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Book Details
Abstract
Child Abuse and Neglect: Diagnosis, Treatment and Evidence focuses attention on the clinical evidence of child abuse to help you correctly diagnose and treat such cases in your own practice. This unique, well-illustrated clinical reference provides new insights into the presentation and differential diagnosis of physical abuse, a look at shaken baby syndrome, sex offenders and abuse in religious organizations, information on the biomechanics of injury, and more. Great for general review, as well as clinical reference, it’s also ideal for those taking the American Board of Pediatrics’ new subspecialty board exam in Child Abuse Pediatrics.
- Identify an abusive injury and treat it effectively by reviewing evidence and critical analyses from leading authorities in the field.
- Recognize the signs of shaken baby syndrome, sex offenders and abuse in religious organizations.
- Understand the biomechanics of injury to determine whether abuse was truly the cause of a child’s injury.
View illustrations that show first-hand examples of child abuse or neglect.
Expert clinical evidence to recognize, diagnose and treat child abuse
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Child Abuse and Neglect | i | ||
| Copyright page | iv | ||
| Dedication | v | ||
| contributors | vii | ||
| preface | xv | ||
| acknowledgments | xvii | ||
| Table of Contents | xix | ||
| I Epidemiology of Child Maltreatment | 1 | ||
| 1 Epidemiological Issues in Child Maltreatment Research, Surveillance, and Reporting | 3 | ||
| Introduction | 3 | ||
| Terminology | 3 | ||
| Epidemiological Studies in Child Abuse | 5 | ||
| Problems in Conducting Research in Child Abuse and Neglect | 6 | ||
| Data Collection Issues | 6 | ||
| Ethical Issues | 7 | ||
| Difficulties Identifying Child Abuse and Neglect | 8 | ||
| Strength of the Evidence | 8 | ||
| Future Directions | 9 | ||
| References | 9 | ||
| 2 Epidemiology of Physical Abuse | 10 | ||
| Introduction | 10 | ||
| Scope of the Problem | 10 | ||
| Risk Factors for Physical Abuse | 11 | ||
| Child Characteristics | 11 | ||
| Caregiver Characteristics | 11 | ||
| Family Characteristics | 12 | ||
| Neighborhood Characteristics | 12 | ||
| Physical Abuse Epidemiology by Injury Type or Body Section | 12 | ||
| Head (Excluding Brain and Skull) and Neck | 12 | ||
| Visceral Injuries | 13 | ||
| Skeletal Injury | 13 | ||
| Skin Injury | 13 | ||
| Future Research | 14 | ||
| References | 14 | ||
| 3 Epidemiology of Sexual Abuse | 16 | ||
| History | 16 | ||
| Terminology | 16 | ||
| Case Finding | 16 | ||
| Incidence | 16 | ||
| Prevalence | 18 | ||
| Why CSA is Declining | 18 | ||
| Recurrence | 19 | ||
| Risk and Protective Factors | 19 | ||
| Strength of the Evidence and Directions for Future Research | 21 | ||
| References | 21 | ||
| 4 Epidemiology of Intimate Partner Violence | 23 | ||
| Introduction | 23 | ||
| Definitions | 23 | ||
| Scope of the Issue | 23 | ||
| Risk Factors | 23 | ||
| Social Considerations | 24 | ||
| Barriers to Seeking Help | 24 | ||
| Motivators for IPV Victims to Seek Help | 25 | ||
| Provider Barriers | 25 | ||
| Effect of Intimate Partner Violence on Children | 25 | ||
| Strength of the Medical Evidence | 26 | ||
| Directions for Future Research | 26 | ||
| References | 26 | ||
| 5 Epidemiology of Child Neglect | 28 | ||
| Introduction | 28 | ||
| Definitional Issues | 28 | ||
| How Much Care is Adequate? Neglect and a Continuum of Care | 28 | ||
| The Quest for an Evidence-Based Definition | 28 | ||
| Actual vs. Potential Harm | 28 | ||
| Further Refining the Definition of Neglect: A Heterogeneous Phenomenon | 29 | ||
| The INCIDENCE of Child Neglect | 29 | ||
| Contributors to Neglect | 30 | ||
| Individual Level | 30 | ||
| Parental Characteristics | 30 | ||
| Child Characteristics | 30 | ||
| Family Level | 31 | ||
| Community/Neighborhood Level | 31 | ||
| Societal Level | 31 | ||
| Professional Level | 32 | ||
| Protective Factors | 32 | ||
| Conclusion | 32 | ||
| References | 32 | ||
| 6 Epidemiology of Abusive Head Trauma | 35 | ||
| Introduction | 35 | ||
| Population-Based Incidence Studies of Abusive Head Trauma | 35 | ||
| Population at Risk | 37 | ||
| Societal Risk Factors | 37 | ||
| Family Characteristics | 37 | ||
| Adult Characteristics | 37 | ||
| Child Characteristics | 37 | ||
| Crying as a Potential Trigger | 37 | ||
| Summary | 37 | ||
| References | 38 | ||
| II Interviewing | 39 | ||
| 7 Interviewing Children and Adolescents About Suspected Abuse | 41 | ||
| Introduction | 41 | ||
| Forensic (Investigative) Interviews | 41 | ||
| Importance of the Medical History | 42 | ||
| Legal Considerations | 43 | ||
| Factors that Impact Patterns of Disclosure | 43 | ||
| Clinical Approach to the Medical History | 45 | ||
| Language Acquisition and Development in Children (Table 7-2) | 45 | ||
| Important Principles in Interviewing Children | 45 | ||
| Approach to the Interview | 46 | ||
| Components of the Medical History | 47 | ||
| Information About Abusive Events | 47 | ||
| Gynecological History | 49 | ||
| Family History and Responses to Abuse Disclosure | 49 | ||
| Safety Issues | 49 | ||
| Other Information | 49 | ||
| References | 50 | ||
| 8 Interviewing Caregivers of Suspected Child Abuse Victims | 51 | ||
| The Pediatric History before Concern for Maltreatment | 51 | ||
| Recognizing Red Flags During the History and Examination | 51 | ||
| Important Interactional Cues and Behavioral Observations | 52 | ||
| Separation of Caregiver from the Child for the Interview | 52 | ||
| Beware of Bias | 52 | ||
| The Detailed Interview Once There is Concern for Abuse | 52 | ||
| First Things First | 53 | ||
| Rapport | 53 | ||
| Separation of Caregivers from One Another for the Interview | 54 | ||
| Key Details to Ask | 54 | ||
| Specific Questions for Physical Abuse | 54 | ||
| Interview Questions Specific to Sexual Abuse | 55 | ||
| Interviewing About Suspected Child Neglect | 55 | ||
| When and How to Inform Caregivers About Concern for Maltreatment | 55 | ||
| Contextual Issues/Special Circumstances | 57 | ||
| When the Caregiver Is Also a Victim | 57 | ||
| Caregiver Substance Use/Abuse or Mental Illness | 57 | ||
| Cultural Factors | 57 | ||
| Medical Child Abuse | 58 | ||
| The Importance of Documentation | 58 | ||
| Strength of Medical Evidence | 58 | ||
| Suggested Directions for Future Research | 58 | ||
| References | 58 | ||
