ABSTRACT
BACKGROUND: Fractures are one of the most common presentations of child abuse second only to soft tissue damage, with â¼60% of fractures being femur, humerus or tibia fractures. Although studies have shown increased health care costs associated with nonaccidental trauma (NAT), there is little data regarding the cost of NAT-associated fractures compared with accidental trauma (AT) related fractures. The purpose of this study was to consider the economic burden of NAT related femoral fractures compared with AT femoral fractures. METHODS: We performed a retrospective study of children under the age of one with femoral fractures treated with a spica cast at a Level 1 Pediatric Trauma Center between 2007 and 2016. Variables included age, sex, length of hospital stay, and estimated total billing cost obtained from this hospital's billing department. In addition, fracture site (mid-shaft, distal, proximal, and subtrochanteric) and pattern were assessed. RESULTS: Sixty children with a mean age of 7 months were analyzed. NAT was suspected in 19 cases (31.7%) and confirmed in 9 (15%) before discharge. Two groups were analyzed: the NAT group included suspected and confirmed cases of abuse (28) and the AT group contained the remaining 32 cases. There was no significant difference in the demographics between these 2 groups. Children in NAT group had a longer length of stay compared with AT group (78.9 vs. 36.7 h, P<0.001). Overall consumer price index-adjusted hospital costs were $24,726 higher for NAT group compared with AT group (P=0.024), with costs of laboratory workup, radiology, and nonorthopaedic physician fees being the top 3 components contributing to the increased costs. CONCLUSIONS: The overall incidence of NAT was 46.6% in children presenting with femoral fracture under 1 year of age. The overall hospital cost of treating fractures in the NAT group was 1.5 times higher than the AT group, with imaging charges the most significant contributor to cost difference. LEVEL OF EVIDENCE: Level III-retrospective review.
Subject(s)
Battered Child Syndrome/economics , Battered Child Syndrome/therapy , Femoral Fractures/economics , Femoral Fractures/therapy , Casts, Surgical/economics , Child Abuse , Female , Femur , Health Care Costs/statistics & numerical data , Hospital Costs , Hospitals , Humans , Infant , Length of Stay/economics , Length of Stay/statistics & numerical data , Male , Radiography/statistics & numerical data , Retrospective StudiesABSTRACT
Significant barriers exist in access to evidence-based, trauma-focused treatment among youth from economically disadvantaged backgrounds, those living in rural areas, and belonging to a racial and ethnic minority group, despite the high prevalence rates of trauma exposure among these underserved groups. The present study is proof-of-concept pilot of trauma-focused cognitive-behavioral therapy (TF-CBT) delivered to underserved trauma-exposed youth ( N = 15) via telehealth technology (i.e., via one-on-one videoconferencing), aimed at addressing barriers in access to TF treatment. This pilot study provides preliminary evidence of the ability to successfully deliver TF-CBT via a telehealth delivery format. Results demonstrated clinically meaningful symptom change posttreatment (large effect sizes for youth-reported ( d = 2.93) and caregiver-reported ( d = 1.38) reduction in posttraumatic stress disorder symptoms), with no treatment attrition (0% dropout). These findings are promising in showing treatment effects that are comparable with TF-CBT delivered in an in-person, office-based setting and an important first step in determining how to best address the mental health needs of trauma-exposed youth with barriers in access to care.
