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Education Newsletter

Offered by the PTS Education Committee

Journal Scan:
Child Abuse

Prepared by: Leslie Dingeldein, MD, Rainbow Babies and Children's Hospital, Cleveland, OH

University Hospitals, Rainbow Babies and Children's Hospital

Article #1:

Abusive Head Trauma in Infants and Children, An AAP Policy Statement
Sandeep K. Narang, MD, JD, Amanda Fingarson, DO, James Lukefahr, MD, AAP Council on Child Abuse and Neglect
Pediatrics, https://doi.org/10.1542/peds.2020-0203
Published:
April 2020

Abstract
Abusive head trauma (AHT) remains a significant cause of morbidity and abstract mortality in the pediatric population, especially in young infants. In the past decade, advancements in research have refined medical understanding of the epidemiological, clinical, biomechanical, and pathologic factors comprising the diagnosis, thereby enhancing clinical detection of a challenging diagnostic entity. Failure to recognize AHT and respond appropriately at any step in the process, from medical diagnosis to child protection and legal decision-making, can place children at risk. The American Academy of Pediatrics revises the 2009 policy statement on AHT to incorporate the growing body of knowledge on the topic. Although this statement incorporates some of that growing body of knowledge, it is not a comprehensive exposition of the science. This statement aims to provide pediatric practitioners with general guidance on a complex subject. The Academy recommends that pediatric practitioners remain vigilant for the signs and symptoms of AHT, conduct thorough medical evaluations, consult with pediatric medical subspecialists when necessary, and embrace the challenges and need for strong advocacy on the subject.

Article #2:

Identifying Populations at Risk for Child Abuse: A Nationwide Analysis
Hallie J. Quiroz, Joshua Parreco, Lavanya Easwaran, Brent Willobee, Anthony Ferrantella, Rishi Rattan, Chad M. Thorson, Juan E. Sola, Eduardo A. Perez
Journal of Pediatric Surgery, https://doi.org/10.1016/j.jpedsurg.2019.09.069
Published:
September 2019

Abstract
Purpose: Child abuse is a national, often hidden, epidemic. The study objective was to determine at-risk populations that have been previously hospitalized prior to their admission for child abuse.
Methods: The Nationwide Readmissions Database (NRD) was queried for all children hospitalized for abuse. Outcomes were previous admissions and diagnoses. ?2 analysis was used; significance equals p<0.05.
Results: 31,153 children were hospitalized for abuse (half owing to physical abuse) during the study period. 11% (n=3487) of these children had previous admissions (one in three to a different hospital), while 3% (n=1069) had multiple hospitalizations. 60% of prior admissions had chronic conditions, and 12% had traumatic injuries. Children with chronic conditions were more likely to have sexual abuse (89% vs. 57%, p<0.001) and emotional abuse (75% vs. 60%, p<0.01). 25% of chronic diagnoses were psychiatric, who were also more likely to have sexual and emotional abuse (47% vs. 5.5% and 10% vs. 1%, all p<0.001).
Conclusion: This study uncovers a hidden population of children with past admissions for chronic conditions, especially psychiatric diagnoses that are significantly associated with certain types of abuse. Improved measures to accurately identify at-risk children must be developed to prevent future childhood abuse and trauma.

Article #3:

Physical Child Abuse Demands Increased Awareness During Health and Socioeconomic Crises Like COVID-19: A Review and Education Material
Polina Martinkevich, Lise Langeland Larsen, Troels Grosholt-Knudsen, Gitte Hesthaven, Michel Bach Hellfritzsch, Karin Kastberg Petersen, Bjarne Miller-Madsen & Jan Duedal Rolfing
Acta Orthopaedica, https://doi.org/10.1080/17453674.2020.1782012 Published: June 2020

Abstract
Background and purpose: Physical abuse of children, i.e., nonaccidental injury (NAI) including abusive head trauma (AHT) is experienced by up to 20% of children; however, only 0.1% are diagnosed. Healthcare professionals issue less than 20% of all reports suspecting NAI to the responsible authorities. Insufficient knowledge concerning NAI may partly explain this low percentage. The risk of NAI is heightened during health and socioeconomic crises such as COVID-19 and thus demands increased awareness. This review provides an overview and educational material on NAI and its clinical presentation.
Methods: We combined a literature review with expert opinions of the senior authors into an educational paper aiming to help clinicians to recognize NAI and act appropriately by referral to multidisciplinary child protection teams and local authorities.
Results: Despite the increased risk of NAI during the current COVID-19 crisis, the number of reports suspecting NAI decreased by 42% during the lockdown of the Danish society. Healthcare professionals filed only 17% of all reports of suspected child abuse in 2016. Interpretation: The key to recognizing and suspecting NAI upon clinical presentation is to be aware of inconsistencies in the medical history and suspicious findings on physical and paraclinical examination. During health and socioeconomic crises the incidence of NAI is likely to peak. Recognition of NAI, adequate handling by referral to child protection teams, and reporting to local authorities are of paramount importance to prevent mortality and physical and mental morbidity.


CME Opportunitues

What Are the Health Consequences of Childhood Maltreatment?
According to a review by Lippard and colleagues, childhood maltreatment, including neglect and physical, emotional, and sexual abuse, is the leading risk factor for mood disorders and psychiatric disorders. This article review will address these devastating consequences of child maltreatment.

CME/CNE Link