| III Sexual Abuse of Children | 61 | ||
| 9 The Physical Examination of the Child When Sexual Abuse Is Suspected | 63 | ||
| Introduction | 63 | ||
| Medical Evaluation | 63 | ||
| Approach to the Physical Examination | 63 | ||
| Timing of the Examination | 63 | ||
| Preparing the Child for Examination | 64 | ||
| The Medical Examination | 64 | ||
| Examination Positions | 65 | ||
| Examination Equipment | 66 | ||
| Specific Anatomical Areas | 67 | ||
| Debriefing the Child and Caregivers after the Examination | 67 | ||
| Documentation | 67 | ||
| Interpretation of Medical Findings | 67 | ||
| References | 68 | ||
| 10 Normal and Developmental Variations in the Anogenital Examination of Children | 69 | ||
| Genital Embryology | 69 | ||
| Variants in Female Genital Anatomy | 70 | ||
| Hymenal Configurations | 70 | ||
| The Newborn Hymen | 72 | ||
| Developmental Changes to the Hymen | 72 | ||
| Longitudinal Intravaginal Ridges | 74 | ||
| External Ridges | 74 | ||
| Vestibular Bands | 74 | ||
| Hymenal Tags and Mounds | 74 | ||
| Notches/Clefts | 75 | ||
| Transverse Hymenal Diameters | 76 | ||
| Width of the Inferior Hymenal Rim | 76 | ||
| Vascularity and Erythema of the Hymen and Vestibule | 76 | ||
| Linea Vestibularis | 76 | ||
| Lymphoid Follicles | 77 | ||
| Paraurethral Cysts | 77 | ||
| Imperforate Hymen | 77 | ||
| Perineal Variants | 77 | ||
| Infantile Pyramidal Protrusion | 77 | ||
| Failure of Midline Fusion | 77 | ||
| Median Raphe | 78 | ||
| Perianal Variants | 78 | ||
| Diastasis Ani | 78 | ||
| Prominent Skin Folds and the Pectinate Line | 78 | ||
| Anal Skin Tags | 78 | ||
| Anal Dilatation | 78 | ||
| Venous Congestion | 79 | ||
| Variants in Male Genital Anatomy | 79 | ||
| Pearly Papules | 79 | ||
| Hypospadias | 80 | ||
| Hydroceles | 80 | ||
| Varicocele | 80 | ||
| Future Research | 80 | ||
| References | 80 | ||
| 11 Physical Findings in Children and Adolescents Experiencing Sexual Abuse or Assault | 82 | ||
| Introduction | 82 | ||
| Importance of Standardization of Examination Techniques | 82 | ||
| Acute Genital Findings Following Sexual Trauma | 82 | ||
| Healing of Acute Anogenital Injuries | 84 | ||
| Nonacute Examinations of Prepubertal Children | 85 | ||
| Nonacute Examinations of Adolescents | 87 | ||
| Evaluation of Serious Genital Injuries from Sexual Assault | 89 | ||
| Genital and Anal Injuries in Sexual Abuse of Males | 90 | ||
| Anal Injuries | 91 | ||
| Directions for Research | 91 | ||
| References | 92 | ||
| 12 Medical Conditions with Genital/Anal Findings that Can Be Confused with Sexual Abuse | 93 | ||
| Irritants and Dermatitis | 93 | ||
| Labial Adhesions | 94 | ||
| Crohn Disease | 95 | ||
| Genital/Anal Infections | 96 | ||
| Foreign Bodies | 96 | ||
| Vascular Problems | 97 | ||
| Neoplasia | 97 | ||
| Anal Findings | 97 | ||
| Urethral Prolapse | 98 | ||
| Ureterocele | 99 | ||
| Lichen Sclerosus Et Atrophicus | 99 | ||
| Genital Ulcers | 100 | ||
| Accidental Anogenital Injury | 101 | ||
| Anal/Genital Injuries Due to Physical Abuse | 103 | ||
| Strength of Medical Evidence and Directions for Future Research | 103 | ||
| References | 104 | ||
| 13 The Forensic Evidence Kit | 106 | ||
| Introduction | 106 | ||
| Collecting Forensic Evidence | 106 | ||
| Consent | 106 | ||
| Collection and Handling of Evidence | 106 | ||
| Chain of Custody | 107 | ||
| Timing of Evidence Collection | 107 | ||
| The Rape Kit | 107 | ||
| Clothing | 108 | ||
| Swabs | 108 | ||
| Bite Marks | 109 | ||
| Hair | 109 | ||
| Nails | 109 | ||
| Toluidine Dye | 109 | ||
| Alternative Light Sources | 109 | ||
| Saliva | 109 | ||
| Frequency of Recoverable Evidence | 110 | ||
| Frequency of Forensic Evidence in Children | 110 | ||
| Strength of Medical Evidence and Directions for Future Research | 110 | ||
| References | 111 | ||
| 14 Tests Used to Analyze Forensic Evidence in Cases of Child Sexual Abuse and Assault | 112 | ||
| Introduction | 112 | ||
| Analysis of Bodily Fluids | 112 | ||
| Semen/Seminal Fluid | 112 | ||
| Blood | 113 | ||
| Saliva | 113 | ||
| Trace Evidence | 114 | ||
| Clinical Considerations | 115 | ||
| Legal Issues | 115 | ||
| Strength of the Medical Evidence | 116 | ||
| Suggested Directions for Future Research | 116 | ||
| References | 116 | ||
| 15 Drug-Facilitated Sexual Assault | 118 | ||
| Occurrence and Characteristics of Drug-Facilitated Sexual Assault | 118 | ||
| Substances Commonly Used in DFSA | 120 | ||
| Ethyl Alcohol | 120 | ||
| Benzodiazepines and Flunitrazepam | 120 | ||
| Cannabis | 121 | ||
| Cocaine | 121 | ||
| Amphetamines/Methamphetamines | 122 | ||
| GHB (Gamma-Hydroxybutyric Acid), GBL (Gamma-Butyrolactone), and 1,4 BD (1,4-Butanediol) | 122 | ||
| Recommendations | 122 | ||
| References | 125 | ||
| 16 Adolescent Sexual Assault and Statutory Rape | 127 | ||
| Adolescent Perceptions and Attitudes | 127 | ||
| Populations at Risk | 127 | ||
| The Clinical Implications of Sexual Assault and Abuse | 128 | ||
| Intimate Partner Violence | 128 | ||
| Statutory Rape | 129 | ||
| Medical and Psychological Consequences of Sexual Abuse and Assault | 129 | ||
| Sexual Abuse and Assault and Pregnancy | 129 | ||
| Rape Trauma Syndrome | 130 | ||
| Examination of the Sexually Assaulted Adolescent Patient | 130 | ||
| Establishing Adolescent Rapport and Confidentiality | 130 | ||
| Encouraging the Adolescent to Cooperate with the Examination | 130 | ||
| Adolescents’ Understanding of “Sex” | 131 | ||
| Managing the System’s Response to Adolescent Sexual Assault and Abuse | 131 | ||
| When A Parent Requests An Examination to Determine if Their Child Is A Virgin | 131 | ||
| Conclusions | 131 | ||
| References | 132 | ||
| 17 Female Genital Mutilation/Cutting | 134 | ||
| Terminology | 134 | ||
| Prevalence and Geographic Distribution | 134 | ||
| Types of Female Genital Mutilation | 134 | ||
| Cultural Issues | 135 | ||
| Preservation of Cultural Identity | 136 | ||
| Marriage | 136 | ||
| Religion | 136 | ||
| Health | 136 | ||
| Hygiene and Aesthetic Reasons | 136 | ||
| Contributing to Social Stability | 136 | ||
| Health Complications | 137 | ||
| Management of FGM | 138 | ||
| Child Protection Management | 138 | ||
| Medical Management | 139 | ||
| International Response | 139 | ||
| References | 140 | ||
| 18 Internet Child Sexual Exploitation | 142 | ||
| Children on the Internet | 142 | ||
| Case Examples | 143 | ||
| Child Pornography | 143 | ||
| Cybersex | 145 | ||
| Recommendations | 145 | ||
| References | 146 | ||
