had at least one residual finding on physical examination, and 78% of those with JDMS had residual dermatologic sequelae. Despite these findings, the mean grade for the group was 4.6 (SD 0.6) for muscle strength, using a scale of 0 to 5 with 0 being no muscle resistance and 5 being normal. In 60% of patients examined by ultrasonography, increased echogenicity indicated possible residual fibrotic change in at least one muscle group. Although MRI showed no active disease process in four patients, scattered intramuscular calcification was found in one patient. Multiple physical and dermatologic sequelae are commonly present in patients with JDMS/PM on long-term follow-up, but these do not preclude a productive life. Ultrasonography and MRI provide additional noninvasive means of analysis, but because of the current high cost, MRI is not routinely recommended.
We studied both the clinical features and CT findings in 24 children who had acute head trauma as... more We studied both the clinical features and CT findings in 24 children who had acute head trauma as a result of child abuse. Twenty-three of them were less than 1 year of age. The diagnosis of whiplash shaken infant syndrome was made in 17. Serial CT, done in 50% of the cases, was useful in managing the medical, legal, and social aspects of the cases and in predicting the neurologic outcome. Three children died and 12 others suffered serious neurologic sequelae. The other five children has lesser degrees of deficit; one was lost to follow-up. Three were neurologically normal on follow-up visits. Two siblings of these children died of child abuse, indicating the necessity for continuing intervention in the abused child's family to prevent further abuse.
To evaluate human papillomavirus (HPV) presentation among children &a... more To evaluate human papillomavirus (HPV) presentation among children <13 years of age and its association with suspected child sexual abuse (CSA), and to assess sexual abuse consideration among different clinical services treating these children. Records of children <13 years of age from 1985 to 2003 were selected for review if the children had a HPV-related International Classification of Diseases, Ninth Revision, code or had been examined in the CSA clinic. Abstracted data included demographic features, clinical findings, clinical services involved, age at diagnosis, age when care was first sought, and age when symptoms were first noted. HPV was identified by clinical examination and/or biopsy for 124 children, 40 with laryngeal lesions, 67 with anogenital lesions, 10 with oral lesions, and 7 with both anogenital and oral lesions. The mean age at HPV diagnosis was 4.0 +/- 2.9 years, compared with 6.4 +/- 3.0 years for 1565 HPV-negative children. Among 108 HPV cases with data for age when symptoms were first noted, the mean age was 3.3 +/- 2.9 years (median: 2.2 years) for children with anogenital and oral HPV and 2.4 +/- 2.3 years (median: 1.9 years) for children with laryngeal HPV. Among HPV-positive patients, 56% were female, compared with 82% of HPV-negative children. Fifty-five (73%) of 75 children with anogenital HPV infections were referred to the CSA clinic for evaluation, compared with none of 49 children with laryngeal or oral HPV infections treated by the otolaryngology service. Laryngeal cases presented earlier than anogenital and oral lesions. Abuse was considered at least possible for 17 of 55 children with any CSA evaluation. The mean age of likely abused, HPV-positive children was 6.5 +/- 3.8 years (median: 5.3 years), compared with 3.6 +/- 2.3 years (median: 2.6 years) for likely not abused, HPV-positive children. The likelihood of possible abuse as a source of HPV infection increased with age. The positive predictive value of HPV for possible sexual abuse was 36% (95% confidence interval: 13-65%) for children 4 to 8 years of age and 70% (95% confidence interval: 35-93%) for children >8 years of age. The data from this epidemiologic study of HPV suggest that many anogenital and laryngeal HPV infections among preadolescent children are a result of nonsexual horizontal transmission, acquired either perinatally or postnatally. It seems that many children >2 years of age acquire HPV infection from nonsexual contact. Different subspecialties vary greatly in their suspicion and evaluation of CSA. At this time, there remains no clear age below which sexual abuse is never a concern for children with anogenital HPV infections. Every case needs a medical evaluation to determine whether enough concern for abuse exists to pursue additional investigations.
