Paediatric hypopharyngeal perforation: child abuse until proved otherwise?

A case of paediatric hypopharyngeal perforation in a 7-month-old infant is reported. The diagnosis was delayed because it was not considered. It later transpired that the injury had been inflicted by one of the child's parents. Criminal proceedings were successfully brought against both parents and the child and his siblings were taken into foster care. A review of the available literature on paediatric hypopharyngeal perforation, excluding iatrogenic and external trauma mechanisms of injury suggests that non-accidental injury is by far the most common aetiology. Suspected child abuse remains one of the most sensitive and challenging areas in medicine. Awareness that non-iatrogenic paediatric hypopharyngeal perforation in the absence of external trauma is highly suggestive of a non-accidental injury is critical, and may save a child from subsequent abuse.

Current diagnosis, management and morbidity in paediatric inflammatory bowel disease.

UNLABELLED: In the 1970s several reports highlighted the long delay in diagnosis often experienced by children with Crohn's disease. In recent years this disorder has attracted much publicity, and many believe that the incidence has increased substantially. The aim of this investigation was to determine whether heightened awareness had shortened the interval to diagnosis, improved clinical management and reduced morbidity. A retrospective study was therefore carried out on 112 children with inflammatory bowel disease (64 Crohn's disease, 41 ulcerative colitis, 7 indeterminate colitis) referred to a paediatric gastroenterology department in the UK between 1994 and 1998. In Crohn's disease the median interval to diagnosis was 47 wk (maximum 7 y). In those without diarrhoea this was longer (66 vs 28 wk; p = 0.005). In ulcerative colitis the median interval was 20 wk (maximum 3 y). Even in severe colitis the median interval was 5.5 wk (range 3-9 wk) and 4 required urgent colectomy soon after referral. Many with unrecognized Crohn's disease had undergone inappropriate treatments, such as growth hormone or psychiatric therapy. Nineteen (17%) had undergone endoscopic investigations in adult units prior to referral. Malnutrition was equally common in Crohn's disease and ulcerative colitis (11%). Short stature was present in 19% with Crohn's disease, and 5% with ulcerative colitis, and was severe in 8% with Crohn's disease. There was a significant correlation between symptom duration and the degree of growth impairment present (r(s) = -0.4; p = 0.004). CONCLUSION: This study suggests that late diagnosis and inappropriate investigation and management are still significant problems.

Female genital mutilation in Britain.

PIP: The practice of female genital mutilation predates the founding of both Christianity and Islam. Though largely confined among Muslims, the operation is also practiced in some Christian communities in Africa such that female genital mutilation takes place in various forms in more than twenty African countries, Oman, Yemen, the United Arab Emirates, and by some Muslims in Malaysia and Indonesia. In recent decades, ethnic groups which practice female genital mutilation have immigrated to Britain. The main groups are from Eritrea, Ethiopia, Somalia, and Yemen. In their own countries, an estimated 80% of women have had the operation. Female genital mutilation has been illegal in Britain since 1985, but it is practiced illegally or children are sent abroad to undergo the operation typically at age 7-9 years. It is a form of child abuse which poses special problems. The authors review the history of female genital mutilation and describe its medical complications. Assuming that the size of the population in Britain of ethnic groups which practice or favor female genital mutilation remains more or less unchanged, adaptation and acculturation will probably cause the practice to die out within a few generations. Meanwhile, there is much to be done. A conspiracy of silence exists in medical circles as well as widespread ignorance. Moreover, none of a number of well-known obstetric and pediatric textbooks mentions female genital mutilation, while the National Society for the Prevention of Cruelty to Children has neither information nor instructional material. It is high time that the problem was more widely and openly discussed.^ieng

Near-fatal aspiration of a child's dummy: design fault or deliberate injury?

A case is described of near fatal aspiration of a child's dummy. This caused extensive injuries to the mouth and pharynx and acute respiratory embarrassment necessitating admission to a paediatric intensive care unit, and multi-disciplinary assessment. A design fault in the dummy is discussed, and it is recommended that the British Standards specification for dummies be changed. Finally, the issue of non-accidental injury is discussed, with the suggestion that injuries to the soft tissues of the mouth and pharynx be treated with the same degree of suspicion as any other childhood injury.

Nutrition of aboriginal infants and children in the Murray Valley.

A cross-sectional anthropometric study of 297 Aboriginal children aged from 0 to 11 years, from four communities in the Murray Valley region of north-western Victoria and south-western New South Wales, revealed significant levels of growth retardation compared with 146 local non-Aboriginal children. Mild, moderate and severe levels of malnutrition (according to anthropometric criteria) and high proportions of infants who were small for gestational age were found among the Aboriginal children. Levels of moderate malnutrition varied from 11% to 26% according to the standards of housing, the degree of community organization and the social pressures that were experienced by each community. The implications of these findings are discussed in terms of Aboriginal participation in primary health care.