| 19 Evaluating Images in Child Pornography | 147 | ||
| Introduction | 147 | ||
| Normative Studies of Physical and Sexual Maturation | 147 | ||
| Reviewing Images and Videos | 148 | ||
| Physical Characteristics and Age Ranges | 148 | ||
| Secondary Sexual Characteristics | 149 | ||
| Supplemental Secondary Sexual Characteristics | 150 | ||
| Ratings Based on Body Size and Habitus in Smaller Children | 150 | ||
| Challenges in Assessing Age and Maturity of Photographic Subjects | 150 | ||
| References | 151 | ||
| 20 Child Molesters | 152 | ||
| Introduction | 152 | ||
| Definitions | 153 | ||
| Child Molesters | 153 | ||
| Pedophilia, Paraphilia, and Hebephilia | 153 | ||
| Internet Child Molesters | 154 | ||
| Etiology of Child Molesters | 154 | ||
| Obtaining Evidence | 155 | ||
| Cognitive Evidence | 155 | ||
| Behavioral Evidence | 156 | ||
| Victim Access | 157 | ||
| Child Molesters: Other Populations | 159 | ||
| Juvenile Child Molesters | 159 | ||
| Female Child Molesters | 160 | ||
| Organized Groups | 161 | ||
| Associated Problems of Child Molesters | 161 | ||
| Treatment | 162 | ||
| Future Directions | 163 | ||
| Acknowledgments | 164 | ||
| References | 164 | ||
| IV Sexually Transmitted Infections in Children—Epidemiology, Diagnosis and Treatment | 167 | ||
| 21 Nonsexually Transmitted Infections of the Genitalia and Anus of Prepubertal Children | 169 | ||
| Normal Vaginal Flora and Nonspecific Vulvovaginitis | 169 | ||
| Miscellaneous Causes | 169 | ||
| Specific Vulvovaginitis | 169 | ||
| Group A β-hemolytic Streptococcus (S. pyogenes) | 170 | ||
| Shigella | 170 | ||
| Other Less Common Bacteria | 170 | ||
| Anaerobic and Mixed Anaerobic Infections | 170 | ||
| Miscellaneous Bacteria | 171 | ||
| Fungal Causes of Vulvovaginitis | 171 | ||
| Viral Causes of Vulvovaginitis | 171 | ||
| Helminths, Parasites, Protozoa, Lice, and Mites | 172 | ||
| Summary | 172 | ||
| References | 172 | ||
| 22 Bacterial Sexually Transmitted Infections in Children | 174 | ||
| Epidemiology | 174 | ||
| Clinical Manifestations | 174 | ||
| Diagnosis | 175 | ||
| Forensic Applications | 175 | ||
| Treatment | 175 | ||
| Follow-Up Considerations | 175 | ||
| Strength of the Evidence | 176 | ||
| Suggested Directions for Future Research | 177 | ||
| References | 177 | ||
| 23 Viral and Parasitic Sexually Transmitted Infections in Children | 179 | ||
| Human Papillomavirus (HPV) | 179 | ||
| Viral Hepatitis | 180 | ||
| Hepatitis A | 180 | ||
| Hepatitis B | 180 | ||
| Hepatitis C | 181 | ||
| Other Types of Viral Hepatitis | 181 | ||
| Hepatitis Viruses and Sexual Assault and Abuse | 181 | ||
| Herpes Simplex Virus (HSV 1 and HSV 2) | 181 | ||
| Molluscum Contagiosum | 182 | ||
| Trichomonas Vaginalis (TV) | 182 | ||
| Scabies | 183 | ||
| Pediculosis | 183 | ||
| Summary | 183 | ||
| Strength of the Evidence | 184 | ||
| Areas for Future Research | 184 | ||
| References | 184 | ||
| 24 HIV and Aids in Child and Adolescent Victims of Sexual Abuse and Assault | 186 | ||
| Introduction | 186 | ||
| Intersection of Aids and Hiv With Child Sexual Abuse and Assault | 186 | ||
| Risk Assessment | 187 | ||
| Postexposure Prophylaxis | 188 | ||
| Treatment Guidelines | 189 | ||
| Strength of the Medical Evidence | 190 | ||
| Suggested Directions for Future Research | 190 | ||
| References | 190 | ||
| 25 Laboratory Methods for Diagnosing Sexually Transmitted Infections in Children and Adolescents | 193 | ||
| Specimen Collection | 193 | ||
| Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) | 198 | ||
| Herpes Simplex Virus | 200 | ||
| Human Papilloma Virus | 201 | ||
| Trichomonas Vaginalis and Other Causes of Vaginitis/Vaginosis | 201 | ||
| Lice | 202 | ||
| Serological Testing | 203 | ||
| Reporting of STIs | 203 | ||
| Strength of Medical Evidence | 203 | ||
| References | 204 | ||
| V Physical Abuse of Children | 207 | ||
| 26 Documenting the Medical History in Cases of Possible Physical Child Abuse | 209 | ||
| The Medical Record | 209 | ||
| The Interview Circumstances | 209 | ||
| The History of Present Illness | 210 | ||
| Past Medical History and Review of Systems | 211 | ||
| The Developmental History | 211 | ||
| The Social History | 212 | ||
| The Family History | 212 | ||
| The Use of Standardized Forms to Record the Medical History | 212 | ||
| Final Reports | 213 | ||
| Toward the Future | 213 | ||
| References | 213 | ||
| 27 Photodocumentation in Child Abuse Cases | 215 | ||
| Introduction | 215 | ||
| Equipment | 215 | ||
| Composition | 217 | ||
| Storage | 218 | ||
| Common Errors | 219 | ||
| Alternate Light Source Photography | 219 | ||
| Legal Issues | 219 | ||
| Conclusion | 220 | ||
| References | 220 | ||
| 28 Abusive Burns | 222 | ||
| Epidemiology and Demographics of Child Abuse by Burning | 222 | ||
| Characteristics of Abusive Burn Perpetrators | 222 | ||
| Classification of Burns | 222 | ||
| Types of Burns and Medical Evidence Suggesting Maltreatment | 223 | ||
| Thermal Burns | 223 | ||
| Abusive Thermal Burn Mimics | 226 | ||
| Contact Burns | 226 | ||
| Chemical Burns | 228 | ||
| Flame Burns | 229 | ||
| Electrical Burn Injury | 229 | ||
| Microwave Oven Burns | 230 | ||
| Friction/Pressure “Burns” | 230 | ||
| Burns Associated with Cultural Medicine Practices | 230 | ||
| Burns and Neglect | 231 | ||
| Presentation of the Burned Child for Medical Care | 231 | ||
| Medical Documentation | 232 | ||
| Dating of Burn Injuries in the Medical Record | 233 | ||
| Additional Medical Testing | 233 | ||
| Scene Investigation | 233 | ||
| Psychological Issues of the Burned Child and the Family | 235 | ||
| Burn Injury Prevention | 235 | ||
| Strength of the Medical Evidence | 236 | ||
| Future Directions for Abusive Burn Injury Research | 236 | ||
| References | 236 | ||
| 29 Bruises and Skin Lesions | 239 | ||
| Introduction | 239 | ||
| Anatomy of the Skin | 239 | ||
| Biomechanical Properties of the Skin | 239 | ||
| Bruising | 241 | ||
| Definitions | 241 | ||
| Bruise Evolution and the Myth of the Aging of Bruises | 241 | ||
| Defining Other Skin Injuries | 243 | ||
| Evaluation of Cutaneous Injuries for Possible Child Abuse | 243 | ||
| History | 243 | ||
| Examination | 243 | ||
| Documentation | 244 | ||
| Interpretation of Findings | 244 | ||
| Other Considerations | 249 | ||
| Complications of Soft Tissue Injury | 250 | ||
| Future Research Directions | 250 | ||
| References | 250 | ||
| 30 Skin Conditions Confused with Child Abuse | 252 | ||
| Introduction | 252 | ||
