Undiagnosed abuse in children younger than 3 years with femoral fracture.

We retrospectively evaluated 138 children younger than 3 years with femoral fractures who presented to the emergency departments of three major Michigan hospitals between 1979 and 1983. Patients were classified into one of the following four subgroups based on presenting history: accident (22%), bone pathology (8%), abuse (10%), and uncertain origin (60%). Distribution of common fracture types among the four subgroups was similar. Of the uncertain group, 22 cases of abuse were identified during admission and 7 additional cases were found at a later date. The total number of femoral fractures secondary to abuse was 43 (31%) of 138. Children younger than 3 years presenting with a femoral fracture should evoke a high suspicion for abuse.

The neglect of our children.

When we consider all the manifestations of the effects of not meeting the basic needs of our children, we can feel nothing short of alarm and concern. The scope of the problem of child neglect, when the responsibility for this neglect is expanded beyond that of the parents or guardians, extends to inadequate health care, poor education, the ineffectiveness of the law, inadequate housing, and other adversities resulting from our social selection policies.

The perinatal period, a window of opportunity for enhancing parent-infant communication: an approach to prevention.

The perinatal period, broadly defined, encompasses the time frame from one year before to 18 to 24 months after the birth of the child. This period constitutes a window of opportunity through which parent-infant interaction may be reinforced, offering the possibility of decreasing the risk of family dysfunction. This review article clarifies the relationship between the enhancement of parent-infant interactions and the prevention of child abuse and neglect. It contains a detailed discussion of the capabilities of the newborn and places in perspective the difficulty experienced when parents who were themselves mistreated in childhood struggle to establish a system of communication with their own newborn children. The perinatal intervention program, a program intended to teach new parents the skills of interaction with their newborns, is described and placed into perspective with other perinatal programs which have been reported to be capable of augmenting the capacity for communication. The authors review the research data demonstrating the efficacy of these perinatal parent-infant programs. The paper concludes with a review of effective interventions, a discussion of what can be expected of each, and suggestions for the practical application of the programs during the perinatal period. The authors recognize that no program taken in isolation is sufficient; taken together they have the ability to improve parent-child relations, and they thus constitute a multifaceted approach to the prevention of child abuse and neglect.

Perinatal coaching: program development.

Perinatal Coaching is a training/educational program introduced to new parents in the first days following the birth of their baby. This program provides support while teaching new parents skills to communicate and interact with their newborn following birth. The article gives an overview of the content of the Perinatal Coaching Program, a review of the newborn's capabilities and their relationship to perinatal coaching, important features of some ongoing programs, early identification and selection of parents, and speculation for future development.

Effects of perinatal coaching on mother-infant interaction.

Perinatal coaching, a skill-training program designed to promote and enhance parent-infant interactions, was evaluated through a controlled design. Forty-two first-time mothers and their clinically well newborns from one private pediatric practice in central Michigan were the sample. Twenty-one of the mothers received perinatal coaching on days 1, 2, and 7 post partum, while the remaining 21 served as the control group. At 28 days post partum, two standardized self-report instruments on parental stress and maternal adaptation, videotaped recordings of mother-infant interactions, and demographic and background data were collected. The groups were comparable on all demographic/background variables assessed. Perinatal coaching was effective in promoting positive mother-infant interactions as demonstrated in five of nine videotaped behavioral assessments, indicating improved interactions for both mother and infant. Some support was found that showed decreased stress in the coached mothers.

Trauma to the bones of small infants from passive exercise: a factor in the etiology of child abuse.

Four infants, three premature and one term, developed serious bony injury from parent- or caretaker-administered passive exercises. In the three infants born prematurely, the exercise program was prescribed by neonatal intensive care unit staff before discharge; in the fourth infant, the babysitter initiated the program. In each case the passive exercise was begun to diminish actual or presumed muscle tightness. When these infants were presented to the physician with a serious traumatic injury between the ages of 4 and 10 months, the presumptive diagnosis of child abuse was made after radiologic assessment revealed multiple bone injuries. The several traumatic injuries to bones resulting from the home-administered physical therapy were most impressive. Passive exercise in three of the four infants was a significant factor in the cause of their injuries. Caution must be used in prescribing this form of "therapy" in small infants.

Atypical measles in adolescent siblings 16 years after killed measles virus vaccine.

The history of killed and live measles vaccine administration and exposure to natural disease is detailed in four adolescent siblings over a 16-year period. In two of these siblings, atypical measles developed 16 years after killed measles virus vaccine was administered, despite intercurrent doses of live measles virus vaccine.