Subject(s)
Battered Child Syndrome/therapy , Cognitive Behavioral Therapy/methods , Telemedicine/methods , Adolescent , Battered Child Syndrome/psychology , Child , Female , Health Services Accessibility , Humans , Male , Pilot ProjectsABSTRACT
Un gran número de menores acogidos en recursos residenciales del Sistema de Protección a la Infancia reciben atención psicológica sin que aún se haya abordado un análisis profundo y sistemático acerca de los aspectos específicos que delimitan este ámbito de intervención. Se analizan las posibilidades de organización de los dispositivos, considerando las tres grandes opciones de atención (genérica, específica en recursos comunes, y especializada) con sus correspondientes ventajas e inconvenientes. Se revisa el papel de los modelos de comprensión, cuya demanda de complejidad y de un análisis crítico es ilustrada con el repaso de tres perspectivas muy comunes (modelo psicopatológico tradicional, enfoques basados en el trauma, y teoría del apego). Finalmente, se considera la especificidad de las intervenciones técnicas, donde se demandan adaptaciones en función de las características de los menores, las temáticas propias de este campo, y algunos aspectos particulares del contexto
Psychological treatment is provided to a great number of minors fostered in residential centers of the Child Protection System, although a deep and systematic analysis regarding the specific topics of this field has not yet been carried out. We analyze the ways of organizing units to attend children, taking into account three different options (general practice, specific practice in common settings, and specialized programs), and their advantages and disadvantages. We consider the role of the theoretical models, underlining the need for complexity and critical analysis, illustrated by reviewing three common models (the psychopathological, trauma-informed, and attachment perspectives). Finally, we pay attention to the specificity of the technical interventions, calling for modified adaptations based on the characteristics of the minors, specific topics in this field, and some particular aspects of the context
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Battered Child Syndrome/therapy , Child Abuse/therapy , Psychotherapy/methods , Child, Institutionalized/psychology , Child Advocacy/trends , Evaluation of Results of Therapeutic InterventionsABSTRACT
Accumulating evidence suggests that children suffering deprivation and maltreatment at critical times in their development often pay a cognitive toll. While children vary to the extent that neurocognitive domains are affected, those factors influence how children process, manage and understand traumatic and attachment experiences as well as how they respond to treatment. Current research on trauma and attachment favor some aspects of cognition over others. The literature discusses attention, memory, cognitive biases, internal working models, beliefs and attributions as ways that impact an individual's understanding of experience. Other categories such as working memory, processing speed, verbal, auditory or perceptual processing, metacognitive skills, and cognitive rigidity or flexibility rarely surface. This paper examines what is and is not known about the interface of cognition with attachment and complex trauma and how that knowledge can inform treatment. It explores existing research and offers a case vignette as an example of how that knowledge can be integrated into treatment strategies.
Subject(s)
Battered Child Syndrome/therapy , Child Development/physiology , Cognition/physiology , Object Attachment , Child , HumansSubject(s)
Battered Child Syndrome , Battered Child Syndrome/epidemiology , Battered Child Syndrome/history , Battered Child Syndrome/prevention & control , Battered Child Syndrome/psychology , Battered Child Syndrome/therapy , Child , Child Welfare/statistics & numerical data , History, 20th Century , History, 21st Century , Humans , Incidence , Intergenerational Relations , Risk , United States/epidemiologySubject(s)
Battered Child Syndrome/diagnostic imaging , Birth Injuries/diagnostic imaging , Elbow Injuries , Elbow Joint/diagnostic imaging , Epiphyses, Slipped/diagnostic imaging , Humeral Fractures/diagnostic imaging , Humerus/diagnostic imaging , Joint Dislocations/diagnostic imaging , Battered Child Syndrome/therapy , Birth Injuries/therapy , Casts, Surgical , Epiphyses, Slipped/therapy , Female , Follow-Up Studies , Fracture Healing/physiology , Humans , Infant , Infant, Newborn , Joint Dislocations/therapy , UltrasonographyABSTRACT
Este trabajo de investigación tiene como principal propósito Indagar acerca de la situación en la que se encuentran niños y jóvenes discapacitados integrados en la escuela común: si son víctimas de maltrato por parte de sus compañeros que no tienen algún tipo de discapacidad; si son objeto de algún tipo de victimización por parte de los adultos-padres y/ o maestros y si, por todo ello, son doblemente víctimas de la violencia.En función del propósito enunciado, los objetivos que se han establecido son: Determinar y caracterizar la existencia de maltrato en niños y adolescentes discapacitados integrados en la escuela común, en función de sus características gemográficas. Se realizó un estudio exploratorio de niños y adolescentes con algún tipo de discapacidad, del 2º Ciclo de Educación General Básica (EGB.), Ciclo Básico Unificado (CBU) y Ciclo de Especialización, integrados en escuelas oficiales y privadas de la ciudad de Córdoba (Capital), con edades comprendidas entre los 10 y 17 años. Se seleccionaron por sorteo 50 alumnos discapacitados en las escuelas involucradas y se conformó un grupo control de 50 niños y adolescentes no discapacitados de edad y sexo similares, que permitieron la comparación entre ambos gruposSe aplicaron entrevistas a docentes de grado, maestros integradores y personal de los equipos técnicos de las escuelas relevadas. A través de los resultados obtenidos se pudo comprobar que los niños y adolescentes con discapacidad, objeto de nuestro estudio, padecen maltrato por parte de sus compañeros, maltrato que se correlaciona positivamente con la edad, ya que, a medida que crecen se incrementan, se sienten menos ligados, menos contenidos por los compañeros de su misma edad. Se observan además factores de riesgo familiares, sociales y ambientales que refuerzan este doble proceso de victimización...
