• Incest (Book).

      Dubowitz, H. (Wiley-Blackwell, 1983)
    • Case commentary

      Dubowitz, H. (Elsevier, 1985)
    • Sequelae of reporting child abuse.

      Dubowitz, H.; Newberger, E. (American Academy of Pediatric Dentistry, 1986)
    • INFLICTED AND NONINFUCTED INJURIES: Differences in Child and Familial Characteristics

      Dubowitz, H.; Hampton, R.L.; Bithoney, W.G.; Newberger, E.H. (American Psychological Association, 1987)
      Clinicians involved in child protection work are frequently confronted with decisions as to whether a child's injury is inflicted or accidental. This study examines child, parental, familial, and environmental characteristics in a group of 25 abused children compared to a group of 90 children with accidents. Significant differences and commonalities are discussed. 1987 American Orthopsychiatric Association
    • What Residents Know About Child Abuse: Implications of a Survey of Knowledge and Attitudes

      Woolf, A.; Taylor, L.; Melnicoe, L.; Andolsek, K.; Dubowitz, H.; Vos, E.; Newberger, E. (American Medical Association, 1988)
      Residency training programs are the appropriate milieu in which physicians should receive specialized training in the diagnosis and management of child abuse. The purposes of the present study were to assess and compare residents' knowledge of child abuse and their attitudes toward the propriety of different forms of childhood discipline. We surveyed 192 residents from seven different training programs with questionnaires probing their knowledge of child abuse and their attitudes toward childhood disciplinary measures; 161 (84%) of the questionnaires were satisfactorily completed by residents in pediatrics (n = 87), family medicine (n = 51), and surgery (n=23). Both pediatric residents and family medicine residents outperformed surgery residents in one subscale and the total score on the test. Scores were not related to year of training or attitudes toward childhood discipline but were correlated with self-reports of previous child abuse teaching. Residents' performance on a childhood disciplinary measure demonstrated wide latitude in their rating of the acceptability of 23 different modes of childhood discipline. Our findings indicate a need for a more systematic approach to residents' education in childhood intentional injuries and some value clarification of their attitudes toward various forms of childhood discipline. Copyright 1988, American Medical Association. All rights reserved.
    • The changing American family

      Dubowitz, H.; Moore, Newberger, C.; Melnicoe, L.H.; Newberger, E.H. (W.B. Saunders, 1988)
      The increase in single-parent families, step-families, maternal employment, and young children in substitute care are among several important changes in the American family in recent decades. Although it is not clear that these changes necessarily lead to negative outcomes in children, it is apparent that a variety of potential risks and challenges confront many families today. Pediatricians can play a valuable role by helping families to adjust and cope with certain difficulties, such as divorce. However, in other areas such as child care, changes in public policies and programs are needed to better support families to optimally nurture their children.
    • Child abuse programs and pediatric residency training

      Dubowitz, H. (American Academy of Pediatrics, 1988)
      Child maltreatment has become an increasingly important concern for pediatricians. The purpose of this study was to assess, via mailed questionnaires, the training and resources of pediatric residents in the area of child maltreatment. Responses were received from 72% of all US programs. The median amount of training was eight hours during the first and third years of training and seven hours during the second year, approximately half of this was clinical supervision in the care of maltreated children. Eighty-one percent of programs had an interdisciplinary team for suspected cases of child maltreatment. Only 17 of 167 programs reported a separate budget for their team. Although two thirds of programs were rated as adequate or better, 79% of respondents wanted to strengthen their teaching efforts. There appears to be a limited commitment by residency programs to enhance the competency of pediatricians in the area of child maltreatment. There is a need for improved training and resources.
    • Child abuse and failure to thrive: Individual, familial, and environmental characteristics

      Dubowitz, H.; Zuckerman, D.M.; Bithoney, W.G.; Newberger, E.H. (Springer Publishing (US), 1989)
      Similar theories of etiology have been postulated for child abuse and nonorganic failure to thrive (FTT). This study compared individual, familial, and environmental conditions in cases of child abuse to cases of FTT. Assessment of the mother's childhood home, supports, current living situation, attitudes toward her child, and child characteristics (such as temperament, social maturity, and complicating medical conditions) showed the groups to be remarkably alike. The major significant difference was that although both groups were poor, the abuse group was even more impoverished and lived in more crowded conditions than the families with a child with FTT. These data suggest a common etiologic context for different pediatric social illnesses and the need for a broad collaborative approach by pediatricians and colleagues in related disciplines.
    • Prevention of child maltreatment: What is known

