Defining Child Exposure to Domestic Violence: Lessons from a Historical Review of the Literature

Child witnesses of domestic violence policies and practices have been fraught with conceptual challenges that limit their implementation. Such limitations are evident in the case of Minnesota, which amended their definition of child neglect to include a child’s exposure to family violence, only to later repeal this amendment in response to pressure from child welfare administrators and domestic violence advocates (Edleson, Gassman-Pines, & Hill, 2006; Kantor & Little, 2003). The conceptual flaws are also evident in disparities across state statutes for definitions of child witnesses of domestic violence and the legal penalties it carries (Child Welfare Information Gateway, 2021). To enhance the integrity of child witnesses of domestic violence policies and practices, critical attention is needed to clarify and refine the central construct. Pursuant to this goal, this conceptual paper analyzes and synthesizes the history of child welfare. It demonstrates how child witnesses of domestic violence became a social and legal problem. The author traces the evolution of child welfare as a concept and provides new insights. The author also sheds light on the driving forces of child welfare policies and practices. The paper begins in the colonial ages, which gave roots to the contemporary child welfare system. The author describes the early development of child welfare leading to contemporary practice. The paper ends by making evidence-based recommendations for constructing child welfare policies that enhance the safety of children exposed to domestic violence using least restrictive interventions.

Associations of childhood unintentional injuries with maternal emotional status during COVID-19

Background To explore the characteristics of unintentional childhood-injury during the COVID-19 pandemic and assess the association of unintentional-injury with maternal emotional status. Methods A cross-sectional survey was conducted with a convenience sample of 1300 children under 12-years-old from 21 schools (including nurseries/ kindergartens/ primary schools) in Wuhan and Shanghai during March to April 2020, and the mothers completed questionnaires online. Self-rating Depression/Anxiety Scales were used to evaluate maternal emotional status, questions on child unintentional-injury were based on the International-Statistical-Classification-of-Diseases-and-Related-Health-Problems-version-10 (ICD-10), and a total of 11 kinds of unintentional injuries were inquired. Information on socio-demographic and family-background factors was also collected. Results The children of 0–4, 5–9, and 10–12 years accounted for 29.2, 55.2 and 15.6%, respectively, the unintentional-injury rates were 10.29, 4.18 and 3.45%, respectively (P < 0.001), and boys had higher rates than girls. The three leading causes included “being struck by/against”, falls and animal bites (traffic-injury accounted for a small proportion). Lower maternal educational, living in suburban/rural (vs. urban) areas, grandparents (vs. mothers) being main caregivers, more child exposure to secondhand smoke, close relatives being suspected/ confirmed COVID-19 cases were associated with a higher risk of child unintentional-injury. After adjusting for related confounders, higher maternal depression levels were associated with a higher risk of unintentional injury. Conclusions The characteristics of unintentional childhood injury were different from those in non-pandemic periods. The main causes, risk factors and the association of unintentional injury with maternal depression deserve attention for development of effective measures for preventing children from unintentional injury during COVID-19 pandemic. Graphical abstract

Neurodevelopment in normocephalic children with and without prenatal Zika virus exposure

ObjectiveZika virus (ZIKV) targets neural stem cells in the developing brain. However, the majority of ZIKV-exposed children are born without apparent neurological manifestations. It remains unclear if these children were protected from ZIKV neurotropism or if they harbour subtle pathology that is disruptive to brain development. We assess this by comparing neurodevelopmental outcomes in normocephalic ZIKV-exposed children relative to a parallel control group of unexposed controls.DesignCohort study.SettingPublic health centres in Grenada, West Indies.Patients384 mother–child pairs were enrolled during a period of active ZIKV transmission (April 2016–March 2017) and prospectively followed up to 30 months. Child exposure status was based on laboratory assessment of prenatal and postnatal maternal serum.Main outcome measuresThe INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) package and Cardiff Vision Tests, administered and scored by research staff masked to child’s exposure status.ResultsA total of 131 normocephalic ZIKV exposed (n=68) and unexposed (n=63) children were assessed between 22 and 30 months of age. Approximately half of these children completed vision testing. There were no group differences in sociodemographics. Deficits in visual acuity (31%) and contrast sensitivity (23%) were apparent in the ZIKV-exposed infants in the absence of cognitive, motor, language or behavioural delays.ConclusionsOverall neurodevelopment is likely to be unaffected in ZIKV-exposed children with normal head circumference at birth and normal head growth in the first 2 years of life. However, the visual system may be selectively vulnerable, which indicates the need for vision testing by 3 years of age.