This work of investigation has as principal intention Investigate brings over of the situation in which there are children and young disabled persons integrated to the common school: if theyare victims of mistreatment that their companions who do not have any type of disability; if they are an object of some type of victimization on the part of the adults - parents y/or main and if, forall this, they are doubly victims of the violence. Depending on the purpose set out the objectives that have been established are: To determine and to characterize the existence of mistreatment in children and teen disabled persons integrated to the common school, depending on their demographic characteristics. There was realized an exploratory study of children and teenagers by some type of disability, of 2 º Cycle of General Basic Education (EGB.), Basic Unified Cycle (CBU) and Cycle of Specialization, integrated in official and private schools of the city of Córdoba(Cardinal), withages included between 10 and 17 years.50 disabled pupils were selected by drawing in the involved schools and a group conformed control of 50 children and not disabled similar teenagers of age and sex, who allowed the comparison between both groups.Interviews were applied to teachers of degree, integration teachers and personnel of the technical equipments of the relieved schools. Through the results obtained it was possible to verify that the children and teenagers with disability, object of our study, suffer mistreatment on the part of their companions, mistreatment that is correlated positively by the age, since, as they grow they increase. They feel fewer ligatures, fewer contents for the companions of the same age. Are observed in addition: familiar, social and environmental factors of risk that reinforce this double process of victimization...
Subject(s)
Humans , Child , Adolescent , Adolescent , Battered Child Syndrome , Child Abuse , Crime Victims , Intellectual Disability , Child Abuse/psychology , Psychology, Child , Battered Child Syndrome/therapy , Violence/psychology , Disability Evaluation , Schools , Systems IntegrationABSTRACT
Este trabajo de investigación tiene como principal propósito Indagar acerca de la situación en la que se encuentran niños y jóvenes discapacitados integrados en la escuela común: si son víctimas de maltrato por parte de sus compañeros que no tienen algún tipo de discapacidad; si son objeto de algún tipo de victimización por parte de los adultos-padres y/ o maestros y si, por todo ello, son doblemente víctimas de la violencia.En función del propósito enunciado, los objetivos que se han establecido son: Determinar y caracterizar la existencia de maltrato en niños y adolescentes discapacitados integrados en la escuela común, en función de sus características gemográficas. Se realizó un estudio exploratorio de niños y adolescentes con algún tipo de discapacidad, del 2º Ciclo de Educación General Básica (EGB.), Ciclo Básico Unificado (CBU) y Ciclo de Especialización, integrados en escuelas oficiales y privadas de la ciudad de Córdoba (Capital), con edades comprendidas entre los 10 y 17 años. Se seleccionaron por sorteo
This work of investigation has as principal intention Investigate brings over of the situation in which there are children and young disabled persons integrated to the common school: if theyare victims of mistreatment that their companions who do not have any type of disability; if they are an object of some type of victimization on the part of the adults - parents y/or main and if, forall this, they are doubly victims of the violence. Depending on the purpose set out the objectives that have been established are: To determine and to characterize the existence of mistreatment in children and teen disabled persons integrated to the common school, depending on their demographic characteristics. There was realized an exploratory study of children and teenagers by some type of disability, of 2 º Cycle of General Basic Education (EGB.), Basic Unified Cycle (CBU) and Cycle of Specialization, integrated in official and private schools of the city of Córdoba(Cardinal), withages included between 10 and 17 years.50 disabled pupils were selected by dra
Subject(s)
Humans , Child , Adolescent , Child Abuse , Child Abuse/psychology , Psychology, Child , Crime Victims , Violence/psychology , Battered Child Syndrome , Battered Child Syndrome/therapy , Adolescent , Intellectual Disability , Schools , Systems Integration , Disability EvaluationABSTRACT
The authors report an infant with clinical and neuroimaging findings of shaken baby syndrome. The pitfalls encountered in the assessment on the cause of the bilateral frontal and interhemispheric subdural hematomas in this child are also briefly discussed. We have called this condition "benign" shaken baby syndrome and emphasize that not always acute subdural hematomas are of non-accidental nature
Los autores describen un lactante con hallazgos clínicos y de neuroimagen sugestivos del síndrome del niño maltratado. Se discuten brevemente las dificultades para la identificación de la causa del hematomasubdural agudo frontal bilateral e interhemisférico que el niño presentaba. Hemos denominado a esta entidad síndrome "benigno" del niño maltratado para destacar que el hallazgo de un hematoma subdural agudo en un niño pequeño no significa necesariamente maltrato infantil
Subject(s)
Infant , Humans , Battered Child Syndrome/complications , Hematoma, Subdural, Acute/etiology , Battered Child Syndrome/diagnosis , Battered Child Syndrome/therapy , Hematoma, Subdural, Acute/diagnosis , Hematoma, Subdural, Acute/therapy , Acute DiseaseABSTRACT
This study examines the correlates and impacts of child treatment in 68 cases referred to community agency providers after reports of child physical or sexual abuse. Standardized clinical assessments were conducted with child victims and their caregivers at intake and short-term follow-up (FUP-1), supplemented by official record reviews at a long-term follow-up (FUP-2). Child treatment was received by 19% and 50% of the children at FUP-1 and FUP-2, respectively. There were few correlates of initial child treatment involvement (sexual abuse or parent and family services received concurrently). Initial child treatment was not associated with significant gains in child outcomes. Child improvement in abuse-related outcomes was associated with post-traumatic stress disorder and lower adjustment at intake. Initial child treatment was unrelated to reabuse or out-of-home placement by FUP-2. Additional studies are needed to more fully evaluate the process and outcome of referral of child abuse victims to community-based services.
