Indian J Dermatol Venereol Leprol. 2010 Jul-Aug; 76(4): 317-26
Ermertcan AT, Ertan P

Child abuse is a major public health problem all over the world. There are four major types of abuse: physical abuse, sexual abuse, emotional abuse and neglect. The most common manifestations of child abuse are cutaneous and their recognition; and differential diagnosis is of great importance. Clinicians, especially dermatologists, should be alert about the skin lesions of child abuse. In the diagnosis and management of child abuse, a multidisciplinary approach with ethical and legal procedures is necessary. In this manuscript, cutaneous manifestations of physical, sexual, emotional abuse and neglect are reviewed and discussed.

Perspect Public Health. 2010 May; 130(3): 118-26
Lazenbatt A

AIM: Using a healthy settings framework, this study aims to compare and contrast how midwives working in either hospital or community settings are currently responding to the co-occurrence of domestic and child abuse; their perceived role and willingness to identify abuse; record keeping; reporting of suspected or definite cases of child abuse; and training received. METHODS: A survey questionnaire was sent to 861 hospital and community midwives throughout Northern Ireland, which resulted in 488 midwives completing the questionnaire, a 57% response rate. Comparisons were made using descriptive statistics and cross-tabulation and the questionnaire was validated using exploratory factor analysis. RESULTS: Community midwives reported receiving more training on domestic and child abuse. Although a high percentage of both hospital and community midwives acknowledged a link between domestic and child abuse, it was the community midwives who encountered more suspected and definite (p < 0.001) cases of child abuse. More community midwives reported being aware of the mechanisms for reporting child abuse. However, an important finding is that although 12% of community midwives encountered a 'definite' case of child abuse, only 2% reported the abuse, leaving a 10% gap between reporting and identifying definite cases of child abuse. Findings suggest that lack of education and training was a problem as only a quarter of hospital midwives reported to have received training on domestic violence and 40% on child abuse. This was significantly less than that received by community midwives, where the figures were 57% and 62%, respectively. CONCLUSION: Midwives need training on how to interact with abused mothers using non-coercive, supportive and empowering mechanisms. Many women may not spontaneously disclose the issues of child or domestic abuse in their lives, but often respond honestly to a sensitively asked question. This issue is important as only 13% of the sample actually asked a woman a direct question about domestic violence.

Behav Brain Res. 2010 Jul 16;
Sato A, Nakagawasai O, Tan-No K, Onogi H, Niijima F, Tadano T

Olfactory bulbectomy (OBX) induces behavioral, physiological, and neurochemical alterations resembling clinical depression and is widely used as an animal model of depression. It has been reported that depression is a critical cause of child abuse and neglect and that maternal behavior involves dopaminergic neurons of the mesolimbic pathway. In a previous study we found that OBX mice show maternal behavior deficits which are improved by administration of apomorphine, a non-selective dopamine agonist. Therefore, in this study, we investigated the effect of l-3,4-dihydroxyphenylalanine (l-DOPA) on maternal behavior deficits to examine the influence of pre-synaptic dopaminergic function in OBX mice. Furthermore, we measured tyrosine hydroxylase (TH) levels using microphotometry and quantified dopamine D1- and D2-like receptors using autoradiography in the nucleus accumbens (NAc). As a result, 25mg/kg l-DOPA with 12.5mg/kg benserazide improved disrupted maternal behavior in OBX mice and there are no changes in TH levels or number of D1- and D2-like receptors between sham and OBX mothers. The behavioral data support the hypothesis that changed dopaminergic function may contribute to maternal behavior deficits in OBX mice. However, our findings concerning dopaminergic function suggest that the deficits in OBX mice are not simply due to changes in TH levels or dopamine receptor number in the NAc.

Pediatr Dermatol. 2010 Jul; 27(4): 401-2
Berk DR, Bayliss SJ

A 3-month-old girl presented with a 6-week history of a curvilinear hyperpigmented patch on the left wrist, which began within a day of using a tight mitten. Mitten-line hyperpigmentation is analogous to the recently described condition known as infantile "sock-line hyperpigmentation," or more generally "sock-line bands." Distinguishing this benign condition from child abuse, amniotic band syndrome, and acquired raised bands of infancy is important but sometimes challenging.

