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Alghanim FF, Almubayedh TA, Alseba Z. Assessing Awareness, Knowledge, and Attitude of Saudi Mothers Regarding Shaken Baby Syndrome in the Eastern Province of Saudi Arabia: A Cross-Sectional Prospective Study. Cureus 2024; 16:e51884. [PMID: 38192531 PMCID: PMC10773940 DOI: 10.7759/cureus.51884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/10/2024] Open
Abstract
Shaken baby syndrome (SBS) is a form of traumatic brain injury. Shaking babies can cause the brain matter to bounce within the cranium causing bruising and bleeding, which can result in permanent brain injury. Understanding the attitudes and knowledge of mothers on SBS would help establish effective interventions to raise awareness and establish preventive measures and education programs to avoid debilitating sequelae from SBS in newborns and infants. This study aimed to explore the awareness and attitude regarding SBS. An observational, cross-sectional study was conducted from April 1st through July 31st, 2023. The study population is comprised of mothers who are residents of the Eastern Province of Saudi Arabia and excluded females with no children and those who refused to participate, in addition to mothers not in the Eastern Province. The final sample size included 403 participants. An online-based validated questionnaire was used in the Arabic language. The questionnaire included demographic information and questions to assess the knowledge and attitude of participants regarding SBS. The chi-square test was used to test for significant associations. The majority of the participants were married (72%), while 15.6% were divorced and 10.2% were widowed. Only 7.4% of the participants were illiterates, 30.5% had primary education only, and 15.9% had postgraduate studies. Of note, 37% of the participants said that they would shake their children to calm them if they started to cry. Only 33% of the participants said that shaking babies is harmful. The most commonly reported complications of shaking babies were intracranial bleeding (48.1%), behavioral changes (23.8%), and learning disability (23.5%). Regarding attitude toward SBS, more than two-thirds (72.5%) of the participants said that they want to know more about SBS. Only the educational level had statistically significant relationship between the awareness and the sociodemographic level of the participants. This study concludes that Saudi mothers' knowledge about SBS is inadequate despite the favorable attitude toward gaining information about it. The awareness level is significantly associated with educational status, which reflects the importance of education programs, especially during the pregnancy period, in raising awareness about SBS and its complications.
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Affiliation(s)
| | | | - Zahra Alseba
- Pediatrics, Maternity and Children Hospital, Dammam, SAU
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2
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Younas F, Gutman LM. Parental Risk and Protective Factors in Child Maltreatment: A Systematic Review of the Evidence. TRAUMA, VIOLENCE & ABUSE 2023; 24:3697-3714. [PMID: 36448533 PMCID: PMC10594837 DOI: 10.1177/15248380221134634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
This study systematically reviews and synthesizes evidence on parental risk and protective factors along with identifying differences in the presence of these factors based on maltreatment type. In all, 68 quantitative, published, empirical studies were included from electronic databases for the systematic review. Quality appraisal did not exclude any studies and data were extracted from all. Results were narratively synthesized using the Risk and Resilience Ecological framework. The findings revealed more risk factors on the micro (individual and family) ecological level compared to mezzo and macro levels. At the micro level, findings mirror results of prior systematic reviews such as parental substance abuse, history of childhood maltreatment, and intimate partner violence (IPV). Social support was the most significant protective factor across all ecological levels and across all maltreatment types except child sexual abuse but differed in definition widely across studies. Physical abuse had the most risk factors unique to this type followed by neglect, and IPV was a common risk factor across all maltreatment types. Fewer studies on emotional abuse, sexual abuse, and protective factors were identified. The findings of this review delineated key parental risk and protective factors at various ecological levels along with associations between distinct factors and types of maltreatment. Interventions working with parents to reduce child maltreatment risk can use these findings to guide development of targeted programs for families based on risk and maltreatment type. For researchers, the findings can guide further investigation in under-researched areas of parental sexual and emotional abuse and protective factors.