Either your web browser doesn't support Javascript or it is currently turned off. In the lat... more Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. ... Find all citations by this author (default). ... Find all citations by this author (default).
ABSTRACT Although dating violence frequently begins during adolescence, few studies have focused ... more ABSTRACT Although dating violence frequently begins during adolescence, few studies have focused on date fighting in middle and high school students. Fewer studies have studied gender differences in date violence. This study examines whether gender-specific patterns of risk behaviors exist among adolescents who report date fighting. The study was conducted on data collected from 21 297 students in grades 8 through 12 participating in the Vermont 1995 Youth Risk Behavior Survey. Data were analyzed on 20 724 students (females = 50.1%) who reported: 1) never having been involved in a physical fight (n = 8737); 2) that their last physical fight was with a girlfriend, boyfriend, or other dating partner (n = 432); and 3) that their last fight was with someone other than a dating partner (n = 11 555). Indicators of violence (weapon carrying, being threatened, and fighting), suicide attempts, substance use, sexual behavior, and pregnancy were analyzed with chi(2) tests. Significant variables were analyzed with stepwise logistic regression. Of the males, 1.8% and of the females, 4.2% reported that their last fight was with a boyfriend, girlfriend, or dating partner. Risk behaviors significantly associated among females who only experienced date fighting included the number of male sexual partners in the past 3 months (adjusted odds ratio: 1. 48; 95% confidence interval: 1.26-1.74), number of suicide attempts in the past 12 months (1.55; 1.30-1.85), riding in a car with a drinking driver (1.23; 1.10-1.37), injection of illegal drugs (2.87; 1.10-7.50), use of alcohol before last sexual encounter (1.53; 1. 27-1.86), number of pregnancies (1.66; 1.26-2.21), forced sex (2.92; 2.18-3.91), and inhalant use (1.19; 1.06-1.34). Risk behaviors significantly associated among males who experienced only date fighting were sexual activity (4.11; 2.24-7.53), number of male partners in the past 3 months (1.40; 1.12-1.75), number of times of getting someone pregnant (1.68; 1.17-2.40), experiencing forced sex (2.38; 1.11-5.13), and the number of times threatened with physical violence in past 12 months (1.82; 1.53-2.17). When compared with adolescents who reported fighting with someone other than a date, risk factors significantly associated with date fighting among females were the number of male sexual partners in the past 3 months (1.21; 1.10-1.34), older age (1.21; 1.10-1.34), carrying a weapon in the past 30 days (.77;.66-.90), experiencing forced sex (1.70; 1. 30-2.22), condom non-use (1.96; 1.60-2.41), and number of times of being threatened with physical violence in past 12 months (1.11; 1. 01-1.22). The risk factors among males were the number of male sexual partners in the past 3 months (1.43; 1.28-1.60), experiencing forced sex (1.91; 1.02-3.60), and older age (1.34; 1.14-1.57). The patterns of risk behaviors differed among male and female adolescents reporting dating violence. Females who reported date fighting were more likely than were nonfighters to have attempted suicide, to engage in sexual and human immunodeficiency virus risk behaviors (use of injectable drugs), to have been pregnant, experienced forced sex, and to have ridden in a car with a drinking driver. Sexual behaviors, including same-gender sexual partners, forced sex, and having been threatened with physical violence, were associated with date fighting among males. These findings are important in screening adolescents at risk for date violence.date fighting, adolescence, risk behaviors, gender.
JAMA: The Journal of the American Medical Association, 2002
... baby they had just seen. He was shaken back and forth, head snapping and rolling on the thin ... more ... baby they had just seen. He was shaken back and forth, head snapping and rolling on the thin stalk of neck like the head of a Raggedy Andy dolland thrown" Stephen King Insomnia Page 6. Contents ❖ ❖ <f Figures Foreword ...
... Part 1508-Require-ments for full-size baby cribs. Banning of hazardous full-size baby cribs; ... more ... Part 1508-Require-ments for full-size baby cribs. Banning of hazardous full-size baby cribs; Establishment of safety require-ments. Federal Register 38:32129 (November 21), 1973. 4. Dunn SE: Title 16-Commercial Practices. ... Non-full-size baby cribs. Banning of ...