Niger J Med. 2010 Apr-Jun; 19(2): 168-72
Opara PI, Eke GK, Akani NA

BACKGROUND: Sexuality education is the process of acquiring information and forming attitudes and beliefs about sex, sexual identity, relationships and intimacy. It develops young people's skills so that they make informed choices about their behaviour, and feel confident and competent about acting on these choices. It also equips children to face developmental challenges and empowers them against the ills of abuse, exploitation, unwanted pregnancies amongst others. Mothers who are the primary caregivers should be well informed about sexuality issues. The objective of the study is to determine mothers' perception of sexuality education in children, in Port Harcourt. METHODOLOGY: A structured, anonymous and self-administered questionnaire, used as instrument for data collection, was distributed amongst a convenient sample of women attending a Christian women's convention in Port Harcourt. RESULTS: One hundred and fifty eight women participated in the study. Most of them were married (80.4%), and belonged to the 30-49 years age bracket. Seventy one (44.9%) of the respondents had tertiary education. Over 80% agreed that children needed sexuality education but only 15 women (9.5%) had a good knowledge of the concept of sexuality education. One hundred and eleven (70.2%) believed it was the responsibility of both parents to educate their children and over 70% acknowledged that the home was the best place for such education. 64 (40.5%) believed that 6-10 years was the ideal age for starting sex education while 49% thought that the ideal age was 11-15 years. 65% of respondents discussed sexuality issues with their children at least occasionally, the content mostly involved description of body parts and reproductive organs. The average age of menarche amongst respondents was 14.0. One hundred (63%) of the women had prior knowledge of menstruation before menarche. About half of them had received information from their mothers. CONCLUSION: The study highlights the need for enlightenment of women on sexuality education to enable them empower their against the ills of child abuse.

Acta Med Port. 2010 May-Jun; 23(3): 413-8
Nunes P, Raminhos I

Introduction: In Portugal child abuse is a reality, although its true incidence is still unknown. Population and methods: Retrospective study by consulting child abuse processes of children hospitalized in Paediatric Nursery and Neonatal Special Care Unit of Centro Hospitalar de Setúbal, E.P.E between January 1, 2006 and June 30, 2008. The following variables were studied: sex, age, year of hospitalization, length of stay, type of abuse, aggressor, drug abuse in family; mother's age, entities involved in the process and the applied measures to promote and/or protect. Results: Sample of 65 children, with discrete predominance of male (35/65) and mostly < 1 month (n = 39). The largest number of hospitalizations was in 2007 (n = 34) and in 77% of the cases the length of stay was less than one month. It was practiced more than one type of abuse in 30,8% of the cases, negligence being the most practiced, in 80% of cases, followed by physical abuse, in 20%. The aggressor belongs almost always to nuclear family (59/65), being the mother in 41,5% of cases. There was at least 27,7% cases of children with parental drug abuse and 13, 8% with adolescent mothers. The support near the parents was the measure of promotion and protection applied in 43% of children and two children were adopted. In 80% of the cases, there was intervention of the Comissão de Protecção de Crianças e Jovens and six cases were solved just by the social services of the hospital. Conclusions: The precocious detection of risk factors such as pregnancy in the adolescence and drug abuse, among others, as well as the follow-up and signalling of dangerous situations are professional obligations of health institutions and must be stimulated. In spite of efforts in updating the social support and the legal framing of these situations, the prevalence of child abuse remains high.

Child Maltreat. 2010 Jul 20;
Conley A, Duerr Berrick J

Traditionally, the American child welfare system intervenes in cases of evident and severe maltreatment. Families in need of help, but who have not reached a crisis, are excluded from typical services. Some suggest that if these families were served, few would be rereferred to the child welfare system. California's Differential Response (DR) has three tracks, of which "Track 1" targets families screened out of child protective services (CPS) and refers them to agencies that provide voluntary, home-based services and referrals. This study examined child-welfare trajectories for families receiving Track 1 DR services in one California county. Using survival analysis, treatment group children (N = 134) were compared to children eligible for services but denied due to program capacity (comparison group N = 511). Findings suggest no statistically significant differences between groups on the likelihood of a re-report following program participation, timing of maltreatment reports, or report investigations. The ability to draw strong conclusions from this study, however, is limited by selection bias because prior child maltreatment reports were more common in the treatment group. The intervention may provide families with important supports, but evidence for maltreatment prevention may not be supported. Future studies should examine potential effects on a range of family domains.