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Alzahrani F, Al-Jabri BA, Ramadan SAL, Alshehri AM, Alsheikh AS, Mushaeb HH, Albisher SF, AlSwealh MS. Parental Knowledge and Awareness about Shaken Baby Syndrome in Jeddah, Saudi Arabia: A Cross-Sectional Study. Pediatr Rep 2023; 15:311-322. [PMID: 37218927 DOI: 10.3390/pediatric15020027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Despite the serious consequences of shaken baby syndrome (SBS), previous studies revealed a low level of knowledge among Saudi parents. METHODS This is a cross-sectional study. An electronic questionnaire was distributed through social media platforms to parents of pediatric age group children in Jeddah, Saudi Arabia. A total of 524 responses were received. Data about participants' demographics, knowledge, attitude, and practice regarding SBS were collected through convenient random sampling. RESULTS A total of 524 responses were received; 30.7% of the participants were familiar with SBS. The Internet and the social media platforms were the most common sources of information. There was no statistically significant correlation between knowledge levels and participants' sociodemographic factors; only 32.3% of individuals had good knowledge. Of them, 84% had a positive attitude towards learning more about SBS, and 40.1% and 34.3% were interested in learning more about SBS before and during pregnancy, respectively. Carrying the baby and shaking were the actions most frequently taken when a baby was crying. Of them, 23.9% forcefully shake their child, while 41.4% of them throw their infant up in the air and catch it. CONCLUSIONS It is important to conduct health education programs on SBS for mothers throughout the prenatal period.
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Affiliation(s)
- Fatma Alzahrani
- Pediatric Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Basma A Al-Jabri
- Pediatric Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Non-accidental Trauma in Infants: a Review of Evidence-Based Strategies for Diagnosis, Management, and Prevention. CURRENT TRAUMA REPORTS 2022. [DOI: 10.1007/s40719-021-00221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose of Review
To provide a resource for providers that may be involved in the diagnosis and management of infant non-accidental trauma (NAT).
Recent Findings
Infants are more likely to both suffer from physical abuse and die from their subsequent injuries. There are missed opportunities among providers for recognizing sentinel injuries. Minority children are overrepresented in the reporting of child maltreatment, and there is systemic bias in the evaluation and treatment of minority victims of child abuse.
Summary
Unfortunately, no single, primary preventative intervention has been conclusively shown to reduce the incidence of child maltreatment. Standardized algorithms for NAT screening have been shown to increase the bias-free utilization of NAT evaluations. Every healthcare provider that interacts with children has a responsibility to recognize warning signs of NAT, be able to initiate the evaluation for suspected NAT, and understand their role as a mandatory reporter.
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Attachment and Caregiving in the Mother–Infant Dyad: Evolutionary Developmental Psychology Models of their Origins in the Environment of Evolutionary Adaptedness. EVOLUTIONARY PSYCHOLOGY 2022. [DOI: 10.1007/978-3-030-76000-7_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Bailhache M, Lafagne A, Lagarde M, Richer O. Do Victims of Abusive Head Trauma Visit Emergency Departments More Often Than Children Hospitalized for Fever? A Case-Control Study. Pediatr Emerg Care 2022; 38:e310-e315. [PMID: 33105462 DOI: 10.1097/pec.0000000000002264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE During the first years of life, infant crying is a common trigger of abusive head trauma (AHT). Emergency department (ED) use by AHT victims before visits for child abuse symptoms is not well known, particularly for infant crying. Furthermore, diagnosis could be missed. In the same period, fever is a common reason for hospitalization unconnected with AHT. The main goal of our study was to compare the ED use by AHT victims before visits for child abuse symptoms and by children of the same age hospitalized for fever. METHODS We conducted a retrospective case-control study from 2011 to June 2018 in a French hospital. We compared cases of AHT selected using the International Classification of Diseases and control subjects hospitalized in the general pediatric unit for fever without immunodeficiency matched in age. Univariate and multivariate analyses were performed. RESULTS Among the 75 victims of AHT, 5 had at least 1 previous ED visit not linked with abuse. None had visited for infant crying. Among the control subjects, 34 had at least 1 previous ED visit, including 6 for infant crying. Among the 57 dyads of controls and cases living in the hospital's area, the controls had significantly more previous ED visits than the cases (P < 0.001). There were more male infants among the cases (72% vs. 55%, P = 0.033). CONCLUSIONS Our study suggests that AHT victims had no more ED visits before visits for child abuse symptoms, particularly not for infant crying.