Famine Exposure in Early Life and Risk of Type 2 Diabetes in Adulthood: Findings From Prospective Cohort Studies in China

Background: This study will investigate effect of famine exposure in early life associated with the risk of type 2 diabetes in adulthood during the Chinese Famine.Methods: A total of 3,418 individuals aged 35-74 years free of diabetes in 2006 and in 2009 study surveys, were prospectively followed up to 2009 and 2012, respectively. Individuals were grouped into non-exposed (1962-1978), fetal-exposed (1959-1961), childhood-exposed (1949-1958) and adolescence/adult-exposed cohorts (1931-1948). Logistic regression model was employed to assess effect of famine exposure on diabetes incidence, adjusting for potential covariates.Results: During a mean follow up of 3 years, the age-adjusted cumulative incidences of type 2 diabetes were 6.3%, 13.0% 11.0% and 13.8% in non-exposed, fetal, child and adolescence/adult-exposed cohorts, respectively (P=0.026). Compared with non-exposed individuals, relative risks (95% confidence intervals) for diabetes incidence were 2.15(1.29-3.60), 1.53(0.93-2.51), and 1.65(0.75-3.63) in those exposure in fetal, child and adolescence/adult, controlling for covariates. The interactions between famine exposure and obesity, education, family history of diabetes were not observed, except for famine exposure and residential areas. Individuals lived in rural areas increased risk for type 2 diabetes in fetal and child exposure, with an incidence relative risk (95% confidence interval) of 8.79(1.82-42.54) and 2.33(1.17-4.65), respectively.Conclusions: Our findings indicate that famine exposure in early life is an independent predictor on type 2 diabetes, particularly in women. The identification and intervention on critical time can prevent residents from diabetes in later life.The clinical trial was registered, more detail linked in https://clinicaltrials.gov/ct2/home, as registration no. NCT01053195.

Shared worlds and shared consequences: Initial validation of the Assessment of Parent and Child Adversity (APCA)

Background: Advancing understanding of how early adversity arises, manifests, and contributes to health difficulties depends on accurate measurement of children’s experiences. In addition to fetal exposure to the physiological consequences of prenatal adversity, individuals’ exposure to adversity is often intertwined with that of their caregivers in early life. Here, we introduce and present psychometric properties of a novel measure of adversity, the Assessment of Parent and Child Adversity (APCA), which simultaneously characterizes parents’ and children’s adversity.Methods: During pregnancy, women from a longitudinal cohort reported their past adverse experiences. When their children were at ages 3–5 years, a subset of 97 mothers completed the APCA, the Childhood Trauma Questionnaire, and the Benevolent Childhood Experiences scale. They reported their current symptoms of depression and anxiety and their child’s emotional and behavioral problems. Using the APCA, we distinguished between maternal adversity during different periods (childhood, preconception, prenatal, since child’s birth) and obtained metrics of child witnessing of and direct exposure to adversity. Results: The APCA efficiently captured maternal exposure to 40 types of adversity and child exposure to 10 types of direct adversity; it also demonstrated good convergent and divergent validity with other measures of maternal adverse and positive experiences, respectively. Measures of maternal adversity were strongly associated with maternal symptoms of psychopathology, with evidence for effects of developmental timing. Children whose mothers experienced greater adversity, particularly in the prenatal period, had more emotional and behavioral problems, as did children who were directly exposed to greater adversity.Conclusions: The APCA has good usability and convergent, discriminant, and criterion validity. Leveraging the ability of the APCA to distinguish between adversity occurring during different life stages and originating from different sources, our findings highlight potentially distinct effects of different aspects of maternal and child adversity on difficulties in maternal and child mental health.

Prevalence and Factors Associated With Suicidal Ideation Among Children and Adolescents Attending a Pediatric HIV Clinic in Uganda

Background: Suicidal behavior and HIV/AIDS are vital public health challenges especially in low and middle-income countries. As suicide in adults is perturbing for those closest to them, this sentiment is much more intense and generalized in the case of a child or adolescent. Knowledge of factors associated with suicidal ideation in HIV infected children and adolescents may inform suicide prevention strategies needed to improve their quality of life. This study aimed to assess the prevalence and factors associated with suicidal ideation among HIV infected children and adolescents attending a pediatric HIV clinic in Uganda.Methods: Data from a sample of 271 children and adolescents aged 6–18 years living with HIV/AIDS attending a pediatric HIV clinic was analyzed. Child characteristics and clinical variables were assessed using a socio-demographic questionnaire and medical records respectively. Suicidal ideation and depression were assessed using the Child Depression Inventory. The types of behavioral problems and the parent–child relationship were assessed using Child Behavioral Check List (6–18 years) and the Parent Child Relationship Scale respectively. Child exposure to different stressful life events was assessed with a series of standardized questions. Logistic regression models were used to explore factors independently associated with suicidal ideation.Results: The prevalence of suicidal ideation was 17%. In the multivariate analysis; Child exposure to family or friend’s death (prevalence rate ratio (PRR = 2.02; 95% CI, 1.01–4.03), p = 0.046), HIV wasting syndrome (PRR = 0.39; 95% CI, 0.21–0.75, p = 0.04), Depression (PRR = 1.08; 95% CI, 1.03–1.12, p = 0.001), Anxiety symptoms (PRR = 1.10; 95% CI, 1.01–1.20, p = 0.024) and Rule breaking behavior (PRR = 1.06; 95% CI, 0.99–1.13, p = 0.051) were independently associated with suicidal ideations.Conclusion: The prevalence of suicidal ideation among children and adolescents living with HIV/AIDS is substantial. Children and adolescents with exposure to family or friend’s death, those with higher depression scores, anxiety symptoms and rule breaking behavior are more likely to report suicidal ideation. Those with HIV wasting syndrome were less likely to report suicidal ideation. There is urgent need for HIV care providers to screen for suicide and link to mental health services.

