Caring for Children in the Juvenile Justice System: A Trauma and Surgical Subspecialty-Focused Approach.

INTRODUCTION: Youth in the juvenile justice system are a vulnerable, high-risk population. While the role of pediatricians and mental health professionals in providing care for these children is well studied, the surgical needs of this population are not well understood. We sought to characterize the physical trauma and surgical subspecialty needs of this population. METHODS: A retrospective chart review was performed of all children transported under custody to a stand-alone urban children's hospital. Demographic information and inpatient and outpatient encounter data were collected and analyzed. RESULTS: Between January 2020 and March 2021, 74 patients were transported for 199 subspecialty evaluations. Sixty-nine (93%) were male, 66 (89%) identified as Black, and the median age was 16 y (range, 13-20). Of all patients, 19% had at least one documented medical condition, 43% had behavioral health history, and 73% had previous arrest. Of the 199 encounters, 137 were for physical trauma (65%). Of these, 47 (34%) were for physical trauma incurred at the time of their arrest. Sixty-three patients (85%) experienced previous physical trauma (69% blunt, 12% penetrating, and 7% both), 54% had documented head trauma, 23% had a history of self-harm, and 60% of girls had experienced sexual trauma. Of the 54 children with a previous arrest, 91% had a history of physical trauma compared to 70% who were not previously incarcerated (P = 0.03). CONCLUSIONS: Most subspecialty and emergency encounters for incarcerated children are for physical trauma, revealing an opportunity for trauma-focused care in this vulnerable population. Pediatric surgeons and emergency physicians play a major role in the care of incarcerated children.

Prevalence, predictors, and attitudes toward cosleeping in an urban pediatric center.

Cosleeping is the normative practice in many of the world's societies but is not endorsed by the Consumer Products Safety Commission or by the American Academy of Pediatrics. A survey was performed on 101 caregivers in an urban setting, designed to assess the prevalence of cosleeping and parental attitudes for this practice. Cosleeping rate was 88% with predictors being as follows: single parent (p=0.006), high school or less education (p=0.035), 2 or fewer rooms used for sleeping (p=0.023). A majority (65%) stated that cosleeping was acceptable.