J Pediatr. 2010 Jul 20;
Yin S

OBJECTIVE: To describe malicious administration of pharmaceutical agents to children. STUDY DESIGN: We performed a retrospective study of all pharmaceutical exposures involving children 1 exposed substance. The most common reported major pharmaceutical categories were analgesics, stimulants/street drugs, sedatives/hypnotics/antipsychotics, cough and cold preparations, and ethanol. In 51% of cases there was an exposure to at least one sedating agent. There were 18 (1.2%) deaths. Of these, 17 (94%) were exposed to sedating agents, including antihistamines (8 cases) and opioids (8 cases). CONCLUSIONS: Malicious administration of pharmaceuticals should be considered an important form of child abuse.

Educ Theory. 2010; 60(3): 357-69
Smith R

In this essay, Richard Smith observes that being a parent, like so much else in our late-modern world, is required to become ever more efficient and effective, and is increasingly monitored by the agencies of the state, often with good reason given the many recorded instances of child abuse and cruelty. However, Smith goes on to argue, this begins to cast being a parent as a matter of "parenting," a technological deployment of skills and techniques, with the loss of older, more spontaneous and intuitive relations between parents and children. Smith examines this phenomenon further through a discussion of how it is captured to some extent in Hannah Arendt's notion of "natality" and how it is illuminated by Charles Dickens in his classic novel, Dombey and Son.

Eur J Public Health. 2010 Jul 15;
McGee H, Garavan R, Byrne J, O'Higgins M, Conroy RM

BACKGROUND: Sexual violence is a worldwide problem affecting children and adults. Knowledge of trends in prevalence is essential to inform the design and evaluation of preventive and intervention programmes. We aimed to assess the prevalence of lifetime sexual violence for both sexes and to document the prevalence of adult and child abuse by birth year in the general population. METHODS: National cluster-randomized telephone interview study of 3120 adults in Ireland was done. RESULTS: Child sexual abuse involving physical contact was reported by 20% of women and 16% of men. In adulthood, figures were 20% and 10% for women and men, respectively. Prevalence of any form of sexual violence across the lifespan was 42% (women) and 38% (men). Analysis by year of birth indicated a curvilinear pattern for child sexual abuse with lower prevalence in the oldest and youngest participants. Sexual violence in young adulthood showed a linear pattern with higher prevalence in the youngest participants. CONCLUSION: The trend of lower rates of experience of child sexual abuse in younger adults in the sample is in keeping with findings from other countries. The trend of higher rates of adult sexual violence in younger adults is worrying, particularly since the same participants reported less experience of child sexual abuse than the preceding generations. There is a paucity of international data addressing the issue of cohort differences in exposure to sexual violence. Within-study analysis, and follow-up studies designed to maximize replicability, are needed to inform discussion about societal trends in different types of sexual violence.

Arch Dis Child. 2010 Jul 20;
González-Izquierdo A, Woodman J, Copley L, van der Meulen J, Brandon M, Hodes D, Lecky F, Gilbert R