| Conditions Confused with Bruising | 252 | ||
| Congenital Conditions | 252 | ||
| Dermatological Conditions | 252 | ||
| Disorders of Pigmentation | 252 | ||
| Hypersensitivity Syndromes | 253 | ||
| Vasculitic Disorders | 253 | ||
| Connective Tissue Disorders | 254 | ||
| Hematologic Conditions | 254 | ||
| Oncological Disorders | 255 | ||
| Cultural Practices | 255 | ||
| Other Conditions | 255 | ||
| Conditions Confused with Burns | 256 | ||
| Dermatological Conditions | 256 | ||
| Infections | 256 | ||
| Cultural Practices | 257 | ||
| Accidental Burns | 257 | ||
| Chemical Burns | 257 | ||
| Conclusion | 258 | ||
| References | 258 | ||
| 31 Bone Health and Development | 260 | ||
| Anatomy and Bone Development | 260 | ||
| Factors Affecting Bone Strength | 261 | ||
| Noninvasive Measures of Bone Strength | 261 | ||
| Bone Physiology and Disease Processes | 261 | ||
| Calcium Homeostasis and Parathyroid Hormone | 261 | ||
| Nutritional Factors that Influence Calcium Balance | 262 | ||
| Parathyroid Hormone | 262 | ||
| Hypoparathyroidism | 262 | ||
| Pseudohypoparathyroidism | 262 | ||
| Hypomagnesemia | 262 | ||
| Phosphate Homeostasis | 262 | ||
| X-linked Hypophosphatemic Rickets (XLH, also known as vitamin D-resistant rickets). | 263 | ||
| Autosomal Dominant Hypophosphatemic Rickets. | 263 | ||
| Fanconi Syndrome. | 263 | ||
| Oncogenic Hypophosphatemic Osteomalacia. | 263 | ||
| Vitamin D | 263 | ||
| Vitamin D metabolism. | 263 | ||
| Sources of Vitamin D. | 263 | ||
| Vitamin D Deficiency. | 263 | ||
| Clinical Manifestations of Vitamin D Deficiency. | 264 | ||
| Diagnosis of Rickets. | 264 | ||
| Metabolic Causes of Rickets. | 264 | ||
| Biochemical Changes in Rickets. | 264 | ||
| Treatment of Rickets. | 264 | ||
| Vitamin D Deficiency and Fractures. | 264 | ||
| Copper Deficiency | 265 | ||
| Vitamin C Deficiency | 265 | ||
| Vitamin A Intoxication | 265 | ||
| Caffey Disease | 265 | ||
| Hypophosphatasia | 266 | ||
| Osteoporosis | 266 | ||
| Primary Osteoporosis. | 266 | ||
| Secondary Osteoporosis. | 266 | ||
| Neuromuscular Disease | 266 | ||
| Chronic Illness | 267 | ||
| Reproductive and Endocrine Disorders | 267 | ||
| Iatrogenic Agents Associated with Pediatric Osteoporosis | 267 | ||
| Infections That Affect Bone Health | 268 | ||
| Prematurity | 268 | ||
| Osteogenesis Imperfecta | 269 | ||
| Type I. | 269 | ||
| Type II. | 269 | ||
| Type III. | 269 | ||
| Type IV. | 269 | ||
| Type V. | 270 | ||
| Type VI. | 270 | ||
| Type VII. | 270 | ||
| Laboratory Findings. | 270 | ||
| Diagnosis. | 270 | ||
| Differential Diagnosis | 271 | ||
| Osteogenesis Imperfecta Versus Nonaccidental Trauma | 271 | ||
| Temporary Brittle Bone Disease | 271 | ||
| Summary | 272 | ||
| References | 273 | ||
| 32 Abusive Fractures | 275 | ||
| Fracture Assessment and Injury Plausibility | 275 | ||
| The Provided Versus the Obtained History | 275 | ||
| Bony Injuries | 276 | ||
| Overview of Fracture Incidence | 276 | ||
| Fractures in Different Stages of Healing | 276 | ||
| Subperiosteal New Bone Formation | 276 | ||
| Multiple Fractures | 276 | ||
| Fractures with a High Specificity for Abuse | 277 | ||
| Classic Metaphyseal Lesions (CML). | 277 | ||
| Scapular Fractures. | 285 | ||
| Sternal and Pelvic Fractures. | 286 | ||
| Vertebral Fractures. | 286 | ||
| Hand Fractures. | 287 | ||
| Foot Fractures. | 287 | ||
| Fractures Common in Both Abusive and Accidental Trauma (Not Specific for Abuse) | 287 | ||
| Femur Fractures. | 287 | ||
| Tibia/Fibula Fractures. | 289 | ||
| Humerus Fractures. | 289 | ||
| Radius/Ulna Fractures. | 290 | ||
| Skull Fractures. | 290 | ||
| Clavicle Fractures. | 293 | ||
| Summary | 293 | ||
| References | 293 | ||
| 33 Imaging of Skeletal Trauma in Abused Children | 296 | ||
| Introduction | 296 | ||
| Skeletal Survey | 296 | ||
| Nuclear Medicine (Bone Scintigraphy) | 296 | ||
| Radiographic “Red Flags” | 296 | ||
| Red Flag No. 1: Nonambulatory Children with Long Bone Fractures | 297 | ||
| Red Flag No. 2: Characteristic Fracture Line | 298 | ||
| Red Flag No. 3: Multiple Injuries of Differing Ages | 299 | ||
| Red Flag No. 4: Metaphyseal “Corner” Fracture (The Classic Metaphyseal Lesion [CML]) | 302 | ||
| Red Flag No. 5: Rib Fractures, Especially Posterior Fractures | 302 | ||
| Red Flag No. 6: Skull Fractures | 304 | ||
| Strength of Medical Evidence | 305 | ||
| Future Research | 306 | ||
| References | 306 | ||
| 34 The Role of Cross-Sectional Imaging in Evaluating Pediatric Skeletal Trauma | 308 | ||
| Introduction | 308 | ||
| Ultrasonography | 308 | ||
| Computed Tomography | 309 | ||
| Magnetic Resonance Imaging | 311 | ||
| Summary | 313 | ||
| References | 314 | ||
| 35 Long Bone Fracture Biomechanics | 317 | ||
| Introduction | 317 | ||
| Overview of Long Bone Anatomy | 317 | ||
| Biomechanical Concepts Important to Understanding Fractures | 317 | ||
| Force | 317 | ||
| Moment | 317 | ||
| Stress | 318 | ||
| Strain | 318 | ||
| Biomechanical Material Properties | 318 | ||
| Elasticity | 318 | ||
| Yield Strength | 318 | ||
| Ultimate Strength | 320 | ||
| Anisotropy | 320 | ||
| Factors Affecting Likelihood of Fracture | 321 | ||
| Intrinsic Factors | 321 | ||
| Bone Material Properties | 321 | ||
| Elastic Modulus. | 321 | ||
| Anisotropy and Strength. | 321 | ||
| Density and Strength. | 322 | ||
| Bone Geometric Characteristics. | 322 | ||
| The Importance of Intrinsic Factors Related to Pediatric Bone Tissue | 322 | ||
| Extrinsic Factors | 322 | ||
| Types and Characteristics of Loads | 322 | ||
| Bending. | 322 | ||
| Torsion. | 323 | ||
| Response to Rate (Speed) of Loading Application | 323 | ||
| Combining Intrinsic and Extrinsic Factors | 323 | ||
| Qualitative Fracture Assessment Model | 324 | ||
| Injury Causation | 324 | ||
| Injury Mechanism | 324 | ||
| Fracture Type | 324 | ||
| Fracture Assessment Case 1: Skiing Incident | 325 | ||
| Fracture Assessment Case 2: Sofa Fall | 325 | ||
| Key Points in Fracture Assessment | 325 | ||
| References | 325 | ||
| 36 Abdominal and Chest Injuries in Abused Children | 326 | ||
| Introduction | 326 | ||
| Epidemiology | 326 | ||
| Pathophysiology | 326 | ||
| Mechanisms of Injury | 326 | ||
| Spectrum of Injuries | 327 | ||
| Intraabdominal Solid Organ Injury | 327 | ||
| Intraabdominal Hollow Viscus Injury | 327 | ||
| Miscellaneous Abdominal Injuries | 328 | ||
| Thoracic Injuries | 328 | ||
| Associated Injuries | 328 | ||
| Diagnostic Evaluation | 329 | ||
| History | 329 | ||
