Now showing items 21-40 of 301

    • Child Welfare in the United States: In Theory and Practice

      Dubowitz, H.; DePanfilis, D. (Nova Science Publishers, Inc., 2009)
    • Childhood abuse and neglect predicts subsequent gastrointestinal symptoms in children: A prospective study

      Van Tilburg, M. A.; Chitkara, D. K.; Zolotor, A.; Graham, J. C.; Dubowitz, H.; Litrownik, A.; Whitehead, W. E.; Runyan, D.; Flaherty, E.G. (Elsevier, 2007)
    • Preschool Children of Adolescent Parents Benefit from Supportive Mother-partner Relationships but not from Three-generation Households

      Black, M.M.; Kerr, M.; Dubowitz, H.; Hunter, W.; English, D.; Schneider, M.; Hussey, J.M. (American Academy of Pediatrics, 2000)
    • Maternal Substance Use and Neglectful Parenting: Relationships with Children's Development

      Harrington, D.; Dubowitz, H.; Black, M.M.; Binder, A. (Routledge, 1995)
    • Impact of early home intervention on the growth of low-income infants with failure-to-thrive: Infancy through age

      Black, M.M.; Hutcheson, J.; Winslow, M.; Dubowitz, H.; Starr, R.H., Jr. (Federation of American Societies for Experimental Biology, 1996)
      Evaluated the longterm impact of home intervention on growth of children with failure-to-thrive (FTT). 130 children under age 2 (mean age = 12.7 months, SD = 6.4) recruited from urban pédiatrie primary care clinics. Born at gestational age > 36 weeks, birthweight AGA, no organic problems. Weight-for-age < 5th percentile at recruitment. Randomized into clinic plus home intervention (n=64) or clinic only (n=66). All children followed in a multidisciplinary Growth and Nutrition Clinic. Home intervention conducted by trained lay personnel who provided maternal support and guidance in parent-child developmental activities during weekly visits for one year. Hierarchial linear modeling used to examine intraindividual growth curves from recruitment through age 4. Rate of linear growth higher among children who received home intervention. No difference in rate of weight gain as a function of home intervention. Findings support a cautious optimism regarding the impact of home intervention on growth among children with FTT. Funded by the Maternal and Child Health Research Program.
    • Sequelae of reporting child abuse.

      Dubowitz, H.; Newberger, E.H. (American Academy of Pediatric Dentistry, 1986)
    • A randomized clinical trial of home intervention for children with failure to thrive

      Black, M.M.; Dubowitz, H.; Hutcheson, J.; Berenson-Howard, J.; Starr, R.H., Jr. (American Academy of Pediatrics, 1995)
      Objective. To evaluate the efficacy of a home-based intervention on the growth and development of children with nonorganic failure to thrive (NOFTT). Design. Randomized clinical trial. Participants. The NOFTT sample included 130 children (mean age, 12.7 months; SD, 6.4) recruited from urban pediatric primary care clinics serving low income families. All children were younger than 25 months with weight for age below the fifth percentile. Eligibility criteria included gestational age of at least 36 weeks, birth weight appropriate for gestational age, and no significant history of perinatal complications, congenital disorders, chronic illnesses, or developmental disabilities. Children were randomized into two groups: clinic plus home intervention (HI) (n = 64) or clinic only (n = 66). There were no group differences in children's age, gender, race, or growth parameters, or on any of the family background variables. Most children were raised by single, African-American mothers who received public assistance. Eighty-nine percent of the families (116 of 130) completed the 1-year evaluation. Interventions. All children received services in a multidisciplinary growth and nutrition clinic. A community-based agency provided the home intervention. Families in the HI group were scheduled to receive weekly home visits for 1 year by lay home visitors, supervised by a community health nurse. The intervention provided maternal support and promoted parenting, child development, use of informal and formal resources, and parent advocacy. Measurements. Growth was measured by standard procedures and converted to z scores for weight for height and height for age to assess wasting and stunting. Cognitive and motor development were measured with the Bayley Scales of Infant Development, and language development was measured by the Receptive/Expressive Emergent Language Scale. Both scales were administered at recruitment and at the 12- month follow-up. Parent-child interaction was measured by observing mothers and children during feeding at recruitment and at the 12-month follow-up, and the quality of the home was measured by the Home Observation Measure of the Environment 18 months after recruitment. Analyses. Repeated-measures multivariate analyses of covariance were used to examine changes in children's growth and development and parent-child interaction. Analyses of covariance were used to examine the quality of the home. Independent variables were intervention status and age at recruitment (1.0 to 12.0 vs 12.1 to 24.9 months). Maternal education was a covariate in all analyses. When changes in developmental status and parent-child interaction were examined, weight for height and height for age at recruitment were included as covariates. Results. Children's weight for age, weight for height, and height for age improved significantly during the 12-month study period, regardless of intervention status. Children in the HI group had better receptive language over time and more child-oriented home environments than children in the clinic-only group. The impact of intervention status on cognitive development varied as a function of children's ages at recruitment, with younger children showing beneficial effects of home intervention. There were no changes in motor development associated with intervention status. During the study period, children gained skills in interactive competence during feeding, and their parents became more controlling during feeding, but differences were not associated with intervention status. Conclusions. Findings support a cautious optimism regarding home intervention during the first year of life provided by trained lay home visitors. Early home intervention can promote a nurturant home environment effectively and can reduce the developmental delays often experienced by low income, urban infants with NOFTT. Subsequent investigations of home intervention should consider alternative options for toddlers with NOFTT.
    • Medical neglect: what can physicians do?

