Fractures in the first year of life. A diagnostic dilemma.

Thirty-four patients with 55 fractures in the first year of life were studied. There were 189 patients with 21 skull fractures and 16 patients with 19 extremity fractures. Extremity fractures occurred at a significantly younger age than did skull fractures. Cause was defined as accidental in 15 patients (44%) and nonaccidental (child abuse) in 19 patients (56%), representing a greater incidence of accidental cause than previous reports indicated in this age group. There were no significant differences between the two groups with regard to mean age, percentage of girls, number of fractures per patient, and distribution of fractures. Eight patients had notable constitutional abnormalities contributing to the causes of their fractures. There was no difference between this group and normal patients with regard to mean age, percentage of girls, distribution of fractures, and number of fractures per patient.

Cerebral injury in child abuse: a changing profile.

This report of 21 patients with cerebral injury resultant from child abuse, identifies a broad profile of central nervous sequelae from such injuries, 6 patients were admitted with whiplash shaken infants syndrome, all with severe signs of CS dysfunction. 3 children presented with acute cerebral confusions, 2 with severe cord injuries with resultant paresis and 10 with skull fractures or miscellaneous injuries. Computer tomography has proved to be of great assistance in precise identification of site and size of subdural/intracerebral hematomas in abused children and in identifying posterior fossa lesions and providing longitudinal assessment of sequelae of cerebral trauma. Also the role of the Child Protection Team in management of such acutely injured children is defined.

The development of an education program in the pediatric emergency department.

The pediatric emergency department is a major educational resource in ambulatory pediatrics. A literature review indicates a lack of programs based on the identification of specific educational objectives in this setting. A model educational program for third-year pediatric clinical clerks and pediatric level I and II house officers is presented. Learning is defined in three areas: patient management, behavioral care needs, and hospital and community health care needs. Information on specific educational goals and objectives, learning experiences derived from them, and methods for evaluation of learning is provided.

Comprehensive pediatric care: the patient viewpoint.

Two meanings of the term comprehensive care are delineated. The first refers to a wide scope of health services, the second to a humanistic approach to the patient. Findings from a sample of patients from one pediatric practice suggest that the two meanings constitute two independent variables with respect to patient expeciations. Patient responses to questions regarding their expectations of the pediatrician revealed a tendency to hold a traditional disease orientation. Comprehensive care as a broad scope of health services that include mother guidance in child rearing is not a common goal for mothers utilizing the pediatric practice under study. On the other hand, a comprehensive approach by the pediatrician is a standard shared by most respondents in the sample: high priority is accorded the pattern of the personal physician with whom a patient forms a continuous doctor-patient relationship which instills in the patient trust that the physician's recommendations are based on thorough knowledge of the patient as an individual.