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Affiliation(s)
| | - Ambre Lafagne
- From the Department of Pediatrics, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon
| | - Marie Lagarde
- From the Department of Pediatrics, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon
| | - Olivier Richer
- From the Department of Pediatrics, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon
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Soares AP, d'Affonseca SM, Brino RDF. Trauma Craniano Violento (TCV): Relação entre Conhecimento de Pais, Potencial de Abuso Infantil e Status Socioeconômico Familiar. PSICOLOGIA: TEORIA E PESQUISA 2021. [DOI: 10.1590/0102.3772e37315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Resumo Descreve a relação entre conhecimento sobre Trauma Craniano Violento (TCV), status socioeconômico e potencial de maus-tratos infantis. Dezenove pais e 61 mães responderam aos instrumentos Escala de Atitudes Frente ao Choro do Bebê, Inventário de Potencial de Abuso Infantil e Questionário Socioeconômico. A correlação de Spearman demonstrou resultados significativos entre escolaridade e renda com crenças sobre cuidados com o bebê (r = 0,32, p = 0,004; r = 0,22, p = 0,05, respectivamente), poder aquisitivo e escolaridade com conhecimentos sobre choro infantil (r = -0,40, p<0,001; r = -0,22, p = 0,05, respectivamente), número de filhos com estratégias para lidar com choro (r = -0,29, p = 0,01) e rigidez com consequências de sacudir o bebê e crenças sobre cuidados com o bebê (r = -0,29, p = 0,008; r = -0,359, p = 0,001, respectivamente). Considera importante direcionar intervenções às necessidades de cada população e trabalhar a flexibilidade parental para reduzir o TCV.
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Heazell A, Budd J, Smith LK, Li M, Cronin R, Bradford B, McCowan L, Mitchell EA, Stacey T, Roberts D, Thompson J. Associations between social and behavioural factors and the risk of late stillbirth - findings from the Midland and North of England Stillbirth case-control study. BJOG 2020; 128:704-713. [PMID: 32992405 DOI: 10.1111/1471-0528.16543] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate behavioural and social characteristics of women who experienced a late stillbirth compared with women with ongoing live pregnancies at similar gestation. DESIGN Case-control study. SETTING 41 maternity units in the UK. POPULATION Women who had a stillbirth ≥28 weeks' gestation (n = 287) and women with an ongoing pregnancy at the time of interview (n = 714). METHODS Data were collected using an interviewer-administered questionnaire which included questions regarding women's behaviours (e.g. alcohol intake and household smoke exposure) and social characteristics (e.g. ethnicity, employment, housing). Stress was measured by the 10-item Perceived Stress Scale. MAIN OUTCOME MEASURE Late stillbirth. RESULTS Multivariable analysis adjusting for co-existing social and behavioural factors showed women living in the most deprived quintile had an increased risk of stillbirth compared with the least deprived quintile (adjusted odds ratio [aOR] 3.16; 95% CI 1.47-6.77). There was an increased risk of late stillbirth associated with unemployment (aOR 2.32; 95% CI 1.00-5.38) and women who declined to answer the question about domestic abuse (aOR 4.12; 95% CI 2.49-6.81). A greater number of antenatal visits than recommended was associated with a reduction in stillbirth (aOR 0.26; 95% CI 0.16-0.42). CONCLUSIONS This study demonstrates associations between late stillbirth and socio-economic deprivation, perceived stress and domestic abuse, highlighting the need for strategies to prevent stillbirth to extend beyond maternity care. Enhanced antenatal care may be able to mitigate some of the increased risk of stillbirth. TWEETABLE ABSTRACT Deprivation, unemployment, social stress & declining to answer about domestic abuse increase risk of #stillbirth after 28 weeks' gestation.