| Physical Examination | 329 | ||
| Laboratory Evaluation | 329 | ||
| Radiographic Evaluation | 330 | ||
| Outcomes | 331 | ||
| Strength of the Medical Evidence | 331 | ||
| Suggested Directions for Future Research | 331 | ||
| References | 331 | ||
| 37 Ear, Nose, and Throat Injuries in Abused Children | 332 | ||
| Introduction | 332 | ||
| Facial Injuries | 332 | ||
| Ear Injuries | 332 | ||
| Nasal Injuries | 334 | ||
| Oral Injuries | 334 | ||
| Neck/Pharyngeal Injuries | 335 | ||
| Strength of the Medical Evidence | 335 | ||
| Suggested Directions for Future Research | 335 | ||
| References | 336 | ||
| 38 Sudden Infant Death Syndrome or Asphyxia? | 337 | ||
| Introduction | 337 | ||
| Sudden Infant Death Syndrome | 337 | ||
| Definition and Epidemiology | 337 | ||
| Risk Factors | 337 | ||
| Autopsy Findings | 338 | ||
| Triple Risk Hypothesis | 338 | ||
| Disorders Mimicking Sudden Infant Death Syndrome | 338 | ||
| Asphyxia | 339 | ||
| Historical Developments | 339 | ||
| Pathophysiology | 339 | ||
| Categories | 339 | ||
| (1) Insufficient Oxygen in the Surrounding Atmosphere | 339 | ||
| (a) Displacement of Oxygen. | 339 | ||
| (b) Consumption of Oxygen. | 339 | ||
| (2) Reduced Transfer of Oxygen from the Atmosphere to the Blood | 339 | ||
| (a) External Airway Obstruction (Smothering). | 339 | ||
| (b) Internal Airway Obstruction. | 339 | ||
| (c) Extrinsic Compromise of Thoracic Cage Function. | 340 | ||
| (d) Intrinsic Compromise of Thoracic Cage Function. | 340 | ||
| (3) Impaired Oxygen Transport in the Circulating Blood | 340 | ||
| (a) Reduced Oxygen-Binding Capacity. | 340 | ||
| (b) Local Vascular Compression. | 340 | ||
| (4) Interference with Oxygen Uptake at the Cellular Level | 340 | ||
| (a) Chemical Asphyxia. | 340 | ||
| (5) Combinations of Mechanisms that Impede Oxygenation | 340 | ||
| Pathological Features | 340 | ||
| Petechiae | 341 | ||
| Oronasal Blood. | 341 | ||
| Pulmonary Intraalveolar Siderophages | 342 | ||
| Pulmonary Intra-Alveolar Hemorrhage. | 342 | ||
| Other Findings. | 342 | ||
| Differentiation from Sids | 342 | ||
| Conclusion | 343 | ||
| References | 343 | ||
| VI Abusive Head Trauma | 347 | ||
| 39 Abusive Head Trauma | 349 | ||
| Incidence and Epidemiology | 349 | ||
| Historical Context | 349 | ||
| Nomenclature | 349 | ||
| Responsibilities of the Child Abuse Medical Specialist | 350 | ||
| The Clinical Spectrum | 350 | ||
| Missed Cases | 350 | ||
| Reporting Suspected Abuse | 351 | ||
| The Relevant Forensic Issues | 351 | ||
| The Differential Diagnosis | 351 | ||
| Injury Mechanisms | 351 | ||
| Timing of Injury | 352 | ||
| The Diagnostic Evaluation | 352 | ||
| History | 352 | ||
| Physical Examination | 353 | ||
| Neuroimaging | 353 | ||
| Laboratory Studies, Medical Consultations and Secondary Diagnostic Evaluations | 355 | ||
| Diagnostic Objectivity | 356 | ||
| Communication | 356 | ||
| Strength of the Medical Evidence | 356 | ||
| Suggested Directions for Future Research | 357 | ||
| Conclusion | 357 | ||
| References | 357 | ||
| 40 Biomechanics of Head Trauma in Infants and Young Children | 359 | ||
| Introduction | 359 | ||
| Mechanics of Traumatic Brain Injury | 359 | ||
| Material Response of Pediatric Brain and Skull to Loads | 360 | ||
| Animal Models of Pediatric Traumatic Brain Injury | 360 | ||
| Mechanisms of Abusive Head Trauma | 361 | ||
| Computational Models of Pediatric Head Injury | 361 | ||
| Role of Biomechanics in Abusive Head Trauma | 361 | ||
| References | 361 | ||
| 41 The Case for Shaking | 364 | ||
| Introduction | 364 | ||
| Biomechanics | 365 | ||
| A Brief Primer | 365 | ||
| Applicability of Biomechanical Studies to Human Infant Shaking | 365 | ||
| An Infant Is not Simply a Small Adult | 366 | ||
| The Biochemical Response of the Developing Brain to Abusive Head Injury | 367 | ||
| Accidental Brain Injuries—Spectrum and Pattern of Injuries | 368 | ||
| Clinical Evidence of Shaking—Perpetrator Confessions | 369 | ||
| Toward a Better Understanding of the Mechanisms of Shaking-Induced Traumatic Brain Injury | 370 | ||
| References | 370 | ||
| 42 Imaging of Abusive Head Trauma | 373 | ||
| Introduction | 373 | ||
| The Neuroimaging Examination | 373 | ||
| Computed Tomography | 373 | ||
| Magnetic Resonance Imaging | 373 | ||
| Total Body MR Imaging | 375 | ||
| Specific Traumatic Head Injuries | 376 | ||
| Traumatic Injuries of the Brain | 376 | ||
| Extraaxial Injury in Abusive Head Trauma | 378 | ||
| Determining the Age of Head Injury | 382 | ||
| Differential Diagnosis | 386 | ||
| Benign Extraaxial Fluid of Infancy (BEAF) | 386 | ||
| Accidental Head Trauma | 386 | ||
| Parturitional Head Trauma | 387 | ||
| Infectious and Inflammatory Disease | 387 | ||
| Coagulopathy | 387 | ||
| Metabolic Disease | 388 | ||
| Future Directions for Research | 388 | ||
| References | 389 | ||
| 43 Neck and Spinal Cord Injuries in Child Abuse | 392 | ||
| Introduction | 392 | ||
| Injury Via Access through the Mouth | 392 | ||
| Hypopharyngeal Laceration | 392 | ||
| Introduction of a Foreign Body | 393 | ||
| Introduction of Caustic or Irritating Agents | 393 | ||
| Direct External Trauma to the Neck (Strangulation) | 394 | ||
| Nonstrangulation Blunt Trauma | 395 | ||
| Indirect Application of Forces to the Neck | 395 | ||
| Anatomy of the Neck | 395 | ||
| Spine Biomechanics | 396 | ||
| Neck and Cervical Spine Injuries Report in Child Abuse Cases | 396 | ||
| Injury of the Bony Spine and Surrounding Ligaments | 396 | ||
| Injury to Vascular Structures of the Neck | 396 | ||
| Extraaxial Hemorrhage of the Spine | 396 | ||
| Injuries of the Spinal Cord | 397 | ||
| Injury of Other Cervical Structures | 397 | ||
| Presenting Symptoms in and Associated Injuries in Cases of Spinal Injuries in Abused Children | 397 | ||
| Recognizing Cervical Injuries in Abused Children | 397 | ||
| Differentiating abusive from nonabusive cervical injuries | 398 | ||
| Neck Injury and Shaking | 398 | ||
| Strength of the Evidence | 399 | ||
| Areas for new research | 399 | ||
| References | 399 | ||
| 44 Eye Injuries in Child Abuse | 402 | ||
| Introduction | 402 | ||
| Blunt Impact Injuries to the Eye | 402 | ||
| Indirect Ocular and Visual Injury Related to Abusive Head Injury | 403 | ||
| Retinal Hemorrhage | 403 | ||
| Incidence | 403 | ||
| Types and Patterns | 404 | ||
| Mechanisms | 406 | ||
| Differential Diagnosis | 408 | ||
| Documentation and the Role of the Ophthalmologist | 408 | ||
