Follow up study eight years after diagnosis of sexual abuse.

AIM: To study the outcome over an eight year period of children determined by paediatricians in 1989 as definitely or probably sexually abused. METHOD: Information was obtained on 140 of 148 children diagnosed in 1989 when aged 7 or less. Sources were hospital medical records and school health records. School health records of a comparison group of 83 children were also examined. RESULTS: A variety of problematic characteristics were found significantly more often in the abused group than the comparison group. These included surname changes (30% v 2%), removal from home (25% v 1%), number of home addresses (2.8 v 1.4), and schools attended (3.4 v 2.2). Other significant findings included further abuse (35% v 0%), adverse behaviours (60% v 16%), educational problems (24% v 5%), chronic health problems (54% v 36%), and involvement of mental health services (32% v 1%).

The British Case Conference in child sexual abuse: another model for America.

In 1990, I had an opportunity to observe the civic response to child sexual abuse in Leeds, England. During this time, I also attended the British Case Conference and found it to be a central event in the development of diagnosing and treating child abuse, especially sexual abuse. The purpose of this report is to describe this multidisciplinary, multiagency procedure that is used throughout Britain, and to offer opinions on its strengths and weaknesses.

Children's perceptions of genital examinations during sexual abuse evaluations.

Children's reactions to the medical evaluation of sexual abuse and the methods that enhance their coping ability have not been well addressed in the literature. For many children, a genital examination can be highly stressful, and may even trigger memories of the sexual abuse itself. Stress can be reduced by preparing the child for the examination, by giving the child greater control, and by debriefing the child (and parents) afterward. Research is needed to develop the most effective techniques for reducing children's stress during a genital examination.

Child development knowledge, childrearing attitudes, and social support among first- and second-time adolescent mothers.

This paper compares the parenting characteristics of first- and second-time adolescent mothers. Using a case control design, immediately after delivery and at two months postpartum we administered a pretested questionnaire to 51 second-time adolescent mothers, 47 first-time adolescent mothers, and 25 second-time adult mothers. The questionnaire measured the subject's social support system, contraceptive use, and education level. Scales measuring stressful life events, knowledge of child development, and childrearing attitudes were included. The adolescent groups were similar except that significantly more second-time adolescent mothers dropped out of school (p less than or equal to 0.05). Greater maternal education and higher infant five-minute Apgar scores were associated with less negative childrearing attitudes immediately after the birth (p less than or equal to 0.05). At two months postpartum, the age of the father and the time he spent with the child were associated with positive childrearing attitudes (p less than or equal to 0.05). Increased paternal involvement and completion of high school may enhance adolescent attitudes toward childrearing and improve mother-child relations.

Prepubertal female genitalia: examination for evidence of sexual abuse.

Experience with more than 375 cases of possible sexual abuse has taught us that much work still needs to be done in understanding normal prepubertal female anatomy and interpreting findings in sexual abuse cases. Because pediatric clinicians are often called upon to assess possible sexual abuse victims, knowledge of what is known and how best to examine the genitalia of a young girl is essential. Two cases are discussed that involve normal and abnormal anatomy. Examination techniques for adequate visualization include proper tension and timing with the spreading of the labia in the supine position, the knee-chest position, and lateral traction on the buttocks while lying flat on the abdomen to look for anal relaxation. The hymen, contrary to common notion, is often a slack, thick, folded, stretchable tissue which may persist after digital or penile penetration. Findings secondary to sexual abuse are often subtle. Acute tears or bruising are rare because force is seldom a part of the sexual acts committed against a child. A vaginal opening of greater than 5 mm is not common and may indicate vaginal penetration with a finger, object, or penis. An "intact" hymen does not necessarily preclude vaginal penetration. Lack of physical evidence never rules out abuse because many sexual acts leave no physical findings.

Toxocara canis infestation. Clinical and epidemiological associations with seropositivity in kindergarten children.