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Affiliation(s)
- Aep Heazell
- Faculty of Biology, Medicine and Health, Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK.,St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Budd
- St Mary's Hospital, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - L K Smith
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - M Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - R Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - B Bradford
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lme McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - E A Mitchell
- Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
| | - T Stacey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.,Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - D Roberts
- Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Jmd Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.,Department of Paediatrics: Child Health and Youth Health, University of Auckland, Auckland, New Zealand
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Kazmir S, Rosado N. Abusive Head Trauma: A Review of Current Knowledge. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Puls HT, Anderst JD, Farst K, Hall M. Intrauterine Substance Exposure and the Risk for Subsequent Physical Abuse Hospitalizations. Acad Pediatr 2020; 20:468-474. [PMID: 32081768 DOI: 10.1016/j.acap.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/24/2020] [Accepted: 02/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe the relative risk for a physical abuse hospitalization among substance exposed infants (SEI) with and without neonatal abstinence syndrome (NAS). METHODS We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify newborns, predictor variables, and subsequent hospitalizations for physical abuse within 6 months of discharge from newborns' birth hospitalization. Predictor variables included newborn demographics, prematurity or low birth weight, and intrauterine substance exposure: non-SEI, SEI without NAS, and SEI with NAS. Multiple logistic regression calculated adjusted relative risks and 95% confidence intervals. A subanalysis of newborns with narcotic exposure was performed. RESULTS There were 3,740,582 newborns in the cohort; of which 13,024 (0.4%) were SEI without NAS and 20,196 (0.5%) SEI with NAS. Overall, 1247 (0.03%) newborns were subsequently hospitalized for physical abuse within 6 months. Compared to non-SEI, SEI with NAS (adjusted relative risks: 3.84 [95% confidence intervals: 2.79-5.28]) were at increased risk for having a subsequent hospitalization for physical abuse, but SEI without NAS were not. A similar pattern was observed among narcotic-exposed infants; infants with NAS due to narcotics were at increased risk, but narcotic-exposed infants without NAS were not. CONCLUSIONS Our results suggest that newborns diagnosed with NAS are at increased risk of physical abuse during early infancy, above that of substance-exposed infants without NAS. These results should improve the identification of higher-risk infants who may benefit from more rigorous safety planning and follow-up care.
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Affiliation(s)
- Henry T Puls
- Division of Hospital Medicine, Department of Pediatrics (HT Puls and M Hall), Children's Mercy Kansas City, Kansas City, Mo.
