Abusive head trauma in Maine infants: medical, child protective, and law enforcement analysis

Ricci, Lawrence R.; Giantris, Amy; Merriam, Phyllis; Hodge, Sandra; Doyle, Tim

doi:10.1016/s0145-2134(03)00006-1

Cited by 43 publications

(33 citation statements)

References 16 publications

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“…Educational campaigns designed to prevent "shaken-infant syndrome" (also referred to as abusive head trauma) are most likely to reach mothers of young infants. However, Starling et al 33 and Ricci et al 32 have shown that few mothers are perpetrators of abusive head trauma, and in the present study, mothers were perpetrators for just 20% of all inflicted injuries. A broader message that includes training on early childhood development as well as methods for identifying safe and appropriate child care should ideally be provided to all likely caregivers of infants and young children.…”

Section: Discussioncontrasting

confidence: 51%

“…3,32,33 Starling et al 33 identified perpetrators of both fatal and nonfatal abusive head trauma over a 12-year period (1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994) at the Children's Hospital of Denver and reported that 68.5% were male. For fatal abusive head trauma only, men were perpetrators in 74.2% of the cases, providing support for the Bergman et al findings that males were responsible for more severe injuries.…”

Section: Discussionmentioning

confidence: 99%

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Child Deaths Resulting From Inflicted Injuries: Household Risk Factors and Perpetrator Characteristics

2005

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ABSTRACT. Objective. To determine the role of household composition as an independent risk factor for fatal inflicted injuries among young children and describe perpetrator characteristics.Design, Setting, and Population. A population-based, case-control study of all children <5 years of age who died in Missouri between January 1, 1992, and December 31, 1999. Missouri Child Fatality Review Program data were analyzed. Cases all involved children with injuries inflicted by a parent or caregiver. Two age-matched controls per case child were selected randomly from children who died of natural causes.Main Outcome Measure. Inflicted-injury death. Household composition of case and control children was compared by using multivariate logistic regression. We hypothesized that children residing in households with adults unrelated to them are at higher risk of inflicted-injury death than children residing in households with 2 biological parents.Results. We identified 149 inflicted-injury deaths in our population during the 8-year study period. Children residing in households with unrelated adults were nearly 50 times as likely to die of inflicted injuries than children residing with 2 biological parents (adjusted odds ratio: 47.6; 95% confidence interval: 10.4 -218). Children in households with a single parent and no other adults in residence had no increased risk of inflicted-injury death (adjusted odds ratio: 0.9; 95% confidence interval: 0.6 -1.9). Perpetrators were identified in 132 (88.6%) of the cases. The majority of known perpetrators were male (71.2%), and most were the child's father (34.9%) or the boyfriend of the child's mother (24.2%). In households with unrelated adults, most perpetrators (83.9%) were the unrelated adult household member, and only 2 (6.5%) perpetrators were the biological parent of the child.Conclusions. Young children who reside in households with unrelated adults are at exceptionally high risk for inflicted-injury death. Most perpetrators are male, and most are residents of the decedent child's household at the time of injury. Using vital-records data makes it possible to conduct large, population-based studies to identify risk factors for fatal inflicted injuries. It is well documented, however, that studies based on vital records severely underestimate child maltreatment deaths, with 50% to 85% of child maltreatment deaths misclassified as resulting from other causes. [3][4][5][6][7] In addition, vital-records data are typically limited to a small subset of maternal and child variables and provide no information on household composition, the perpetrators, or their relationship to the decedent child. This combination of pronounced misclassification and lack of risk-factor information in vital records severely limits the usefulness of these data for child-maltreatment research. 1,[8][9][10] Combining data from multiple sources, now a common practice in many state-based child-fatalityreview programs, can greatly reduce the misclassification of maltreatment fatalities as resulting from other c...

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Child Deaths Resulting From Inflicted Injuries: Household Risk Factors and Perpetrator Characteristics

2005

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“…Evidence of prior injury on physical examination or radiographs at the time of diagnosis of child maltreatment has been documented in the literature (15)(16)(17). Although in recent years there has been an increase in the awareness and more accurate diagnosis of child abuse by the medical community, physicians still often fail to identify and diagnose potentially life-threatening abuse (18 -21).…”

Section: Background and Importancementioning

confidence: 99%

Association of Injury Visits in Children and Child Maltreatment Reports

Spivey

Schnitzer

Kruse

et al. 2009

The Journal of Emergency Medicine

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“…4 In 1 study of abuse victims younger than 24 months, 75% had evidence of previous trauma or history of a previous injury. 21 Child abuse may recur 35% of the time without appropriate detection and intervention. 22 As with other types of child maltreatment, there have been recent advances in medical knowledge regarding physical abuse.…”

Section: Role Of the Pediatricianmentioning

confidence: 99%

Evaluation of Suspected Child Physical Abuse

Kellogg¹

2007

Pediatrics

250

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This report provides guidance in the clinical approach to the evaluation of suspected physical abuse in children. The medical assessment is outlined with respect to obtaining a history, physical examination, and appropriate ancillary testing. The role of the physician may encompass reporting suspected abuse; assessing the consistency of the explanation, the child's developmental capabilities, and the characteristics of the injury or injuries; and coordination with other professionals to provide immediate and long-term treatment and follow-up for victims. Accurate and timely diagnosis of children who are suspected victims of abuse can ensure appropriate evaluation, investigation, and outcomes for these children and their families. PREVALENCEIn 2004, 152 250 children and adolescents were confirmed victims of physical abuse in the United States. 1 Of the 4 types of child maltreatment (neglect, physical abuse, sexual abuse, and emotional abuse), physical abuse is second to neglect, constituting approximately 18% of the total. 1 Despite these statistics, the estimated number of victims is much higher; in 1 retrospective cohort study of 8613 adults, 26.4% reported they were pushed, grabbed, or slapped; had something thrown at them; or were hit so hard they got marks or bruises at some time during their childhood. 2 It has been estimated that 1.3% to 15% of childhood injuries that result in emergency department visits are caused by abuse. 3 Physical abuse remains an underreported (and often undetected) problem for several reasons including individual and community variations in what is considered "abuse," inadequate knowledge and training among professionals in the recognition of abusive injuries, unwillingness to report suspected abuse, and professional bias. For example, in 1 study, 4 31% of children and infants with abusive head trauma were initially misdiagnosed. Misdiagnosed victims were more likely to be younger, white, have less severe symptoms, and live with both parents when compared with abused children who were not initially misdiagnosed. Such studies suggest a need for practitioners to be vigilant to the possibility of abuse when evaluating children who have atypical accidental injuries or obscure symptoms that are suggestive of traumatic etiologies but who do not have a history of trauma.Child abuse has significant long-term medical and mental health morbidity. 5 Children with abusive head or abdominal injuries are more likely to die or become more severely incapacitated than are children with head or abdominal injuries caused by accidents. 6-8 Victims of physical abuse in childhood are more likely to www.pediatrics.org/cgi

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Abusive head trauma in Maine infants: medical, child protective, and law enforcement analysis

Cited by 43 publications

References 16 publications

Child Deaths Resulting From Inflicted Injuries: Household Risk Factors and Perpetrator Characteristics

Child Deaths Resulting From Inflicted Injuries: Household Risk Factors and Perpetrator Characteristics

Association of Injury Visits in Children and Child Maltreatment Reports

Evaluation of Suspected Child Physical Abuse

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