      Dubowitz, H. (MedChi, 1994)
      Neglect is the most prevalent form of child maltreatment. Although the morbidity and mortality associated with it are significant, child neglect has attracted relatively little attention from professionals, the media, and the public. This article focuses on unmet, basic needs of children, particularly with regard to health care. In addition to defining neglect, the article discusses incidence, etiology, various forms of medical neglect, and principles for evaluation and management.
    • Failure to thrive

      Krugman, S.D.; Dubowitz, H. (American Academy of Family Physicians, 2003)
      Failure to thrive is a condition commonly seen by primary care physicians. Prompt diagnosis and intervention are important for preventing malnutrition and developmental sequelae. Medical and social factors often contribute to failure to thrive. Either extreme of parental attention (neglect or hypervigilance) can lead to failure to thrive. About 25 percent of normal infants will shift to a lower growth percentile in the first two years of life and then follow that percentile; this should not be diagnosed as failure to thrive. Infants with Down syndrome, intrauterine growth retardation, or premature birth follow different growth patterns than normal infants. Many infants with failure to thrive are not identified unless careful attention is paid to plotting growth parameters at routine check-ups. A thorough history is the best guide to establishing the etiology of the failure to thrive and directing further evaluation and management. All children with failure to thrive need additional calories for catch-up growth (typically 150 percent of the caloric requirement for their expected, not actual, weight). Few need laboratory evaluation. Hospitalization is rarely required and is indicated only for severe failure to thrive and for those whose safety is a concern. A multidisciplinary approach is recommended when failure to thrive persists despite intervention or when it is severe. Copyright Copyright 2003 American Academy of Family Physicians.
    • 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.
    • Maria: stubborn, willful, and always full of energy.

      Stein, M.T.; Graziano, A.; Howard, B.; Dubowitz, H. (Lippincott Williams & Wilkins, 1996)
    • Behavior problems of children in kinship care

      Dubowitz, H.; Zuravin, S.; Starr, R.H., Jr.; Feigelman, S.; Harrington, D. (Lippincott Williams & Wilkins, 1993)
      An increasing number of children needing out-of-home care are being placed with relatives. Despite this pervasive policy, there has been scant research on children in this arrangement called kinship care. The objectives of this study were (1) to assess the behavior of children in kinship care and (2) to identify predictors of their behavior. The caregivers of 346 children in kinship care completed the Child Behavior Checklist (CBCL). Background information was obtained from caregivers and caseworkers. Forty-two percent of boys and 28% of girls had overall CBCL scores in the clinical range, compared with an expected 10% in the general population. Logistic regressions revealed several variables significantly associated with behavior problems including: Reason for placement, gender, race, caregiver's perception of the child, caregiver's educational level, number of contacts between caregiver and caseworker, long-term plan, and child's age. The frequent behavior problems among these high-risk children in kinship care suggest they all deserve mental health evaluations; at a minimum, periodic screening is indicated. Copyright 1993 by Williams & Wilkins.
    • 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.
    • 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.
    • 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.
    • Medical neglect: A child-focus view

      Dubowitz, Howard; Watson, D.; Farley, J. (American Medical Association, 2002)
    • International aspects of child abuse and neglect

      Dubowitz, Howard; Merrick, Joav (Hauppauge, N.Y. : Nova Science, 2010)
      It is very clear that children in every country experience abuse and neglect. The descriptions of the child welfare systems in different countries in this book illustrate several common themes: the lack of clear definitions, ambiguous policies, laws not being implemented, limited data on the extent and nature of the problem, and inadequate resources for addressing child maltreatment. Challenges facing Argentina are remarkably familiar to someone in the United States. At the same time, there are also striking differences in approaches and resources. The field of child protection is relatively young; in many areas optimal policies and practice remain uncertain. The goal of this book is to promote dialogue across borders to learn from each other and advance this multifaceted field, and to better serve children and families. This book highlights some of the main themes evident in the descriptions of the different child welfare systems. Copyright 2010 by Nova Science Publishers, Inc. All rights reserved.
    • 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.
    • 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.H. (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.