| Postmortem Examination and Findings | 410 | ||
| Strength of the Medical Evidence | 410 | ||
| Suggested Directions for Future Research | 410 | ||
| References | 411 | ||
| 45 Neuropathology of Abusive Head Trauma | 413 | ||
| Introduction | 413 | ||
| Neuropathological Findings | 413 | ||
| External Examination | 413 | ||
| Internal Soft Tissue Injury | 413 | ||
| Fractures | 413 | ||
| Intracranial Hemorrhage | 414 | ||
| Epidural Hemorrhage (EDH) | 414 | ||
| Subdural Hemorrhage (SDH) | 415 | ||
| Subarachnoid Hemorrhage (SAH) | 417 | ||
| Parenchymal/Intraventricular Hemorrhage | 417 | ||
| Cerebrospinal Contusions/Lacerations | 417 | ||
| Superficial Contusions/Lacerations | 418 | ||
| Deep Contusions/Lacerations | 418 | ||
| Gliding Contusions/Lacerations. | 419 | ||
| Axonal Injury. | 420 | ||
| Brainstem and Spinal Injuries | 421 | ||
| Traumatic Brain Injury/Edema/Swelling | 422 | ||
| Anoxic Encephalomyelopathy/Infarction | 423 | ||
| Hypoxic Lesions | 423 | ||
| Ischemic Lesions | 424 | ||
| Chronic Lesions | 424 | ||
| Optic Nerve and Retinal Injury | 424 | ||
| Medical Evidence Relating to Inflicted Neurotrauma | 426 | ||
| References | 426 | ||
| 46 Biochemical Markers of Head Trauma in Children | 429 | ||
| Introduction | 429 | ||
| The Use of Biomarkers of Injury in the Field of Pediatrics | 430 | ||
| The Brain vs. Other Organs | 430 | ||
| Candidate Biomarkers of Brain Injury: A 30-Year Odyssey Continues (Table 46-3) | 431 | ||
| The Potential Role of Serum Brain Biomarkers | 432 | ||
| Diagnosis of Head Trauma | 432 | ||
| Differentiation of Head Trauma and TBI | 434 | ||
| Assessment of the Severity of Head Trauma/Outcome Prediction after Head Trauma | 434 | ||
| Development of Treatment Interventions | 435 | ||
| Evaluation of Treatment Efficacy | 436 | ||
| Specific Issues Related to Biomarkers and AHT | 437 | ||
| Strength of the Medical Evidence | 437 | ||
| Suggested Directions for Future Research | 438 | ||
| References | 438 | ||
| 47 Conditions Confused with Head Trauma | 441 | ||
| Introduction | 441 | ||
| Coagulopathy and Hemostasis Defects | 441 | ||
| Vitamin K Deficiency | 441 | ||
| Factor XIII Deficiency | 442 | ||
| Hemophilia A (Factor VIII Deficiency) | 442 | ||
| Von Willebrand Disease | 442 | ||
| Trauma-Related Coagulopathy | 442 | ||
| Platelet Disorders | 443 | ||
| What Evaluation Should Be Performed to Rule Out Coagulopathy in Suspected Abuse Cases? | 443 | ||
| PIVKA-II | 444 | ||
| Platelet Function Testing | 444 | ||
| Testing for Factor XIII Deficiency | 444 | ||
| Traumatic Events Misdiagnosed as Abusive Head Trauma | 444 | ||
| Accidents | 444 | ||
| Birth-Related Head Injuries | 445 | ||
| Other Conditions Possibly Mistaken for AHT | 445 | ||
| Intracranial Fluid Collections | 445 | ||
| Scurvy | 446 | ||
| Glutaric Aciduria, Type 1 | 446 | ||
| Menkes Disease | 447 | ||
| Conclusion | 447 | ||
| References | 447 | ||
| 48 Outcome of Abusive Head Trauma | 451 | ||
| Introduction | 451 | ||
| Neurobehavioral and Neuropsychological Outcomes | 451 | ||
| Outcome of Abusive Head Trauma in Relation to Noninflicted Head Trauma or Community Comparison Groups | 453 | ||
| Descriptive Studies of Abusive Head Trauma | 454 | ||
| Mechanism of Injury, Neuroimaging Findings, and Biomarkers in Relation to Outcome | 454 | ||
| Family Environment | 455 | ||
| Illustrative Case Report | 455 | ||
| Strength of the Evidence | 456 | ||
| Suggestions for Future Research | 456 | ||
| References | 457 | ||
| VII Psychological Aspects of Child Maltreatment | 459 | ||
| 49 Psychological Impact and Treatment of Sexual Abuse of Children | 461 | ||
| Introduction | 461 | ||
| History of Awareness | 461 | ||
| Efforts to Characterize Child Sexual Abuse and Associated Impacts | 462 | ||
| Child Sexual Abuse Accommodation Syndrome | 462 | ||
| Traumagenic Dynamics | 462 | ||
| Risk Factors | 463 | ||
| Sexual Behavior | 463 | ||
| Short-Term Effects | 464 | ||
| Early Childhood (2-6) | 464 | ||
| Middle Childhood (7-12) | 465 | ||
| Adolescence/Young Adult (13-18) | 465 | ||
| Child Sexual Abuse and Psychiatric Diagnosis | 465 | ||
| Long-Term Outcomes of Childhood Sexual Abuse | 466 | ||
| Posttraumatic Stress Disorder | 466 | ||
| Depression | 466 | ||
| Domestic Violence/Revictimization | 466 | ||
| Eating Disorders | 466 | ||
| General Mental Health | 466 | ||
| Substance Abuse/Dependence | 467 | ||
| Parenting | 467 | ||
| Medical Problems | 467 | ||
| Gender Differences in The Effects of Sexual Abuse | 467 | ||
| Disclosure | 467 | ||
| Reporting to Child Protective Services | 468 | ||
| Medical Examination and Interaction with Child Abuse Team | 468 | ||
| Disclosure vs. Forensic Interview | 469 | ||
| Treatment | 469 | ||
| Play Therapy | 469 | ||
| Abuse Specific Therapy | 469 | ||
| Symptom-Focused Therapy | 469 | ||
| Supportive Therapy | 470 | ||
| Cognitive-Behavioral Therapy | 470 | ||
| Psycho-Education | 470 | ||
| Relaxation Techniques | 470 | ||
| Affect Expression | 470 | ||
| Cognitive Coping | 471 | ||
| Trauma Narrative | 471 | ||
| Cognitive Processing | 471 | ||
| Parenting Skills | 471 | ||
| Parent–Child Sessions | 471 | ||
| Group Therapy | 471 | ||
| Involvement and Treatment of Nonoffending Parents | 471 | ||
| Family Therapy | 472 | ||
| Pharmacological Treatments | 472 | ||
| Strength of the Medical Evidence | 473 | ||
| Future Research and Development | 473 | ||
| References | 473 | ||
| 50 Psychological Impact and Treatment of Physical Abuse of Children | 476 | ||
| Introduction | 476 | ||
| Child Physical Abuse and the Continuum of Force | 476 | ||
| Definitions | 476 | ||
| Prevalence/Scope | 476 | ||
| Characteristics and Consequences | 477 | ||
| Cognitive/Learning and Attributions | 477 | ||
| Behavior and Mental Health Problems | 477 | ||
| Social/Interpersonal Competence and Relationship Skills | 478 | ||
| Posttraumatic Stress Disorder | 478 | ||
| Health/Medical | 478 | ||
| Summary | 478 | ||
| Screening and Assessment/Evaluation | 478 | ||
| Interview Probes for Exploring Exposure to Physical Discipline and Child Physical Abuse | 478 | ||
| Formal Instruments/Tools | 479 | ||
| Injury/Re-Abuse (Recidivism) and High-Risk Behaviors | 479 | ||
| Clinical Problems/Symptoms | 479 | ||
| Functional Impairment | 480 | ||
| Environmental Context | 480 | ||
| Services or Intervention Experience | 480 | ||
| Summary | 480 | ||
| Service Referral, Access, and Use | 480 | ||
| Intervention and Treatment | 481 | ||
| Child-Focused Intervention | 481 | ||