We studied a cohort of 333 children in kindergarten to determine the prevalence of seropositivity to Toxocara canis, and to detect and measure chronic health effects that might be attributable to past infection. We found that 23.1% of the children had serologic evidence of infection (antibody titer greater than or equal to 1:32), assayed by means of an enzyme-linked immunosorbent assay. Black children were more frequently infested than white children, as were children of parents who did not graduate from high school. In a subsample of seropositive and seronegative children, we found associations between seropositivity and both pica and puppy ownership; we did not find differences in the symptoms and signs that occur in toxocaral visceral larva migrans nor differences in measures of growth and nutrition. No child had ocular toxocariasis although 31.8% (106) of the children had antibody titers greater than or equal to 1:16. In a population in which approximately 20 to 30% of the children show serologic evidence of Toxocara infestation, care must be taken in differentiating toxocariasis-like ophthalmic lesions, due to the potential for the coincidental occurrence of retinoblastoma in a child who is seropositive for the Toxocara parasite.

Disproportionate intra-uterine head growth and developmental outcome.

The authors examined the relationship between disproportionate intra-uterine head growth, or a relatively small head, and later development, using data collected as part of the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke. Within the population of infants who are normal by conventional criteria (term infants with appropriate weight and head-circumference for gestational age), a group with relatively small heads was defined by each of four different methods. Developmental outcome measures included the Bayley Mental and Motor Scales at eight months, Stanford-Binet IQ at four years and Wechsler Intelligence Scales IQ at seven years. No clinically meaningful differences in developmental outcome were found between the infants with relatively small heads and the remainder of the infants.

Toxocara canis infection: clinical and epidemiological associations with seropositivity in kindergarten children.

To determine epidemiological and clinical associations with Toxocara canis seropositivity, we studied 333 (87%) children of a cohort of 383 five- to seven-year-olds. The prevalence of seropositivity (antibody titer to T canis, greater than or equal to 1:32) was 23.1%. Black children were more frequently seropositive than were white children, as were children of parents who did not graduate from high school. In a sample of seropositive and seronegative children, seropositivity was associated with both a history of pica and puppy ownership, but not with a greater frequency of symptoms and signs that occur in visceral larva migrans or with poor growth. No child had evidence of ocular toxocariasis on retinal examination. For the whole sample, poor reading achievement, marked distractibility, and lower intelligence were associated with seropositivity, but by using multiple regression analysis, we found that these associations may be attributable to confounding variables.

Teenage pregnancy: a prospective study of self-esteem and other sociodemographic factors.

A prospective study was undertaken to examine the relationship of self-esteem and other factors theorized to contribute to teenage pregnancy. The Coopersmith Self-Esteem Inventory and a questionnaire concerning demographic, attitudinal, and other factors, were administered to 874 of the 1,007 teenage women enrolled in two city high schools. During the following year, 95 of 858 teenage women followed up became pregnant, a pregnancy rate of 11.1%. The data show no significant association of self-esteem with subsequent pregnancy. Twelve of the 27 questionnaire items were associated significantly with pregnancy. However, further analysis revealed that either alone or in combination, there were no more than 57% sensitivity and 67% specificity for prediction of subsequent pregnancy from the questionnaires.

Adaptations of the Denver Developmental Screening Test: a study of preschool screening.

Developmental screening tests are only rarely used in pediatric practice, reportedly because of lack of available time. This study evaluated a shortened form of the Denver Developmental Screening Test (DDST-S) consisting of only those items immediately to the left of the child's individual are line, three in each sector or a total of 12. This DDST-S was administered to four cohorts of preschool children (aged 52 to 64 months), 1,819 children in all. Subsamples of these children returned within three months for one of several developmental (criterion) tests (McCarthy Scales of Children's Abilities, the complete DDST, or the Stanford-Binet). The DDST-S was scored by selecting the profile of passes and failures most predictive of McCarthy test results, using indices of copositivity, connegativity, underreferral, and overreferral as the basis for the decision. Utilizing this scoring system, use of the DDST-S was able to identify low scorers (those scoring less than 70) on the Stanford-Binet (sensitivity = .67, specificity = .95, predictive value = .54, underreferral = 2.5%, overreferral = 4%) as well as the complete DDST. Low scoring children could thus be identified in less than half the time required by the complete DDST. A two-stage DDST-S and DDST procedure was found to have even greater predictive value (76%; 100% if borderline cases [score of 70 to 80] are considered positive) than either form alone.