Subject(s)
Child Abuse/statistics & numerical data , Community Health Services/statistics & numerical data , Adolescent , Analysis of Variance , Battered Child Syndrome/complications , Battered Child Syndrome/therapy , Child , Child Abuse/therapy , Follow-Up Studies , Humans , Parents/psychology , Recurrence , Stress Disorders, Post-Traumatic/etiology , Treatment OutcomeABSTRACT
El Edema agudo hemorrágico del lactante (EHA) es una vasculitis leucocotoclástica, aguda y benigna que cursa con manifestaciones clínicas limitadas habitualmente a la piel. Aunque propia de niños con edades comprendidas entre los 4 y los 24 meses, se ha descrito también en el periodo neonatal. Se considera que puede asociarse a infecciones, vacunaciones o ingesta de fármacos. Plantea interesantes problemas nosológicos (relación con el Síndrome de Schönlein-Henoch, SSH) y de diagnóstico diferencial (AU)
Subject(s)
Female , Infant , Male , Humans , Edema/complications , Edema/diagnosis , Edema/etiology , Edema/therapy , Hemorrhage/complications , Hemorrhage/diagnosis , Hemorrhage/etiology , Hemorrhage/therapy , IgA Vasculitis/complications , IgA Vasculitis/diagnosis , IgA Vasculitis/etiology , IgA Vasculitis/therapy , Medical History Taking/methods , Exanthema/complications , Exanthema/diagnosis , Exanthema/etiology , Exanthema/therapy , Skin Manifestations , Biopsy/methods , Fluorescent Antibody Technique/methods , Steroids/administration & dosage , Steroids/therapeutic use , Recurrence , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/adverse effects , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Diagnosis, Differential , Vaccination/adverse effects , Vaccination , Vaccination/methods , Vaccination , Erythema Multiforme/complications , Erythema Multiforme/diagnosis , Erythema Multiforme/etiology , Erythema Multiforme/therapy , Battered Child Syndrome/complications , Battered Child Syndrome/diagnosis , Battered Child Syndrome/etiology , Battered Child Syndrome/therapy , Sepsis/complications , Sepsis/diagnosis , Sepsis/etiology , Sepsis/therapy , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/etiology , Urticaria/complications , Urticaria/diagnosis , Urticaria/therapyABSTRACT
In summary, inflicted cerebral trauma is a devastating but ultimately preventable brain injury caused by unique physiologic mechanisms that result in a distinctive pattern of injury. Nurses in a variety of settings, from the clinic and emergency room to the pediatric intensive care unit, play a major role in the identification, documentation, diagnosis, treatment, and prevention of ICT. The nurse's unique training also promotes prevention education and nonjudgmental support of the family.