      Dubowitz, H. (American Academy of Pediatrics, 1989)
      There has been increasing awareness of the need to prevent child maltreatment. In this review, prevention programs that have been evaluated are critically assessed. This is based on computer searches of the relevant literature spanning the last decade and final reports regarding prevention programs to state and federal agencies. Although many programs have been implemented, relatively few have been evaluated, and of those that have been, many have serious methodologic flaws. Interventions that do appear promising include home visiting, lay counseling, group and family therapy, and education about sexual abuse. In addition, comprehensive programs that address the multiple contributory factors of child maltreatment appear to be a valuable approach. Suggestions are made as to how the practicing pediatrician might play a preventive role. Finally, there is a need for good evaluation research of prevention programs.
    • Costs and effectiveness of interventions in child maltreatment

      Dubowitz, H. (Elsevier, 1990)
      There has been increasing awareness of the need to prevent child maltreatment at a time of limited public funds. As a result, cost-effectiveness has become important in the planning of health care and social services. Evaluations of child maltreatment interventions that have been analyzed for their cost-effectiveness are reviewed. There has been relatively little work in this area and much of it has serious methodological flaws. Nevertheless, research suggests that home health visitors, lay group counseling, and family and group therapy are promising interventions. Medical foster care has been shown to substantially reduce costs, but its effectiveness has not been determined. Current knowledge on the effectiveness of interventions in child maltreatment is limited, and this needs to be addressed in order to answer the question of cost-effectiveness. Recommendations are made for future research in the field. Copyright 1990.
    • Pediatrician's role in preventing child maltreatment

      Dubowitz, H. (W.B. Saunders, 1990)
      Pediatricians have the opportunity to play an important role in preventing child maltreatment. Major issues that influence pediatrics practice in this area are discussed in this article. General ideas and specific strategies are presented to help guide the pediatrician's prevention efforts.
    • Teaching pediatric residents about child maltreatment

      Dubowitz, H.; Black, M.M. (Lippincott Williams & Wilkins, 1991)
      Child maltreatment is a growing problem faced by pediatricians; however, there are many deficiencies in pediatricians' relevant knowledge and skills. Residency programs typically have included limited teaching in the area of child maltreatment. Fifty pediatric residents participated in an evaluation of a model educational course in child maltreatment developed by an interdisciplinary faculty. The course resulted in significant short-term improvements in knowledge and skills as well as a greater sense of competence in managing cases of child maltreatment. The importance of teaching pediatric residents about the �new morbidity� is discussed. Copyright 1991 Journal of Developmental & Behavioral Pediatrics. All rights reserved.
    • Failure-to-Thrive: Lessons from animal models and developing countries

      Black, M.M.; Dubowitz, H. (Lippincott Williams & Wilkins, 1991)
      To better understand the complex associations between undernutrition and poverty in determining behavioral outcome for infants with failure-to-thrive (FTT), we have reviewed findings from research in undernutrition among animal models and among children in developing countries, where rates of infant undernutrition are extremely high. The associations among undernutrition, poverty, and family functioning persist in both animal and human research, whether manipulated in laboratory settings or observed in natural settings. Although environmental support and stimulation appear to ameliorate many of the negative consequences associated with undernutrition, infants with a history of nutritional deprivation are at increased risk for behavioral and emotional problems. Recommendations for prevention and intervention follow an ecological framework and include adequate access to food, knowledge of nutritional requirements and feeding approaches, support for parents and families, and a nurturant environment for infants. Copyright 1991 Journal of Developmental & Behavioral Pediatrics. All rights reserved.
    • Teaching pediatric residents about child maltreatment