| Parent-Focused Intervention | 482 | ||
| Parent–Child and Family-Focused Treatment | 482 | ||
| Summary | 484 | ||
| Prevention | 484 | ||
| What Can Health Care Providers Do? | 484 | ||
| Strength of the Evidence | 485 | ||
| Directions for Future Research | 486 | ||
| Summary | 486 | ||
| References | 486 | ||
| 51 Psychological Impact and Treatment of Neglect of Children | 490 | ||
| Introduction | 490 | ||
| Predictors of Neglect | 490 | ||
| Poverty | 490 | ||
| Food Insecurity | 490 | ||
| Poor Maternal Nutrition | 491 | ||
| Maternal Depression | 491 | ||
| Stressful Life Events | 491 | ||
| Interpersonal Violence | 491 | ||
| Child Temperament | 491 | ||
| Child Development and Behavior | 491 | ||
| Psychological Consequences of Neglect | 491 | ||
| Infancy | 492 | ||
| School-Aged Children | 492 | ||
| Adolescents | 492 | ||
| Mechanisms Linking Neglect with Children’s Psychological Functioning | 493 | ||
| Biological Stress Response | 493 | ||
| Developmental Systems Theory | 493 | ||
| Direct Effects of Neglect | 493 | ||
| Moderated Effects of Neglect | 494 | ||
| Mediated Effects of Neglect | 494 | ||
| Transactional Effects of Neglect | 494 | ||
| Community Influences on Neglect | 494 | ||
| Programs and Policies Related to Child Neglect | 494 | ||
| Play Therapy | 494 | ||
| Family Interventions | 495 | ||
| Home Visitation | 495 | ||
| Family Connections | 496 | ||
| Long-Term Follow-Up | 497 | ||
| Recommendations for Practice and Future Research | 497 | ||
| References | 498 | ||
| 52 Psychological Impact on and Treatment of Children Who Witness Domestic Violence | 501 | ||
| Introduction | 501 | ||
| Terminology and Taxonomy | 501 | ||
| Prevalence of Children Living in Violent Households | 502 | ||
| Domestic Violence Exposure in an Ecological Context | 503 | ||
| Factors Intrinsic to the Child | 503 | ||
| The Power of Parents | 503 | ||
| Factors Outside the Family: Society and Culture | 503 | ||
| Co-Occurrence of Stressors | 503 | ||
| Mechanisms of Action: The Dual Lenses of Attachment and Trauma | 504 | ||
| The Attachment Lens | 504 | ||
| The Trauma Lens | 505 | ||
| The Dual Lens | 505 | ||
| Children’s Responses to Domestic Violence | 505 | ||
| Exposure to Violence in Infancy and Early Childhood | 506 | ||
| Exposure to Domestic Violence in Middle Childhood | 507 | ||
| The Effect of Exposure on Adolescents | 509 | ||
| Interventions for Children Exposed to Violence | 509 | ||
| Child–Parent Psychotherapy | 510 | ||
| Project SUPPORT | 510 | ||
| Kids’ Club and Kids’ Club Preschool | 510 | ||
| The Learning Club | 510 | ||
| Youth Relationships Project | 510 | ||
| Other Interventions | 510 | ||
| Implications for Health Care Providers | 511 | ||
| Strength of Evidence and Future Directions for Research | 511 | ||
| References | 512 | ||
| 53 Effects of Abuse and Neglect on Brain Development | 516 | ||
| Introduction | 516 | ||
| Developmental Traumatology | 516 | ||
| The Biological Stress Response Systems | 516 | ||
| The Biological Stress Response Systems in Maltreated Children | 517 | ||
| The HPA Axis in Maltreated Children | 517 | ||
| The Locus Coeruleus Noradrenergic Neurotransmitter System and the Autonomic Nervous System in Maltreated Children | 517 | ||
| The Immune System in Maltreated Children | 518 | ||
| A Review of Healthy Brain Development | 518 | ||
| Brain Development in Maltreated Children | 518 | ||
| The Brain and the Corpus Callosum in Maltreated Children | 518 | ||
| The Limbic System of Maltreated Individuals | 520 | ||
| The Medial Prefrontal Cortex of Maltreated Individuals | 521 | ||
| The Cognitive Function of Maltreated Children | 521 | ||
| Genetic Contributions to Outcomes in Maltreated Children: Gene and Environment Interactions | 521 | ||
| Maltreatment Is a Traumatic Stressor: The Strength of the Evidence | 522 | ||
| The Neurobiology of Hope for Maltreated Children | 522 | ||
| Research: Future Directions | 522 | ||
| References | 522 | ||
| VIII Special Topics | 527 | ||
| 54 Substance Abuse and Child Abuse | 529 | ||
| Historical Background | 529 | ||
| Scope of the Problem | 529 | ||
| Substance Abuse Among the Child-Rearing Population | 529 | ||
| Illicit Substance Use and Pregnancy | 529 | ||
| Limitations of Available Data | 529 | ||
| Common Illegal Substances of Abuse | 529 | ||
| Marijuana | 529 | ||
| Cocaine and Methamphetamine | 530 | ||
| Heroin | 531 | ||
| Common Legal Substances of Abuse | 531 | ||
| Alcohol | 531 | ||
| Prescription Substances for Nonmedical Use | 532 | ||
| Impact of Parental Substance Abuse on Children | 532 | ||
| Substance Abuse and Pregnancy | 532 | ||
| The Home Environment in Substance-Abusing Families | 533 | ||
| Substance Abuse and Social Stressors | 533 | ||
| Substance Abuse and Parental Mental Health | 534 | ||
| Addiction and Parenting | 534 | ||
| Parental Substance Abuse and Children’s Behavior | 534 | ||
| Substance Abuse and Parental Incarceration | 535 | ||
| Drug Treatment and Family Disruption | 535 | ||
| Screening for Family Substance Abuse in the Health Care Setting | 535 | ||
| Prenatal Visits | 535 | ||
| Infancy and Early Childhood | 535 | ||
| School-Aged Children | 535 | ||
| Adolescents | 535 | ||
| Substance Abuse Solutions for Parents | 536 | ||
| Treatment for Pregnant Women | 536 | ||
| Family Treatment Drug Courts | 536 | ||
| Effective Drug Treatment | 536 | ||
| Ineffective Approaches to Drug Treatment | 536 | ||
| Effective interventions for Children of Substance Abusers | 536 | ||
| References | 537 | ||
| 55 Definitions and Categorization of Child Neglect | 539 | ||
| Introduction | 539 | ||
| Types of Neglect | 541 | ||
| Degrees of Neglect | 541 | ||
| Outcome | 541 | ||
| Prevention | 542 | ||
| References | 542 | ||
| 56 Dental Neglect | 544 | ||
| Introduction | 544 | ||
| Recognition | 544 | ||
| Possible Causes and Risk Factors | 544 | ||
| Description | 544 | ||
| Special Needs Patients | 545 | ||
| Professional Intervention | 545 | ||
| Future Prognosis | 546 | ||
| References | 546 | ||
| 57 Failure to Thrive | 547 | ||
| Introduction | 547 | ||
| Definition | 547 | ||
| Etiology | 548 | ||
| The Biopsychosocial Model | 549 | ||
| The Biological Sphere | 549 | ||
| The Psychological Sphere | 550 | ||
| The Social Sphere | 552 | ||
| Evaluation | 553 | ||
| Growth Charts | 553 | ||
| History | 553 | ||
| Family History | 555 | ||
| Review of Systems | 555 | ||
| Physical Examination | 555 | ||
| Additional Assessment and Multidisciplinary Involvement | 555 | ||