Paediatric emergency department dog bite attendance during the COVID-19 pandemic: an audit at a tertiary children’s hospital

BackgroundResponses to the COVID-19 pandemic include strict public health measures, such as national lockdowns. During these measures, paediatric emergency department attendances have declined and the prevalence of presenting complaints has changed. This study sought to identify whether dog bite attendance and victim demographics changed during COVID-19 public health measures.MethodsAn audit was conducted of emergency department attendance data from a UK tertiary paediatric hospital between January 2016 and September 2020. Dog bite attendance and victim demographics were explored using χ2 tests and multivariable Poisson regression. The mean monthly percentage of attendance due to dog bites in 2020 was compared against predicted percentages based on previous years’ data.ResultsDog bite attendance rose in conjunction with the introduction of COVID-19 public health measures and reached a peak in July 2020 (44 dog bites, 1.3% of all attendances were due to dog bites). This was a threefold increase in dog bite attendance. By September 2020, attendance had returned to normal. The demographic profile of child dog bite victims remained the same. Boys had the highest attendance rates in 7–12 year-olds, girls in 4–6 year-olds. Girls showed higher attendance rates in the summer, while boys’ attendance rates were constant throughout the year. COVID-19 public health measures were associated with a 78% increase in attendance for boys and a 66% increase in girls.ConclusionsCOVID-19 national public health measures were associated with an increase in paediatric emergency department dog bite attendance, and may be due to increased child exposure to dogs via ‘stay at home’ orders and school closures. National lockdowns are likely to continue globally throughout the COVID-19 pandemic; this is likely to result in more dog bites. Urgent public health communication and injury prevention strategies are needed to help prevent these avoidable injuries.

Child Protective Services Guidelines for Substantiating Exposure to Domestic Violence as Maltreatment and Assigning Caregiver Responsibility: Policy Analysis and Recommendations

The purpose of this study was to examine the range of policy approaches used by child welfare systems in the United States to guide workers in classifying and substantiating child exposure to domestic violence (CEDV) as an actionable form of maltreatment. To that end, we conducted a qualitative document analysis of child protective services (CPS) policy manuals from all state-administered child welfare systems in the U.S. ( N = 41). Our findings indicate that a majority of state-administered systems (71%) have adopted policy requiring workers to demonstrate that children have endured harm or the threat of harm before substantiating CEDV-related maltreatment. Many state systems (51%) also include policy directives that require workers to identify a primary aggressor during CPS investigations involving CEDV, while far fewer (37%) provide language that potentially exonerates survivors of domestic violence from being held accountable for failure to protect on the basis of their own victimization. Based on our findings and identification of policy exemplars, we offer a recommended set of quality policy indicators for states to consider in the formulation of their policy guidelines for substantiating children’s exposure to domestic violence that promotes the safety and wellbeing of both children and adult survivors of domestic violence.

Risk factors for habitual snoring in children aged 2--14 years

Background: Habitual snoring (HS), a prominent symptom of sleep-disordered breathing , is important to also consider the associated, multidimensional risk factors for HS in children. Aim: To identify risk factors for HS in children. Methods: A cross-sectional survey was performed in Chengdu. Children aged 2–14 years from four districts were randomly chosen to participate.Questionnaires were voluntarily completed by the children’s guardians. Results: The survey included 926 boys and 622 girls, who were an average of 7.11 5.25 years old. The sample included 463 habitual snorers (30.38%), 683 occasional snorers (44.82%), and 402 non-snorers (26.38%). HS was found in 51.84% of preschool children and 26.6% of school children.Among the HS group, 31.3% had a maternal education of a college degree or higher and 86.6%had an immediate family member who snores. Breastfeeding duration among the HS group was significantly less than among the occasional snoring and non-snoring groups. History of symptoms of allergic rhinitis, rhinosinusitis, tonsillitis, and pneumonia/bronchitis in the past six months were associated with HS. Likewise, maternal smoking during pregnancy, maternal exposure to secondhand smoke during pregnancy , and child exposure to secondhand smoke were also associated with HS. Conclusion: The prevalence of HS was higher in preschool children. Having a mother with more education, a family history of snoring, a shorter period of breastfeeding, upper respiratory tract inflammation, and passive smoking are important risk factors for HS.