The forensic pediatrician as a child advocate.

This paper focuses on the medicolegal activities of a group of six pediatricians from the Winnipeg Children's Hospital. Increasing legal demands resulted in 93 court appearances for the group, during a 12-month period ending in December 1982. The educational processes and the individual court room issues confronted by both the courts and the six pediatricians, dealing with problems of child protection, are described. Major pediatric roles and principles of advocacy resulting from these experiences are delineated. Society's accountability is discussed with specific reference to the pediatrician's role.

Child abuse in Winnipeg: hospital and community together.

The Winnipeg Children's Hospital Child Protection Centre program for helping physically, sexually and emotionally abused children and their families is presented. The Protection Centre strongly advocates and works within a multidisciplinary approach which includes the hospital, child welfare agencies, the police and the justice system in case management and in carrying out intervention strategies and treatment plans. This approach is considered a most effective means of ensuring the care and protection of children.

The Winnipeg Children's Hospital child protection centre: a provincial medical initiative.

The Winnipeg Children's Hospital child protection centre is a hospital-based provincial protection program that focuses on the diagnosis, treatment and prevention of child abuse and neglect in Manitoba. The multidisciplinary group of professionals working in the centre differs from most hospital-based teams in that it has a strong government liaison both functionally and financially, has strong ties to the welfare system and has legal counsel relating to the court system. The centre represents the philosophy that medical participation in welfare matters relating to children need not be relegated to the sidelines. This paper describes the centre's history and structure, and it outlines some of its research projects.

Reading retardation:a 12-year prospective study. Implications for the pediatrician.

A 12-year study has (1) assessed the predictive efficiency of a preschool test battery in relation to short- and long-term school achievement; (2) evaluated socioeconomic locale and operational school structure as indicators of subsequent progress; (3) observed the effects of some correctional experiences on later school performance. Almost 1,000 children have been involved; 606 remain in the project. Mental ages have ranged from 54 to 104 months though the mean chronologic age at school entry was 74 months. Twenty-three percent failed to complete first-grade requirements in the first year. Failure rates within separate schools ranged from three to 71% and had an inverse relationship to socioeconomic level. Within the middle-class area, children in an open-space school had double the failure rate of their peers in traditional classrooms.

The deprived child in adoption.

There has been an increasing number of older children adopted in Manitoba, Canada, often with adverse results because of early deprivation of the children concerned. 33 children from adoption "breakdowns" and 12 control adoptions were studied. Assessment was made of the time of placement, number of previous moves, development and intelligence quotients, and the behaviour pattern of the children. There were no differences between the control and adoptive breakdown groups with regard to the motivation of the adopting parents, the degree to which the adopted child was considered at risk, or the manner in which placement was carried out. Common to both groups was the difficult behaviour of the children which appeared to stem from early experiences of deprivation. Adopting parents should be told about the possible problems arising from environmental deprivation and appropriate counselling should be given before adoption and after placement. Specific policies in the placement of such high-risk children are given.

Prognosis of infants of diabetic mothers in relation to neonatal hypoglycaemia.

A prospective follow-up study was conducted to determine whether neonatal hypoglycaemia in infants of diabetic mothers affects subsequent neurological and intellectual performance. 37 such infants (25 hypoglycaemic and 12 non-hypoglycaemic) were examined for physical, neurological and developmental performance at an average age of 4 1/2 years. 11 children were abnormal, with generalised retardation and neurological abnormalities, or delays in particular areas of development; three children were possibly abnormal; and 23 children were normal. Abnormality at follow-up could not be related to neonatal blood glucose level, to the duration of hypoglycaemia or to any other measurement made in the neonatal period, nor to any factor relating to the maternal diabetes. Compared with the normal children, the abnormal group had slightly small head-circumferences at birth relative to their gestational age, but a follow-up there was no difference in head size. At follow-up the children of diabetic mothers tended to be shorter than average. The poor prognosis of the infants in this study was not due to brain damage caused by neonatal hypoglycaemia.

The battered child syndrome.

The experience of the Children's Hospital of Winnipeg from 1957 to 1971 with abused infants and children is presented with statistical data on 132 children. Details as to incidence, source and types of abuse are presented along with a discussion of the management of the problem. A follow-up study on a group of the abused children is also presented with comments directed towards some preventive measures.