Growth of abused children. Contrasted with the non-abused in an urban poor community

Frequency of malnutrition in children and adolescents with child maltreatment

INTRODUCTION

child maltreatment (CM) can have a negative impact on physical and mental health in childhood and throughout life.

OBJECTIVE

to determine the frequency of malnutrition in cases of CM from the Clínica de Atención Integral al Niño Maltratado (CAINM) of the Instituto Nacional de Pediatría (INP), Mexico.

MATERIAL AND METHODS

this was a cross-sectional, retrospective, descriptive study of children with CM. Height/age, weight/height, and body mass index/age were used to determine malnutrition status (undernutrition and overweight or obesity). The frequency of malnutrition by age group and sex were compared using X2 tests. The prevalence of malnutrition at CAINM was compared to that expected in Mexico (ENSANUT-2012), serving as a reference for children without CM, using one-sample Poisson tests.

RESULTS

of the 117 cases, 41 % presented wasting or overweight/obesity, and 25 % were growth-stunted. Neither wasting nor stunting displayed any difference between age groups (p > 0.05). Overweight/obesity was observed more frequently in adolescents than in schoolchildren (p < 0.05). Being overweight or obese was most frequently associated with sexual abuse, and wasting and stunting were most often associated with neglect. Compared to the population without CM, the group under 5 years of age had a higher prevalence of wasting (p < 0.01), and those aged 5 to 11 years had a higher prevalence of both wasting and stunting (p < 0.001).

CONCLUSIONS

CM cases were characterized by acute undernutrition and stunting as well as by adolescents who were overweight or obese. Malnutrition in the pediatric population should be analyzed from a wider perspective, including possible CM.

Case report: Forensic anthropological assessment in a suspected case of child abuse from South Africa

Not many case reports of suspected child abuse as assessed solely on skeletal remains are available. Forensic anthropologists have intimate knowledge of normal skeletal anatomy, bone trauma and processes of healing of bone and may therefore be of help in suspected cases of child abuse. Patterns of trauma in juvenile skeletal remains which are suggestive of abuse include fractures in different phases of healing, multiple fractures, typical fractures on ribs and long bones and severe, complicated cranial fractures. The aim of this paper is to report on the findings of the analysis of the skeletal remains of a 3.5 years old boy. Forensic pathological examination indicated that the boy had died from a massive cranial fracture, with multiple injuries present to the rest of the body. After the body had been buried for some time, it was exhumed and we were requested to look for signs of chronic, long-term abuse. Findings included a massive cranial fracture, another fracture in the roof of the orbit, two areas of non-specific subperiosteal bone growth and several untreated carious teeth. No clear healed fracture could be found, except for a possible healed cranial base fracture which stretched transversely across the petrosal bone. This area showed signs of recent bone activity. The court decided that this was not enough evidence of chronic abuse and found the accused guilty of murder but not of chronic child abuse. This case illustrates the difficulty to obtain clear signs of chronic injury on juvenile remains.

Impacts of domestic violence on child growth and nutrition: a conceptual review of the pathways of influence

Domestic violence against women is a global problem, and young children are disproportionate witnesses. Children's exposure to domestic violence (CEDV) predicts poorer health and development, but its effects on nutrition and growth are understudied. We propose a conceptual framework for the pathways by which domestic violence against mothers may impair child growth and nutrition, prenatally and during the first 36 months of life. We synthesize literatures from multiple disciplines and critically review the evidence for each pathway. Our review exposes gaps in knowledge and opportunities for research. The framework also identifies interim strategies to mitigate the effects of CEDV on child growth and nutrition. Given the global burden of child malnutrition and its long-term effects on human-capital formation, improving child growth and nutrition may be another reason to prevent domestic violence and its cascading after-effects.

Patient and injury characteristics in abusive abdominal injuries

OBJECTIVE

To identify patient and injury characteristics associated with suspected child abuse in the setting of blunt abdominal trauma.