| Laboratory and Radiographic Evaluation | 556 | ||
| Hospitalization | 557 | ||
| Treatment | 557 | ||
| Treatment of Biological Issues | 557 | ||
| Treatment of Psychosocial Issues | 558 | ||
| Outcome | 560 | ||
| Strength of the Evidence | 560 | ||
| Future Directions for Research | 560 | ||
| Conclusion | 560 | ||
| References | 560 | ||
| 58 Detecting Drugs in Infants and Children | 563 | ||
| Introduction | 563 | ||
| Drug Testing Methodologies | 563 | ||
| Immunoassays and Rapid Drug Screening | 563 | ||
| Chromatography | 564 | ||
| Biological Matrices | 564 | ||
| Specific Drugs | 565 | ||
| Amphetamine | 565 | ||
| Marijuana | 565 | ||
| Cocaine | 565 | ||
| Ethanol | 566 | ||
| Opiates/Opioids | 566 | ||
| Medical Child Abuse | 568 | ||
| Drug-Facilitated Sexual Assault | 568 | ||
| Pitfalls in Drug Testing | 568 | ||
| Strength of Science/ Research Questions | 568 | ||
| References | 568 | ||
| 59 Injuries Resulting from Falls | 570 | ||
| Introduction | 570 | ||
| Types of Fall Injuries | 570 | ||
| Head Injuries with Fall Histories | 570 | ||
| Abdominal Injuries with Fall Histories | 571 | ||
| Chest Injuries with Fall Histories | 571 | ||
| Less Serious Injuries | 572 | ||
| Recognition and Reporting | 572 | ||
| Is It a Fall or Is It Abuse? Assessing the Child | 572 | ||
| Radiological Imaging | 572 | ||
| Consultations | 572 | ||
| Differential Diagnosis | 572 | ||
| Biomechanical Assessment of Stated Fall Scenarios | 572 | ||
| Scene Investigation for Biomechanical Assessment | 572 | ||
| Biodynamic Compatibility of Stated Cause and Injuries | 575 | ||
| Biomechanical Analyses of Stated Falls | 575 | ||
| The Likelihood of Death or Serious Injury from a Short Fall | 576 | ||
| Responsible Testimony in Cases of Death/Severe Injury from Short Falls | 577 | ||
| References | 577 | ||
| 59 Supplemental Resources Injuries Resulting from Falls | e1 | ||
| The Medical Workup when Differentiating Falls from Abuse | e1 | ||
| Initial Assessment and Stabilization | e1 | ||
| Getting the Medical History | e1 | ||
| Physical Examination | e2 | ||
| General Assessment | e2 | ||
| Central Nervous System (CNS) | e2 | ||
| Head, Eyes, Ears, Nose, and Throat | e2 | ||
| Head. | e2 | ||
| Eyes. | e2 | ||
| Ears. | e2 | ||
| Nose. | e2 | ||
| Oropharynx. | e2 | ||
| Neck. | e2 | ||
| Heart. | e2 | ||
| Chest. | e2 | ||
| Abdomen. | e2 | ||
| Stomach Injuries. | e3 | ||
| Duodenal and Pancreatic Injuries. | e3 | ||
| Hepatic Injury. | e3 | ||
| Splenic Injuries. | e3 | ||
| Renal Injury. | e3 | ||
| Anorectal Injuries. | e3 | ||
| Musculoskeletal Evaluation | e3 | ||
| Skin Injuries. | e3 | ||
| Laboratory Studies | e3 | ||
| References | e6 | ||
| 60 Forensic Dentistry | 579 | ||
| Introduction | 579 | ||
| Orofacial Injuries in Child Abuse | 579 | ||
| Bite Marks and Patterened Injuries | 580 | ||
| Recognition | 580 | ||
| Hickeys and Suction Marks | 581 | ||
| Bite Marks | 581 | ||
| Reporting | 581 | ||
| Recording | 582 | ||
| Photography | 582 | ||
| Salivary Swabbing | 582 | ||
| Impression of the Injury | 583 | ||
| Invasive Analysis | 583 | ||
| Referral | 583 | ||
| Other Aspects of Forensic Odontology | 584 | ||
| Dental Aging | 584 | ||
| Strength of Dental Evidence in Bite Mark Cases | 584 | ||
| Research | 584 | ||
| Participation of Forensic Odontologists on Hospital-Based Child Protection Teams | 584 | ||
| References | 584 | ||
| 61 Medical Child Abuse | 586 | ||
| Introduction | 586 | ||
| Similarities and Differences between Medical Child Abuse and Other Types of Child Abuse | 586 | ||
| Issues of Terminology | 587 | ||
| Treatment of Medical Child Abuse | 587 | ||
| Identifying the Abuse | 588 | ||
| Stopping the Abuse | 588 | ||
| Making Sure the Abuse Does Not Recur | 589 | ||
| Repair the Physical and Psychological Damage Experienced by the Child | 589 | ||
| Preserve the Family if the Safety of the Child Can Be Ensured | 589 | ||
| The Multidisciplinary Team | 589 | ||
| Legal Issues | 590 | ||
| Prevention of Medical Child Abuse | 590 | ||
| References | 590 | ||
| 62 Child Death Review | 592 | ||
| The Purpose and Scope of Child Death Review in the USA | 592 | ||
| Role of Child Death Review in Identifying Maltreatment | 592 | ||
| Case Review Models for Improving Systems and Preventing Deaths | 594 | ||
| Focusing on Systems Improvements. | 594 | ||
| Focusing on Implementing Prevention Programs. | 594 | ||
| The Strengths of Child Death Review | 594 | ||
| The Challenges of Child Death Review | 596 | ||
| Establishing Uniform Definitions of Child Maltreatment | 596 | ||
| Moving Teams from Review to Action | 597 | ||
| Expanding Reviews to Natural, Preventable Child Deaths | 597 | ||
| Expanding Reviews to Serious Non-Fatal Injuries | 597 | ||
| Standardization, Funding Support, and a National CDR Database | 597 | ||
| Conclusion | 597 | ||
| References | 597 | ||
| 62 Supplemental Resources Child Death Review | e7 | ||
| Web-Based Resources for Information on Child Death Review | e7 | ||
| http://www.childdeathreview.org | e7 | ||
| http://www.childdeathreview.org/ toolsforteams.htm | e7 | ||
| http://www.dcfs.state.nv.us/ DCFS_ChildFatalities_BlueRibbon.htp | e7 | ||
| http://childinjuryprevertion.org | e7 | ||
| 63 Religion and Child Neglect | 599 | ||
| Introduction | 599 | ||
| Public Policy | 600 | ||
| Scope of Laws | 600 | ||
| Issues with Adolescents | 601 | ||
| References | 603 | ||
| 64 The Prevention of Child Abuse and Neglect | 605 | ||
| Introduction | 605 | ||
| Victim Considerations | 605 | ||
| Age | 605 | ||
| Developmental Level | 606 | ||
| Location of Abuse | 607 | ||
| Perpetrator Considerations | 607 | ||
| Sexual Abusers | 607 | ||
| Other Types of Abusers | 608 | ||
| Reactive Child and Adolescent Abusers | 608 | ||
| Prevention Programs with Scientific Data on Outcome | 608 | ||
| Conclusion | 608 | ||
| References | 608 | ||
| 64 Supplemental Resources The Prevention of Child Abuse and Neglect | e8 | ||
| Sexual Abuse Prevention Programs | e8 | ||
| Programs that Reduce Motivation to Sexually Abuse | e8 | ||
| index | 645 | ||
| A | 645 | ||
| B | 646 | ||
| C | 647 | ||
| D | 648 | ||
| E | 649 | ||
| F | 649 | ||
| G | 650 | ||
| H | 651 | ||
| I | 651 | ||
| J | 652 | ||
| K | 652 | ||
| L | 652 | ||
| M | 653 | ||
| N | 653 | ||
| O | 654 | ||
| P | 654 | ||
| Q | 655 | ||
| R | 655 | ||
| S | 656 | ||
| T | 657 | ||
| U | 657 | ||
| V | 657 | ||
| W | 657 | ||
| X | 658 | ||
| Y | 658 | ||
| Z | 658 |