Now showing items 21-40 of 174

    • The "New Science" of Abusive Head Trauma

      Lindberg, D.M.; Dubowitz, H.; Alexander, R.C.; Reece, R.M. (Springer Nature Switzerland AG, 2019)
      Claims that new science is changing accepted medical opinion about abusive head injury have been made frequently in the media, legal publications, and in legal cases involving abusive head trauma (AHT). This review analyzes recently published scientific articles about AHT to determine whether this new information has led to significant changes in the understanding, evaluation, and management of children with suspected AHT. Several specific topics are examined as follows: serious or fatal injuries from short falls, specificity of subdural hematoma for severe trauma, biomechanical explanations for findings, the specificity of retinal hemorrhages, the possibility of cerebral sinus thrombosis presenting with signs similar to AHT, and whether vaccines can produce such findings. We conclude (a) that the overwhelming weight of recent data does not change the fundamental consensus, (b) that abusive head trauma is a significant source of morbidity and mortality in children, (c) that subdural hematomas and severe retinal hemorrhages are commonly the results of severe trauma, (d) that these injuries should prompt an evaluation for abuse when identified in young children without a history of such severe trauma, and (e) that short falls, cerebral sinus thrombosis, and vaccinations are not plausible explanations for findings that raise concern for abusive head trauma.
    • The Effectiveness of Food Insecurity Screening in Pediatric Primary Care

      Lane, W.; Dubowitz, H.; Feigelman, S.; Poole, S. (Lifescience Global, 2014)
      Background. Food insecure children are at increased risk for medical and developmental problems. Effective screening and intervention are needed. Methods. Our purpose was to (1) evaluate the validity and stability of a single item food insecurity (FI) screen. (2) Assess whether use may lead to decreased FI. Part of a larger cluster randomized controlled trial, pediatric residents were assigned to SEEK or control groups. A single FI question (part of a larger questionnaire) was used on SEEK days. SEEK residents learned to screen, assess, and address FI. A subset of SEEK and control clinic parents was recruited for the evaluation. Parents completed the USDA Food Security Scale ("gold standard"), upon recruitment and 6-months later. Validity, positive and negative predictive values (PPV, NPV) was calculated. The proportion of screened families with initial and subsequent FI was measured. Screening effectiveness was evaluated by comparing SEEK and control screening rates and receipt of Supplemental Nutrition Assistance Program (SNAP) benefits between initial and 6-month assessments. Results. FI screen stability indicated substantial agreement (Cohen's kappa =0.69). Sensitivity and specificity was 59% and 87%, respectively. The PPV was 70%; NPV was 81%. SEEK families had a larger increase in screening rates than control families (24% vs. 4.1%, p<0.01). SEEK families were more likely to maintain SNAP enrollment (97% vs. 81%, p=0.05). FI rates remained stable at approximately 30% for both groups. Conclusions. A single question screen can identify many families with FI, and may help maintain food program enrollment. Screening may not be adequate to alleviate FI.
    • 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.
    • 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.
    • 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.
    • 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
    • Incest (Book).

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

      Dubowitz, H. (Elsevier, 1985)
    • 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.
    • Kinship care: Research and practice issues

      Dubowitz, H.; Zuravin, S.; Starr, R.H., Jr.; Feigelman, S.; Harrington, D. (Lippincott Williams & Wilkins, 1993)
    • 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)
    • Neglecting the Neglect of Neglect

      Dubowitz, H. (SAGE Publications Inc., 1994)
    • Parenting style and developmental status among children with nonorganic failure to thrive

      Black, M.M.; Hutcheson, J.J.; Dubowitz, H.; Berenson-howard, J. (Oxford University Press, 1994)
      Examined differences in several developmental indices of competence among 102 low-income, inner-city, predominantly African American children with non-organic failure to thrive (NOFTT) and a comparison group of 67 children with adequate growth matched on age, gender, race, and socioeconomic status. Parents were categorized into one of three groups (nurturant, authoritarian, and neglecting) based on observations during feeding. Parents of children with NOFTT were less nurturant and more neglecting than parents of comparison children. Associations between parenting style and children's social-cognitive development were similar across groups. Children of nurturant parents consistently demonstrated better social-cognitive development. Results support the importance of considering heterogeneity among high-risk families and the need to examine the relationships linking parenting style and child development. Copyright 1994 Plenum Publishing Corporation.
    • In Reply

      Dubowitz, H.; Black, M.M.; Harrington, D. (American Medical Association, 1993)
    • A Conceptual Definition of Child Neglect

      Dubowitz, H.; Black, M.M.; Starr, R.H., Jr.; Zuravin, S. (SAGE Publications Inc., 1993)
      Although child neglect is the most common form of child maltreatment, considerable confusion remains regarding its definition. A conceptual definition of neglect is presented based on an ecological model of child maltreatment. The definition focuses on the basic needs of children that are not met, rather than on the intentions or behavior of parents. The replacement of parental culpability by a shared responsibility including parents, families, the community, and society is suggested. Neglect is seen as a heterogeneous phenomenon that varies by type, severity, and chronicity. In addition, neglect is understood as existing on a continuum ranging from optimal to grossly inadequate care. The context within which neglect occurs, including parents' understanding of children's needs, religious and cultural beliefs, and poverty, influences the approaches of clinicians, researchers, and policymakers toward the problem of child neglect. Copyright 1993, SAGE PERIODICALS PRESS. 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)