| | - James D Anderst
- Child Adversity and Resilience, Department of Pediatrics (JD Anderst), Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Karen Farst
- Section for Children at Risk, Department of Pediatrics (K Farst), University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Matthew Hall
- Division of Hospital Medicine, Department of Pediatrics (HT Puls and M Hall), Children's Mercy Kansas City, Kansas City, Mo; Children's Hospital Association (M Hall), Lenexa, Kans
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11
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Kawaguchi H, Fujiwara T, Okamoto Y, Isumi A, Doi S, Kanagawa T, Kimura T, Mitsuda N. Perinatal Determinants of Child Maltreatment in Japan. Front Pediatr 2020; 8:143. [PMID: 32351915 PMCID: PMC7174719 DOI: 10.3389/fped.2020.00143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 03/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Child maltreatment induces significant health problems, both during childhood and into adulthood. To prevent child maltreatment, it is important to detect perinatal risk factors for earlier intervention. The aim of this study was to evaluate the perinatal risk factors associated with child maltreatment during pregnancy. Methods: A case-control study was conducted to compare perinatal data from the Maternal and Child Health Handbook between the case and control groups. Cases were collected from children registered in two Child Guidance Centers in Japan. The control group consisted of 3.5-year-old children in a city in Osaka Prefecture whose mothers responded to questionnaires containing information from the Maternal and Child Health Handbook. The association between perinatal factors and child maltreatment was assessed using multiple logistic regression analysis. Results: The data of 70 cases and 345 controls were collected. The following were found to be perinatal factors related to child maltreatment: teenage pregnancy (OR: 257.3, 95% CI: 17.3-3832.7), a mother aged 20-24 years (OR: 22.8, 95% CI: 4.4-117.8), a father who is older than the mother by 10 years or more (OR: 14.1, 95% CI: 2.1-94.8), an unmarried mother (OR: 15.7, 95% CI: 2.6-93.6), maternal mental disorder (OR: 48.9, 95% CI: 9.3-258.3), the first maternal prenatal visit being later than 20 weeks (OR: 132, 95% CI: 12.7-1384.7), little prenatal care (<10 visits) (OR: 21.4, 95% CI: 2.9-157.1), a low-birth-weight baby (OR: 5.1, 95% CI: 1.1-24.1), and congenital disease (OR: 7.9, 95% CI: 1.1-56.4). Conclusions: This study revealed that young mothers, fathers much older than mothers, unmarried mothers, and maternal mental disorder, mothers with late first visit or little perinatal care, and low-birth-weight babies and babies with congenital disease were associated with child maltreatment. These findings can be used to detect high-risk families for child maltreatment during or after pregnancy.
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Affiliation(s)
- Haruna Kawaguchi
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoko Okamoto
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Kanagawa
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Hospital, Osaka, Japan
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
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12
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Berthold O, Clemens V, Witt A, Brähler E, Plener PL, Fegert JM. Awareness of abusive head trauma in a German population-based sample: implications for prevention. Pediatr Res 2019; 86:537-541. [PMID: 31212304 DOI: 10.1038/s41390-019-0467-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/04/2019] [Accepted: 06/08/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Despite efforts to reduce the incidence of abusive head trauma (AHT), incidence rates remain high. One cause is that prevention programs mostly aim to educate mothers of newborns on AHT and infant crying. However, mothers commonly have already a high knowledge and constitute only a minority among identified AHT perpetrators. The hypothesis was that there are great differences in AHT awareness in different subgroups. To assess awareness of AHT, a population-based study was performed. METHODS A population-based representative sample of the German population aged >14 years (N = 2510) was assessed in a cross-sectional observational survey. The sample was selected in a random route approach between November 2017 and February 2018. RESULTS Overall knowledge of AHT was higher in women (67.9%) than in men (48.8%, p < 0.001). Female gender, having children, higher age, and level of education were predictors for the awareness of AHT. A majority of participants reported to have heard about AHT from the media. CONCLUSIONS Awareness of AHT differs significantly within the population. In groups at higher risk to perpetrate AHT, including men, young caregivers, and those with low educational level, awareness of AHT was low. These subgroups should be targeted by tailored education programs for prevention.
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Affiliation(s)
- Oliver Berthold
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075, Ulm, Germany. .,Child Abuse Clinic, Department of Pediatrics, DRK Kliniken Berlin
- Westend, Spandauer Damm 130, 14050, Berlin, Germany.
| | - Vera Clemens
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075, Ulm, Germany
| | - Andreas Witt
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075, Ulm, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.,University Medical Center of Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhövelstr. 5, 89075, Ulm, Germany
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13
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Smith EB, Lee JK, Vavilala MS, Lee SA. Pediatric Traumatic Brain Injury and Associated Topics: An Overview of Abusive Head Trauma, Nonaccidental Trauma, and Sports Concussions. Anesthesiol Clin 2019; 37:119-134. [PMID: 30711225 DOI: 10.1016/j.anclin.2018.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pediatric traumatic brain injury (TBI) uniquely affects the pediatric population. Abusive head trauma (AHT) is a subset of severe pediatric TBI usually affecting children in the first year of life. AHT is a form of nonaccidental trauma. Sports-related TBI resulting in concussion is a milder form of TBI affecting older children. Current recommended perioperative management of AHT and sports concussions relies on general pediatric TBI guidelines. Research into more specific pediatric TBI screening and management goals is ongoing. This article reviews the epidemiology, mechanisms, clinical signs, and management of AHT and sports-related concussions.
