Instinctual stimulation of children: From common practice to child abuse. Vol. 1: Clinical findings, By John Leopold Weil, International Universities Press, Madison, Connecticut, 1989, 270 pages, $30.00, ISBN: 0–8236–2885-X

Author(s):  
Samuel E. Rubin
2019 ◽  
Vol 39 (01) ◽  
pp. 028-035
Author(s):  
Werner Streif ◽  
Irmina Watzer-Herberth ◽  
Gabriele Hahn ◽  
Uwe Schmidt ◽  
Ralf Knöfler

AbstractChildren with an unexplained bleeding tendency are frequently referred to a haemostaseologist for further evaluation. Careful standardized history taking and clinical evaluation should allow for distinguishing bleeds after minor injury and trauma which are very common in all children. However, in two groups of children bleeding symptoms may be more significant than expected: those with an underlying coagulation disorder and those who have been subjected to physical child abuse. The coexistence of child abuse and a bleeding disorder must always be considered. An extended coagulation diagnostic is required if the morphology of bleedings is not clearly suspicious for child abuse and in the absence of typical concomitant injuries, e.g., bone fractures. An interdisciplinary approach involving a forensic pathologist and a paediatric haemostaseologist for assessment of bleeding symptoms, the explanation of the clinical findings, and the critical evaluation of laboratory results are essential in such cases. This review is focussed on symptoms in accidental and nonaccidental injuries in children assisting haemostaseologists in decision making in cases of child protection issues.


Author(s):  
Mustafa Hussein Ajlan Al-Jarshawi ◽  
Ahmed Al-Imam

Background Medical child abuse describes a child receiving unnecessary, harmful, or potentially harmful medical care at the caretaker's instigation. Objectives To focus on medical child abuse as an entity and emphasize its epidemiology, clinical presentations, prevention, and management. Results In the UK, the annual incidence of medical child abuse in children below one year increased to 3:100,000, while its prevalence in Arabs, including Iraq, is ambiguous due to lack of evidence and improper clinician's awareness. The mean age at diagnosis is 14 months to 2.7 years. Female caregivers are the most common offenders. Clinically, medical child abuse could fit into three stages; falsification of illness story, falsification of illness story and physical signs' fabrication, or induction of illness in children. A successful diagnosis mandates a comprehensive review of medical records to identify discrepancies between caregivers' stories versus clinical findings or investigations. Management requires recognizing abuse, halting it, securing the child's safety, maintaining the family's integrity when possible, and aborting unnecessary lateral referrals within the healthcare system. Conclusion Reported cases of medical child abuse are increasing steadily, while less severe ones go unrecognized. No diagnostic tool can help other than the physician's high index of suspicion. The management follows the same principles applied for other forms of child abuse, while good medical practice ensures its prevention.


PEDIATRICS ◽  
1977 ◽  
Vol 60 (4) ◽  
pp. 642-643
Author(s):  
Arthur C. Jaffe ◽  
Daniel H. Lasser

Ever since Caffey's classic description of its clinical findings,1 physicians have been aware of the syndrome of child abuse and its skeletal pathology. Because of the emphasis placed on them by Caffey1 and others,2,3 it is now considered standard medical practice to obtain roentgenograms of the skull, ribs, and long bones as part of the routine evaluation of suspected child abuse. We are reporting an abused infant with multiple metatarsal fractures, an apparently undescribed finding in maltreatment syndromes. We also raise the question of whether or not roentgenographic search for fractures of the small bones of the extremities should be routinely performed.


PEDIATRICS ◽  
1972 ◽  
Vol 50 (6) ◽  
pp. 881-889
Author(s):  
Gertrude Costin ◽  
Ann K. Kershnar ◽  
Maurice D. Kogut ◽  
Roger W. Turkington

Two 8-year-old girls, one of whom had Down's syndrome, presented with myxedema and precocious sexual development. Elevated circulating thyrotrophin (TSH), luteinizing hormone (LH), follicle-stimulating hormone (FSH) levels, and prolactin activities were documented. Following treatment with thyroid extract, the abnormal clinical findings and the elevated levels of pituitary hormones returned to normal. The results of studies in our patients suggest a derangement in hypothalamic pituitary regulatory mechanisms. It is postulated that low circulating thyroxine may increase the hypothalamic content of thyroid-releasing hormone (TRH) and the sensitivity of the pituitary to TRH stimulation resulting in increased release of TSH and prolactin. The elevated plasma gonadotrophins may result from a nonspecific stimulation of the hypothalamic gonadotrophin-releasing hormone (LH-FSH-RH) or from a direct stimulation by prolactin of the LH-FSH-RH.


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