Background Information on variation in the recording of child maltreatment in administrative healthcare data can help to improve recognition and ensure that services are able to respond appropriately. Objective To examine variation in the recording of child maltreatment and related diagnoses. Design Cross-sectional analyses of administrative healthcare records (Hospital Episode Statistics). Setting and participants Acute injury admissions to the National Health Service in England of children under 5 years of age (1997-2009). Outcome measure Annual incidence of admission for injury recorded by International Classifications of Diseases 10 codes for maltreatment syndrome (child abuse or neglect) or maltreatment-related features (assault, undetermined cause or adverse social circumstances). Proportion of all admissions for injury coded for maltreatment syndrome or maltreatment-related features. Results From 1997 to 2009, the annual incidence of injury admissions coded for maltreatment syndrome declined in infants and in 1-3-year-old children while admissions coded for maltreatment-related features increased in all age groups. The combined incidence of these categories remained stable. Overall, 2.6% of injury admissions in infants, and 0.4-0.6% in older age groups, had maltreatment syndrome recorded. This prevalence more than doubled when maltreatment-related codes were added (6.4% in infants, 1.5-2.1% in older age groups). Conclusion Despite a shift from maltreatment syndrome to codes for maltreatment-related features, the overall burden has remained stable. In combination, the cluster of codes related to maltreatment identify children likely to meet thresholds for suspecting or considering maltreatment and taking further action, as recommended in recent National Institute of Health and Clinical Excellence guidance, and indicate a considerable burden to which hospitals should respond.

Pediatrics. 2010 Jul 26;
Levin AV, Christian CW,

Retinal hemorrhage is an important indicator of possible abusive head trauma, but it is also found in a number of other conditions. Distinguishing the type, number, and pattern of retinal hemorrhages may be helpful in establishing a differential diagnosis. Identification of ocular abnormalities requires a full retinal examination by an ophthalmologist using indirect ophthalmoscopy through a pupil that has been pharmacologically dilated. At autopsy, removal of the eyes and orbital tissues may also reveal abnormalities not discovered before death. In previously well young children who experience unexpected apparent life-threatening events with no obvious cause, children with head trauma that results in significant intracranial hemorrhage and brain injury, victims of abusive head trauma, and children with unexplained death, premortem clinical eye examination and postmortem examination of the eyes and orbits may be helpful in detecting abnormalities that can help establish the underlying etiology.

J Med Philos. 2010 Jul 11;
Block W

The present paper attempts to forge a compromise between those who maintain that stem cell research is out-and-out murder of young helpless human beings and those who favor this practice. The compromise is predicated upon the libertarian theory of private property rights. Starting out with the premise that not only the fetus but even the fertilized egg is a human being, with all rights thereto, it offers a competition between those who fertilize eggs for research and those who wish to adopt them. If and only if the former win this competition will they be allowed to use these very young human beings for the purposes they have constructed them. This is justified on grounds of avoiding child abuse.

BMJ. 2010; 341: c3884
Bridson JM, Samuels M, Speight N, Williams C

BMJ. 2010; 341: c3672
Dyer C

Child Abuse Negl. 2010 Jul 16;
Russell BS

In the last 10 years, over 80% of adults surveyed report some familiarity with Shaken Baby Syndrome (SBS) and the dangers of shaking infants younger than 2 years of age (Dias et al., 2005; Russell & Britner, 2006). Hence, in the context of SBS prevention, the question of whether caregivers knew the safety risks of shaking an infant becomes less meaningful than questioning whether caregivers have an awareness of alternate responses they could use to respond safely to the relatively normative occurrence of inconsolable crying (Barr, Trent, & Cross, 2006). OBJECTIVE: The present work is a continuation of efforts to prevent abusive head injury during infancy particular to SBS by raising awareness and provides prevention professionals with a reliable and shorter, single-page version of the Shaken Baby Syndrome Awareness Assessment (Russell & Britner, 2006). METHODS: A sample of 370 adults completed the short version of the measure during 2008. RESULTS: Psychometric results, including Cronbach's alphas and Pearson's correlations, are all significant and meet acceptability standards. CONCLUSION: These results indicate the short version of the measure is ready for use in the prevention field. PRACTICE IMPLICATIONS: The Shaken Baby Syndrome Awareness Assessment - short version is best used to support child abuse prevention professionals in engaging caregivers in a conversation about responding to a crying infant safely. By talking about the responses a caregiver might be willing to use in the high-stress context of an infant's inconsolable crying bout, intervention efforts can be tailored to maximize on caregiver strengths and achieve a high degree of goodness of fit with the values held in the care environment. Increasing the goodness of fit between caregivers' values and the steps recommended through an intervention program supports the likelihood that the behavior described in the program's service plan will be used.