      Dubowitz, H.; Black, M.M. (Lippincott Williams & Wilkins, 1991)
      Child maltreatment is a growing problem faced by pediatricians; however, there are many deficiencies in pediatricians' relevant knowledge and skills. Residency programs typically have included limited teaching in the area of child maltreatment. Fifty pediatric residents participated in an evaluation of a model educational course in child maltreatment developed by an interdisciplinary faculty. The course resulted in significant short-term improvements in knowledge and skills as well as a greater sense of competence in managing cases of child maltreatment. The importance of teaching pediatric residents about the “new morbidity” is discussed. © 1991 Journal of Developmental & Behavioral Pediatrics. All rights reserved.
    • The Physical Health of Children in Kinship Care

      Dubowitz, H.; Feigelman, S.; Zuravin, S.; Tepper, V.; Davidson, N.; Lichenstein, R. (American Medical Association, 1992)
      Objective. The objectives of this study were to assess the current and chronic health problems and the adequacy of primary health care of children placed with a relative (kinship care) by a public agency. Research Design. Population survey. Setting. Children in kinship care in Baltimore, Md. Participants. Four hundred seven (78%) of 524 children in kinship care in 1989. Interventions. None. Measxurements/Main Results. Information on the child�s health status and care was obtained via a review of medical records; questionnaires sent to primary care physicians, parents, care givers, and caseworkers; and clinical assessment of the child by a nurse, pediatrician, and child psychologist. The children were found to have health problems similar to those in foster and poor children, but more problems than American children in general. Frequent diagnoses included impaired visual acuity and hearing, obesity, dental caries, and asthma; often, these problems had not been identified or treated. Gaps in the medical records precluded firm conclusions concerning the children�s primary care, but suggest an inadequate system for ensuring their health care. Conclusions. There is a need for improving the system of health care for children in kinship care. There is also a need for additional research on this high-risk group of children. Copyright 1992, American Medical Association. All rights reserved.
    • The Diagnosis of Child Sexual Abuse

      Dubowitz, H.; Black, M.M.; Harrington, D. (American Medical Association, 1992)
      Objective. To examine how the history, psychological evaluation, medical examination, and child�s response to the examination contributed to a diagnosis of child sexual abuse by an interdisciplinary team. Design. Patient series. Setting. Subspecialty clinic for evaluating prepubertal children alleged to have been sexually abused. Participants. One hundred thirty-two children alleged to have been sexually abused and their parents or guardian, evaluated consecutively in a subspecialty clinic between September 1989 and June 1990. Measurements/Main Results. A social worker interviewed the parents, a psychologist interviewed the child, and a pediatrician obtained a medical history and examined the child. Parents completed a Child Behavior Check list and the child�s response to the physical examination was noted. Both a disclosure by the child and abnormal physical findings were significantly and independently associated with the team�s diagnosis of sexual abuse, whereas the presence of sexualized behavior, somatic problems, and the child�s response to the examination did not make an additional contribution to the diagnosis. Conclusions. The findings support the need for a skilled psychological interview and a medical examination of a child alleged to have been sexually abused to make the diagnosis of sexual abuse. An interdisciplinary team appears to be a valuable approach for evaluating these children and their families. Copyright 1992, American Medical Association. All rights reserved.
    • Failure to thrive/growth deficiency.

      Bithoney, W.G.; Dubowitz, H.; Egan, H. (American Academy of Pediatrics, 1992)
    • The Pediatrician's Documentation of Child Maltreatment

      Dubowitz, H.; Bross, D.C. (American Medical Association, 1992)
      Pediatricians are increasingly involved in the assessment of suspected child maltreatment. These assessments are a crucial component of the overall evaluation of the patient and provide the basis for interventions to protect the child. An accurate documentation of the pediatrician's assessment is important to convey the information to professionals in the public agencies involved, including the legal system. However, there may be uncertainty among pediatricians concerning what should be documented in the medical record in cases of child maltreatment. The objectives of this article are to provide a detailed but generic description of the information that should be gathered during the evaluation of children who show signs of any form of child abuse and neglect and to provide clear guidelines for the proper written documentation of child maltreatment. Copyright 1992, American Medical Association. All rights reserved.
    • Kinship care: Research and practice issues

      Dubowitz, H.; Zuravin, S.; Starr, R.H., Jr.; Feigelman, S.; Harrington, D. (Lippincott Williams & Wilkins, 1993)
    • In Reply

      Dubowitz, H.; Black, M.M.; Harrington, D. (American Medical Association, 1993)