A series of severe child abuse cases in the state, all involving children who were reportedly hom... more A series of severe child abuse cases in the state, all involving children who were reportedly homeschooled, are cause for concern. We review 4 such cases and the regulations regarding homeschooling in the state of North Carolina, exploring potential deficits in the system and suggesting ways of addressing them.
Journal of the Southern Orthopaedic Association, 1998
Statistics show that more than half the victims of child abuse have fractures. The orthopedic sur... more Statistics show that more than half the victims of child abuse have fractures. The orthopedic surgeon will often be the first person to identify a potentially abused child. In a series at Brenner Children's Hospital, 17% of abused children had a fracture as the initial manifestation of child abuse. For protection of the child, it is essential that the orthopedic surgeon recognize the signs of child abuse and make a referral to the appropriate child protection agency. In this review article, we discuss recognition of common types of child abuse and outline appropriate management of child abuse cases.
... ACKNOWLEDGMENTS We are greatly indebted to Dr Jimmy Simon for critical review of the manuscri... more ... ACKNOWLEDGMENTS We are greatly indebted to Dr Jimmy Simon for critical review of the manuscript and Dr Charles Zemp for allow-ing us to share in the care of his patient. REFERENCES EWELL STEVE ROACH, MD Department of Neurology SARA HENDRICKS SINAL ...
ABSTRACT In 1979 more than 54% of women with children less than 18 years old were in the labor fo... more ABSTRACT In 1979 more than 54% of women with children less than 18 years old were in the labor force. The purpose of this study was to study the attitudes of pediatricians toward maternal employment and substitute child care arrangements. To survey their attitudes toward maternal employment and substitute child care, we sent a questionnaire to 476 North Carolina pediatricians. The response rate was 50%. On the issue of maternal employment the attitudes were 46% favorable, 35% neutral, and 19% unfavorable. Corresponding attitudes for substitute child care were 53%, 30%, and 17%.
Foreign body aspiration in children is commonly seen in emergency departments and carries a signi... more Foreign body aspiration in children is commonly seen in emergency departments and carries a significant mortality. Abusive foreign body suffocation is not well described. We present a case-series of four infants who presented with aspiration of a baby wipe. Each child was found to be a victim of child physical abuse with substantial morbidity and mortality associated with the aspiration of the wipe and associated injuries. We recommend that infants who present with a baby wipe aspiration should be considered as likely victims of child abuse and physicians should evaluate each infant for associated injuries of the oropharynx, skin, skeleton, and head.
This is a literature review of religion-associated medical neglect of children. It attempts to do... more This is a literature review of religion-associated medical neglect of children. It attempts to document the most common denominations involved in religion-associated medical neglect. There is a discussion of the history of religious exemptions to medical care and health risks to children as a result of religious exemption. Suggestions are made for the clinician regarding recognition and management of religion-associated medical neglect in children.
Juvenile dermatomyositis/polymyositis (DMS/PM) are childhood inflammatory myopathies that normall... more Juvenile dermatomyositis/polymyositis (DMS/PM) are childhood inflammatory myopathies that normally affect children between 2 and 15 years of age. The disease is manifested as severe proximal muscle weakness and, in JDMS, as a characteristic cutaneous eruption. It is difficult to predict the course of the disease. This study is aimed at objectively assessing the long-term morbidity of dermatomyositis/polymyositis in children. Twelve cases of JDMS/PM identified through chart review were evaluated by physical and dermatologic examination, muscle testing, ultrasonography, and magnetic resonance imaging (MRI). The patient population included 6 male and 6 female patients with a mean age of 18.8 years (standard deviation 12.4). The mean age at onset of JDMS/PM was 5.8 years (SD 2.8), and the mean time from onset of symptoms to beginning of the study was 10.1 years (SD 9.3). The mean duration of corticosteroid therapy was 53.1 months (SD 40.5), with patients reporting an average of 1.7 relapses (SD 1.5). Patients compared their own activity level with that of healthy control subjects, and on a scale of 1 to 5 with 5 being normal, their mean score was 3.9 (SD 0.9). Fifty-eight percent of the patients had at least one residual finding on physical examination, and 78% of those with JDMS had residual dermatologic sequelae. Despite these findings, the mean grade for the group was 4.6 (SD 0.6) for muscle strength, using a scale of 0 to 5 with 0 being no muscle resistance and 5 being normal. In 60% of patients examined by ultrasonography, increased echogenicity indicated possible residual fibrotic change in at least one muscle group. Although MRI showed no active disease process in four patients, scattered intramuscular calcification was found in one patient. Multiple physical and dermatologic sequelae are commonly present in patients with JDMS/PM on long-term follow-up, but these do not preclude a productive life. Ultrasonography and MRI provide additional noninvasive means of analysis, but because of the current high cost, MRI is not routinely recommended.