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Affiliation(s)
- Erik B Smith
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Jennifer K Lee
- Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Monica S Vavilala
- Department of Anesthesiology, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Sarah A Lee
- Department of Anesthesiology, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA
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14
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Kelly P, Thompson JMD, Rungan S, Ameratunga S, Jelleyman T, Percival T, Elder H, Mitchell EA. Do data from child protective services and the police enhance modelling of perinatal risk for paediatric abusive head trauma? A retrospective case-control study. BMJ Open 2019; 9:e024199. [PMID: 30826760 PMCID: PMC6429859 DOI: 10.1136/bmjopen-2018-024199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES First, to investigate whether there is a relationship between a family being known to child protective services or police at the time of birth and the risk of abusive head trauma (AHT, formerly known as shaken baby syndrome). Second, to investigate whether data from child protective services or police improve a predictive risk model derived from health records. DESIGN Retrospective case control study of child protective service and police records. SETTING Nine maternity hospitals. PARTICIPANTS 142 consecutive cases of AHT admitted to a tertiary children's hospital from 1991 to 2010 and born in one of the nine participating maternity hospitals. 550 controls matched by the date and hospital of birth. OUTCOME MEASURE Abusive head trauma. RESULTS There is a relationship between families known to child protective services or police and the risk of AHT. Notification to child protective services: univariable OR 7.24 (95% CI 4.70 to 11.14). Involvement with youth justice: univariable OR 8.94 (95% CI 4.71 to 16.95). Police call-out for partner violence: univariable OR 3.85 (95% CI 2.51 to 5.91). Other violence offence: univariable OR 2.73 (95% CI 1.69 to 4.40). Drug offence: univariable OR 2.82 (95% CI 1.63 to 4.89). However, in multi-variable analysis with data from perinatal health records, notification to child protective services was the only one of these variables to remain in the final model (OR 4.84; 95% CI 2.61 to 8.97) and had little effect on overall predictive power. The area under the receiver operating characteristic curve was 89.5% (95% CI 86.6 to 92.5) using variables from health data alone and 90.9% (95% CI 88.0 to 93.7) when notification was added. CONCLUSIONS Family involvement with child protective services or police is associated with increased risk of AHT. However, accessing such data at the time of birth would add little predictive power to a risk model derived from routine health information.
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Affiliation(s)
- Patrick Kelly
- Te Puaruruhau, Starship Children’s Health, Auckland, New Zealand
- Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - John M D Thompson
- Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Santuri Rungan
- Community Child Health, Sydney Children’s Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Timothy Jelleyman
- Department of Paediatrics, Waitemata District Health Board, Takapuna, New Zealand
| | - Teuila Percival
- Paediatrics: Child and Youth Health, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Kidz First Children’s Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Hinemoa Elder
- School of Graduate Studies, Te Whare Wānanga o Awanuiārangi, Auckland, New Zealand
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15
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Puls HT, Anderst JD, Bettenhausen JL, Clark N, Krager M, Markham JL, Hall M. Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations. Pediatrics 2019; 143:peds.2018-2108. [PMID: 30683813 DOI: 10.1542/peds.2018-2108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the prevalence of risk factors for abuse and newborns' risks for physical abuse hospitalizations during early infancy. METHODS We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. Newborns were characterized by demographics, prematurity or low birth weight (LBW), intrauterine drug exposure, and medical complexity (including birth defects). Newborns were tracked for 6 months from their birth hospitalization, and subsequent abuse hospitalizations were identified by using International Classification of Diseases, Ninth Revision codes. We calculated adjusted relative risks (aRRs) with multiple logistic regression, and we used classification and regression trees to identify newborns with the greatest risk for abuse on the basis of combinations of multiple risk factors. RESULTS There were 3 740 582 newborns in the cohort. Among them, 1247 (0.03%) were subsequently hospitalized for abuse within 6 months. Among infants who were abused, 20.4% were premature or LBW, and 4.1% were drug exposed. Premature or LBW newborns (aRR 2.16 [95% confidence interval (CI): 1.87-2.49]) and newborns who were drug exposed (aRR 2.86 [95% CI: 2.15-3.80]) were independently at an increased risk for an abuse hospitalization, but newborns with medical complexity or noncardiac birth defects were not. Publicly insured preterm or LBW newborns from rural counties had the greatest risk for abuse hospitalizations (aRR 9.54 [95% CI: 6.88-13.23]). Publicly insured newborns who were also preterm, LBW, or drug exposed constituted 5.2% of all newborns, yet they constituted 18.5% of all infants who were abused. CONCLUSIONS Preterm or LBW newborns and newborns who were drug exposed, particularly those with public insurance and residing in rural counties, were at the highest risk for abuse hospitalizations. Effective prevention directed at these highest-risk newborns may prevent a disproportionate amount of abuse.
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Affiliation(s)
| | - James D Anderst
- Child Abuse and Neglect, Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | | | | | | | | | - Matthew Hall
- Divisions of Hospital Medicine and.,Children's Hospital Association, Lenexa, Kansas
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16
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Puls HT, Anderst JD, Bettenhausen JL, Masonbrink A, Markham JL, Plencner L, Krager M, Johnson MB, Walker JM, Greeley CS, Hall M. Potential Opportunities for Prevention or Earlier Diagnosis of Child Physical Abuse in the Inpatient Setting. Hosp Pediatr 2018; 8:hpeds.2017-0109. [PMID: 29371238 DOI: 10.1542/hpeds.2017-0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To compare rates of previous inpatient visits among children hospitalized with child physical abuse (CPA) with controls as well as between individual abuse types. METHODS In this study, we used the Pediatric Health Information System administrative database of 44 children's hospitals. Children <6 years of age hospitalized with CPA between January 1, 2011, and September 30, 2015, were identified by discharge codes and propensity matched to accidental injury controls. Rates for previous visit types were calculated per 10 000 months of life. χ2 and Poisson regression were used to compare proportions and rates. RESULTS There were 5425 children hospitalized for CPA. Of abuse and accident cases, 13.1% and 13.2% had a previous inpatient visit, respectively. At previous visits, abused children had higher rates of fractures (rate ratio [RR] = 3.0 times; P = .018), head injuries (RR = 3.5 times; P = .005), symptoms concerning for occult abusive head trauma (AHT) (eg, isolated vomiting, seizures, brief resolved unexplained events) (RR = 1.4 times; P = .054), and perinatal conditions (eg, prematurity) (RR = 1.3 times; P = .014) compared with controls. Head injuries and symptoms concerning for occult AHT also more frequently preceded cases of AHT compared with other types of abuse (both P < .001). CONCLUSIONS Infants hospitalized with perinatal-related conditions, symptoms concerning for occult AHT, and injuries are inpatient populations who may benefit from abuse prevention efforts and/or risk assessments. Head injuries and symptoms concerning for occult AHT (eg, isolated vomiting, seizures, and brief resolved unexplained events) may represent missed opportunities to diagnose AHT in the inpatient setting; however, this requires further study.
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Affiliation(s)
| | - James D Anderst
- Child Abuse and Neglect, Department of Pediatrics, Children's Mercy Hospital, School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | | | | | | | | | | | - Christopher S Greeley
- Division of Child Abuse and Neglect, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Matthew Hall
- Divisions of Hospital Medicine and
- Children's Hospital Association, Lenexa, Kansas
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