Cancer Causes Control. 2010 Jul 18;
Jun HJ, Austin SB, Wylie SA, Corliss HL, Jackson B, Spiegelman D, Pazaris MJ, Wright RJ

OBJECTIVE: To examine the mediating effect of childhood abuse on sexual orientation disparities in tobacco and alcohol use during adolescence. METHODS: We carried out analyses with data from over 62,000 women in the ongoing Nurses' Health Study II cohort who provided information on sexual orientation, childhood abuse occurring by age 11, and tobacco and alcohol use in adolescence. We used multivariate regression analyses, controlling for confounders, to estimate the mediating effect of childhood abuse on the association between sexual orientation and tobacco and alcohol use in adolescence. RESULTS: Lesbian and bisexual orientation and childhood abuse were positively associated with greater risk of tobacco and alcohol use during adolescence. For lesbians, the estimated proportion of excess tobacco and alcohol use in adolescence relative to use among heterosexual women that was mediated by abuse in childhood ranged from 7 to 18%; for bisexual women, the estimated proportion of excess use mediated by abuse ranged from 6 to 13%. CONCLUSIONS: Elevated childhood abuse in lesbian and bisexual women partially mediated excess tobacco and alcohol use in adolescence relative to heterosexual women. Interventions to prevent child abuse may reduce sexual orientation disparities in some of the leading causes of cancer in women.

BMJ. 2010; 341: c3074
Viner RM, Roche E, Maguire SA, Nicholls DE

Int J Paediatr Dent. 2010 Jul 18;
Uldum B, Christensen HN, Welbury R, Poulsen S

International Journal of Paediatric Dentistry 2010 Background. Studies from several countries have shown that knowledge of child protection matters among the dental team is inadequate. No such data are available from Denmark. Aim. To describe dental teams perception of their role in child protection matters. Design. A previously used questionnaire regarding the role of the dental team in child protection was adopted to Danish terminology, and mailed to a sample of Danish dentists and dental hygienists. Results. A total of 1145 (76.3%) returned a questionnaire with valid data; 38.3% reported to have had suspicion of child abuse or neglect. Of those who reported a suspicion, 33.9% had reported their suspicion to social services. This was more frequent for dentists than for dental hygienists, and more frequent for respondents working in the municipal dental service than in private practice. Most frequently reported barriers towards referring suspicion to social services were uncertainty about observations, fear of violence in the family towards the child, and lack of knowledge regarding referral procedures. The majority of the respondents expressed a need for further education. Conclusions. Members of the dental team in Denmark do not seem to fill their role sufficiently in child protection matters, and perceive a need for undergraduate and continuing postgraduate training.

Med Educ Online. 2010; 15:
Anderst J, Denise Dowd M

INTRODUCTION: Improvement in child abuse and neglect education has been previously identified as a significant need among physicians. The purpose of this qualitative study was to better understand specific comparative educational needs regarding child abuse diagnosis and management among physicians from differing specialties and practice types. METHODS: A total of 22 physicians participated in focus groups (one family practice (FP), one emergency medicine (EM), and one pediatrician group) facilitated by a professional moderator using a semi-structured interview guide. Five specific domains of child abuse education needs were identified from previously published literature. Child abuse education needs were explored across one general and five specific domains, including (1) general impressions of evaluating child abuse, (2) identification and management, (3) education/resource formats, (4) child/caregiver interviews, (5) medical evaluations, and (6) court testimony. Discussions were audiotaped and transcribed verbatim, then analyzed for common themes and differences among the three groups. RESULTS: Participants identified common areas of educational need but the specifics of those needs varied among the groups. Neglect, interviewing, court testimony, and subtle findings of abuse were educational needs for all groups. EM and FP physicians expressed a need for easily accessible education and management tools, with less support for intermittent lectures. All groups may benefit from specialty specific education regarding appropriate medical evaluations of potential cases of abuse/neglect. CONCLUSIONS: Significant educational needs exist regarding child abuse/neglect, and educational needs vary based on physician training and practice type. Educational program design may benefit from tailoring to specific physician specialty. Further studies are needed to more clearly identify and evaluate specialty specific educational needs and resources.