We studied both the clinical features and CT findings in 24 children who had acute head trauma as... more We studied both the clinical features and CT findings in 24 children who had acute head trauma as a result of child abuse. Twenty-three of them were less than 1 year of age. The diagnosis of whiplash shaken infant syndrome was made in 17. Serial CT, done in 50% of the cases, was useful in managing the medical, legal, and social aspects of the cases and in predicting the neurologic outcome. Three children died and 12 others suffered serious neurologic sequelae. The other five children has lesser degrees of deficit; one was lost to follow-up. Three were neurologically normal on follow-up visits. Two siblings of these children died of child abuse, indicating the necessity for continuing intervention in the abused child's family to prevent further abuse.
To evaluate human papillomavirus (HPV) presentation among children &a... more To evaluate human papillomavirus (HPV) presentation among children <13 years of age and its association with suspected child sexual abuse (CSA), and to assess sexual abuse consideration among different clinical services treating these children. Records of children <13 years of age from 1985 to 2003 were selected for review if the children had a HPV-related International Classification of Diseases, Ninth Revision, code or had been examined in the CSA clinic. Abstracted data included demographic features, clinical findings, clinical services involved, age at diagnosis, age when care was first sought, and age when symptoms were first noted. HPV was identified by clinical examination and/or biopsy for 124 children, 40 with laryngeal lesions, 67 with anogenital lesions, 10 with oral lesions, and 7 with both anogenital and oral lesions. The mean age at HPV diagnosis was 4.0 +/- 2.9 years, compared with 6.4 +/- 3.0 years for 1565 HPV-negative children. Among 108 HPV cases with data for age when symptoms were first noted, the mean age was 3.3 +/- 2.9 years (median: 2.2 years) for children with anogenital and oral HPV and 2.4 +/- 2.3 years (median: 1.9 years) for children with laryngeal HPV. Among HPV-positive patients, 56% were female, compared with 82% of HPV-negative children. Fifty-five (73%) of 75 children with anogenital HPV infections were referred to the CSA clinic for evaluation, compared with none of 49 children with laryngeal or oral HPV infections treated by the otolaryngology service. Laryngeal cases presented earlier than anogenital and oral lesions. Abuse was considered at least possible for 17 of 55 children with any CSA evaluation. The mean age of likely abused, HPV-positive children was 6.5 +/- 3.8 years (median: 5.3 years), compared with 3.6 +/- 2.3 years (median: 2.6 years) for likely not abused, HPV-positive children. The likelihood of possible abuse as a source of HPV infection increased with age. The positive predictive value of HPV for possible sexual abuse was 36% (95% confidence interval: 13-65%) for children 4 to 8 years of age and 70% (95% confidence interval: 35-93%) for children >8 years of age. The data from this epidemiologic study of HPV suggest that many anogenital and laryngeal HPV infections among preadolescent children are a result of nonsexual horizontal transmission, acquired either perinatally or postnatally. It seems that many children >2 years of age acquire HPV infection from nonsexual contact. Different subspecialties vary greatly in their suspicion and evaluation of CSA. At this time, there remains no clear age below which sexual abuse is never a concern for children with anogenital HPV infections. Every case needs a medical evaluation to determine whether enough concern for abuse exists to pursue additional investigations.