Subject(s)
Battered Child Syndrome , Brain Injuries , Whiplash Injuries , Battered Child Syndrome/diagnosis , Battered Child Syndrome/epidemiology , Battered Child Syndrome/etiology , Battered Child Syndrome/therapy , Biomechanical Phenomena , Brain Injuries/diagnosis , Brain Injuries/epidemiology , Brain Injuries/etiology , Brain Injuries/therapy , Child Care , Child, Preschool , Critical Care/methods , Emergency Treatment/methods , Humans , Infant , Infant, Newborn , Nurse's Role , Parents/education , Parents/psychology , Primary Prevention/methods , Prognosis , Risk Factors , Treatment Outcome , Whiplash Injuries/diagnosis , Whiplash Injuries/epidemiology , Whiplash Injuries/etiology , Whiplash Injuries/therapyABSTRACT
Se presentan los datos clínicos y sociales más relevantes que se han observado en pacientes víctimas de cualquier forma del síndrome del niño maltrado, atendidos en el Departamento de Medicina Interna del Instituto Nacional de Pediatría, en los últimos años. Se enfatiza la necesidad de trabajar sobre una definición clara y lo más completa posible para poder abarcar todas las formas de maltrato a los niños. Así mismo, se describen los elementos básicos para que este fenómeno ocurra, presentándose algunos aspectos indispensables de cada uno de ellos. Finalmente, se plantea una forma de abordaje multidisciplinario para cada caso. Para ello se requiere el concurso de un grupo de profesionales, médicos y no médicos, con el objetivo de proporcionar al menor y a su familia una atención integral
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Child Abuse, Sexual , Battered Child Syndrome/diagnosis , Battered Child Syndrome/etiology , Battered Child Syndrome/therapy , Substance-Related DisordersSubject(s)
Child Abuse/diagnosis , Craniocerebral Trauma/etiology , Autopsy , Battered Child Syndrome/diagnosis , Battered Child Syndrome/epidemiology , Battered Child Syndrome/physiopathology , Battered Child Syndrome/therapy , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/etiology , Child Abuse/therapy , Child, Preschool , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/therapy , Diagnosis, Differential , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Tomography, X-Ray ComputedABSTRACT
El motivo de esta presentación es comunicar una experiencia terapéutica que se llevó a cabo en el Servicio de Violencia Familiar del Hospital de Niños Pedro de Elizalde, Buenos Aires, Argentina, con padres de niños maltratados. Comenzaremos con un desarrollo teórico y con un análisis cuantitativo y cualitativo de la muestra. Se trata de un grupo abierto y su creación se debió a la necesidad de contar con un espacio terapéutico en donde, a diferencia de otras psicoterapias, se pudiera trabajar puntualmente con los padres aspectos evolutivos y de puericultura en relación a sus hijos
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Helping Behavior , Child Abuse/prevention & control , Battered Child Syndrome/therapy , Health Education/methods , Child Abuse/statistics & numerical data , Child Abuse/psychology , Self-Help Groups/organization & administration , Self-Help Groups/trends , Battered Child Syndrome/psychology , Battered Child Syndrome/rehabilitation , Socioeconomic FactorsABSTRACT
El motivo de esta presentación es comunicar una experiencia terapéutica que se llevó a cabo en el Servicio de Violencia Familiar del Hospital de Niños Pedro de Elizalde, Buenos Aires, Argentina, con padres de niños maltratados. Comenzaremos con un desarrollo teórico y con un análisis cuantitativo y cualitativo de la muestra. Se trata de un grupo abierto y su creación se debió a la necesidad de contar con un espacio terapéutico en donde, a diferencia de otras psicoterapias, se pudiera trabajar puntualmente con los padres aspectos evolutivos y de puericultura en relación a sus hijos (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Battered Child Syndrome/therapy , Child Abuse/prevention & control , Helping Behavior , Battered Child Syndrome/psychology , Battered Child Syndrome/rehabilitation , Child Abuse/statistics & numerical data , Child Abuse/psychology , Health Education/methods , Self-Help Groups/organization & administration , Self-Help Groups/trends , Socioeconomic FactorsABSTRACT
El síndrome del niño maltratado se constituye en un problema de vigencia diaría que adquiere una singular importancia en la medida en que los estados se modernizan y progresan. Fenómenos estos que como regla general, presentan el tetrimento del nivel de vida de los seres más importantes y que se constituyen en el número mayoritario en los países poblres es decir los menores de 15 años. La presente revisión bibliográfica, pretende sistematizar en forma suscinta la historia natural de este problema de salud con el fin de expresar argumentos que contribuyan a la solución de un problema que se añade al perfil de enfermedades de la niñez en el Ecuador.
Subject(s)
Humans , Child , Battered Child Syndrome/diagnosis , Battered Child Syndrome/prevention & control , Battered Child Syndrome/therapyABSTRACT
Tomando en consideración la marginalidad del síndrome del niño maltratado en los manuales de clasificación y diagnóstico de transtornos del niño, así como su desconocimiento o nula presencia en la literatura médica nacional, se hace una revisión de sus bases conceptuales, de los críterios diagnósticos en uso y su identificación indirecta a través de algunos datos estadísticos y como resultado de procesos que perturban el entorno familiar y las relaciones de niños y padres. Se aportan finalmente algunos consejos para el abordaje de este problema.