PATIENTS

We extracted from the National Pediatric Trauma Registry phases 2 and 3 (October 1995 to April 2001; N = 106,135) all cases of blunt abdominal injury, excluding motor vehicle injuries, in patients aged 0 to 4 years.

MAIN OUTCOME MEASURES

Independent variables included age, mortality, nutritional status, and injury type. The dependent variable was suspected child abuse.

RESULTS

Six hundred sixty-four cases were analyzed. The median age of patients was 2.6 years; 11.4% were undernourished. The 3 most common mechanisms of injury were suspected child abuse (40.5%), fall (36.6%), and struck-not child abuse (9.7%). Hepatic injury (46.1%) was the most common intra-abdominal injury, followed by splenic (26%), hollow viscous (17.9%), and pancreatic (8.6%) injuries. Eighty-four percent of deaths were related to suspected child abuse. There was a greater proportion of children with suspected child abuse in every patient and injury characteristics studied than all other mechanisms combined. In a regression model including age, undernourishment, pancreatic injury, hollow viscous injury, traumatic brain injury, and mortality, all variables were significantly associated with suspected abuse. Hollow viscous injury had the highest odds ratio (OR, 9.5; confidence limits, 5.7, 15.8), whereas traumatic brain injury had the lowest (OR, 3.6; confidence limits, 2.4, 5.6).

CONCLUSIONS

Young children with severe pancreatic or hollow viscous injuries or severe abdominal injuries in the context of either brain injury or undernourishment should be evaluated for the possibility that these injuries resulted from abuse. Increasing the awareness of the possibility of child abuse associated with a set of injury characteristics may allow for more consistent and complete medical evaluation.

Conseqüências da violência familiar na saúde da criança e do adolescente: contribuições para a elaboração de propostas de ação

No Brasil, o conhecimento sobre a dimensão da violência familiar é ainda escasso. Todavia, existem evidências apontando para um cenário merecedor de enfrentamento imediato. Nesta perspectiva, o presente artigo destaca o campo das investigações sobre o tema, procurando explicitamente fazer uma ponte entre a apropriação do conhecimento gerado e efetivas propostas de ação. O artigo divide-se em cinco partes. Inicialmente, é discutida a importância da violência familiar no cenário de morbi-mortalidade de crianças e adolescentes A seguir, procura-se mapear as principais linhas de investigação sobre o tema, sugerindo uma tipologia de estudos da área. A terceira sessão explora com mais ênfase as investigações que avaliam as conseqüências do fenômeno na saúde de crianças e adolescentes. Na quarta seção, são discutidos os possíveis elos entre o conhecimento a ser gerado nesse âmbito e as propostas de ação para o enfrentando da violência familiar. Na última seção, são feitas algumas considerações sobre a importância do enfoque familiar em oposição ao individual; do multidisciplinar, em vez da abordagem compartimentalizada; e sobre a necessidade de integração das várias agências e serviços envolvidos com a violência familiar.

Growth and academic achievement in inner-city kindergarten children. The relationship of height, weight, cognitive ability, and neurodevelopmental level

Measures of height, weight, nonverbal cognitive ability (Ravens progressive matrix), visual-motor-perceptual ability (Beery-Buktenica test of Visual Motor Integration [VMI]), the imitation-of-gestures technique, and academic achievement (Stanford Early Achievement) were obtained for a sample of 82 children from a poor inner-city community. In contrast to prior reports from the United States and about other developed countries, anthropometric measures were related both to academic achievement and to these measures of neurodevelopment. They were not consistently related to measures of nonverbal cognitive ability. Regression analyses revealed that general cognitive ability contributed more variance (39%) to predictions of achievement than all other variables, including weight for age (13%) and VMI (6%). Children with reduced somatic growth were likely to do poorly in school, but the data do not show that undernutrition causes learning failure. Rather, they suggest that environmental problems affecting the development of thought processes and nutrient intake precede both growth and learning failure.