Either your web browser doesn't support Javascript or it is currently turned off. In the lat... more Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. ... Find all citations by this author (default). ... Find all citations by this author (default).
ABSTRACT Although dating violence frequently begins during adolescence, few studies have focused ... more ABSTRACT Although dating violence frequently begins during adolescence, few studies have focused on date fighting in middle and high school students. Fewer studies have studied gender differences in date violence. This study examines whether gender-specific patterns of risk behaviors exist among adolescents who report date fighting. The study was conducted on data collected from 21 297 students in grades 8 through 12 participating in the Vermont 1995 Youth Risk Behavior Survey. Data were analyzed on 20 724 students (females = 50.1%) who reported: 1) never having been involved in a physical fight (n = 8737); 2) that their last physical fight was with a girlfriend, boyfriend, or other dating partner (n = 432); and 3) that their last fight was with someone other than a dating partner (n = 11 555). Indicators of violence (weapon carrying, being threatened, and fighting), suicide attempts, substance use, sexual behavior, and pregnancy were analyzed with chi(2) tests. Significant variables were analyzed with stepwise logistic regression. Of the males, 1.8% and of the females, 4.2% reported that their last fight was with a boyfriend, girlfriend, or dating partner. Risk behaviors significantly associated among females who only experienced date fighting included the number of male sexual partners in the past 3 months (adjusted odds ratio: 1. 48; 95% confidence interval: 1.26-1.74), number of suicide attempts in the past 12 months (1.55; 1.30-1.85), riding in a car with a drinking driver (1.23; 1.10-1.37), injection of illegal drugs (2.87; 1.10-7.50), use of alcohol before last sexual encounter (1.53; 1. 27-1.86), number of pregnancies (1.66; 1.26-2.21), forced sex (2.92; 2.18-3.91), and inhalant use (1.19; 1.06-1.34). Risk behaviors significantly associated among males who experienced only date fighting were sexual activity (4.11; 2.24-7.53), number of male partners in the past 3 months (1.40; 1.12-1.75), number of times of getting someone pregnant (1.68; 1.17-2.40), experiencing forced sex (2.38; 1.11-5.13), and the number of times threatened with physical violence in past 12 months (1.82; 1.53-2.17). When compared with adolescents who reported fighting with someone other than a date, risk factors significantly associated with date fighting among females were the number of male sexual partners in the past 3 months (1.21; 1.10-1.34), older age (1.21; 1.10-1.34), carrying a weapon in the past 30 days (.77;.66-.90), experiencing forced sex (1.70; 1. 30-2.22), condom non-use (1.96; 1.60-2.41), and number of times of being threatened with physical violence in past 12 months (1.11; 1. 01-1.22). The risk factors among males were the number of male sexual partners in the past 3 months (1.43; 1.28-1.60), experiencing forced sex (1.91; 1.02-3.60), and older age (1.34; 1.14-1.57). The patterns of risk behaviors differed among male and female adolescents reporting dating violence. Females who reported date fighting were more likely than were nonfighters to have attempted suicide, to engage in sexual and human immunodeficiency virus risk behaviors (use of injectable drugs), to have been pregnant, experienced forced sex, and to have ridden in a car with a drinking driver. Sexual behaviors, including same-gender sexual partners, forced sex, and having been threatened with physical violence, were associated with date fighting among males. These findings are important in screening adolescents at risk for date violence.date fighting, adolescence, risk behaviors, gender.
JAMA: The Journal of the American Medical Association, 2002
... baby they had just seen. He was shaken back and forth, head snapping and rolling on the thin ... more ... baby they had just seen. He was shaken back and forth, head snapping and rolling on the thin stalk of neck like the head of a Raggedy Andy dolland thrown" Stephen King Insomnia Page 6. Contents ❖ ❖ <f Figures Foreword ...
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