Faculty Bibliography

Understanding why children die is necessary to implement strategies to prevent future deaths and improve the health of any community. Child fatality review teams (CFRTs) have existed since the 1970s and provide a necessary framework to ensure that proper questions are asked about a child's death. CFRTs provide a vital function in a community to ensure that preventable causes of deaths are identified. Pediatricians are necessary members of CFRTs because they provide medical expertise and context around a child's death. All CFRTs should have pediatric physician representation, and results from team meetings should inform public policy at all levels of government. Pediatricians should be supported in their efforts to be present on CFRTs, and they should use data from team meetings to help advocate for implementing prevention strategies.

The United States continues to grapple with longstanding policies and systems that have adversely impacted historically marginalized communities who identify (and are racialized) as non-White. These stem from a legacy of structural and systemic racism, and the long-term consequences of sanctioned colonization. This legacy rests upon a field of scholarly research that is similarly fraught with white supremacy. As a field, we must examine the process of producing and publishing the body of evidence that has codified harmful policies and practices. Although racial and ethnic disparities have been discussed for decades in the child welfare and health systems, systemic racism has received comparatively little attention in academic research and journals. In this commentary, the authors detail concrete steps over the coming years that will advance diversity, equity, inclusion and justice through American Professional Society on the Abuse of Children's (APSACs) flagship journal, Child Maltreatment. The journal is committed to anti-racist publication processes, such that the journal pledges to develop procedures, processes, structures, and culture for scholarly research that promotes diversity, equity, inclusion, and justice in all forms.

In this commentary, the editorial team of Child Maltreatment extends and expands on APSAC's position on diversity, equity, inclusion, and justice, affirms our commitment and plans for addressing these issues in this publication, and highlights articles in this issue that continue the discussion about race and racism in the child welfare and child protection systems.

BACKGROUND:While risk factors have been identified among infants and young children, less is known about child maltreatment fatalities among older children. OBJECTIVES/OBJECTIVE:To describe the social and demographic characteristics of children where abuse or neglect was determined to cause or contribute to their death, compare characteristics and circumstances of the deaths by cause and manner of death and type of maltreatment, and explore the role of abuse and neglect in child suicides. PARTICIPANTS AND SETTING/METHODS:Secondary analysis of deaths due to child abuse or neglect among children ages 5-17 years old occurring during 2009-2018 and documented in the National Fatality Review-Case Reporting System. METHODS:Child, family, and social characteristics were compared by child age (5-10 years vs. 11-17 year-olds), and by cause and manner of death. Frequencies and proportions were reported and compared using chi-square statistics. RESULTS:1478 maltreatment-related deaths were identified. Higher proportions of older children were non-Hispanic white, had a history of chronic disease or disability, had problems in school, and had a history of mental health issues. Forty-three percent of the maltreatment deaths were due to homicide and 10 % by suicide. Higher proportions (65 %) of younger children (5-10 years old) died by homicide, compared to older children (35 % among ages 11-17y). While 58 % of deaths overall were related to neglect, 68 % of deaths in older children were related to neglect, including 80 % of suicides. CONCLUSIONS:The causes of child maltreatment deaths among children 5-17y vary by age. Child neglect caused and/or contributed to most child suicides.

This article describes the extent of the problem and the medical evaluation of child maltreatment, focusing on the outpatient interdisciplinary assessment of suspected child physical and sexual abuse. Separate from their role as clinicians, the roles of the child psychologist before, during, and after the medical assessment are highlighted. The child psychologist is an important member of the interdisciplinary team who helps the team prepare for the evaluation (before), assists in screening and determining immediate psychological safety during the medical evaluation (during), and communicating the need for further treatment and follow-up (after).

AIMS/OBJECTIVE:To examine the effectiveness of an augmented home visiting program in preventing intimate partner violence among Latinx mothers by nativity. BACKGROUND:Intimate partner violence diminishes home visit programs' effectiveness. Immigrant Latinx mothers are especially vulnerable and need culturally tailored prevention. METHODS:We performed secondary analyses of 33 U.S.-born and 86 foreign-born Latinx mothers at baseline, 1-year, and 2-year follow-up in a longitudinal randomized controlled trial of the Nurse Family Partnership program augmented with nurse-delivered Within My Reach relationship education, and violence screening and referrals. We estimated proportional odds models via generalized estimating equations on total physical and sexual victimization and/or perpetration forms (an ordinal variable), adjusting for intervention, wave, age, and education. RESULTS:The intervention-nativity interaction was not significant (p=0.953). Foreign-born status was associated with lower reported violence at baseline (Adjusted Odds Ratio: 0.29, 95% Confidence Interval: 0.13-0.67, p=0.004). This association was marginally significant at 1-year follow-up (0.43; 0.17-1.08, p=0.072) and not significant at 2-year follow-up (0.75; 0.33-1.67, p=0.475). CONCLUSIONS:This augmented program was not effective for Latinx immigrants by nativity. Their nativity gap diminished over time. IMPLICATIONS FOR NURSING MANAGEMENT/CONCLUSIONS:Nursing leaders should support culturally-tailored home visiting programs to detect and prevent intimate partner violence affecting Latinx immigrants.

BACKGROUND:Medical neglect is defined as the failure of a caretaker to heed obvious signs of serious illness, to seek medical care in a timely fashion, or to follow instructions once medical advice is obtained. It is reportable as a form of child maltreatment. OBJECTIVES/OBJECTIVE:(1) identify factors associated with referrals after medical neglect to adoption and foster care services; (2) describe a cohort of children with first-time cases; and (3) assess whether there were factors associated with recurrence. PARTICIPANTS AND SETTING/METHODS:Data from the National Child Abuse and Neglect Data System for 36 U.S. states. METHODS:A cohort of children was constructed with first confirmed reports of medical neglect in 2012 with matched confirmed reports during 2012-2017 to describe child, family, offender, and report factors associated with recurrence. These factors were then used in multivariate models, including logistic regression and Cox proportional hazard models, to assess their effects on recurrence and with referral to foster care and adoption services. RESULTS:Complex family problems were associated with referral for foster care and adoption services, and 8.1% had recurrence within 5 years. Older children with medical problems, Black race, or who were reported by medical or legal personnel had increased risk for recurrence. Only referral to mental health care services was found to decrease this risk. CONCLUSIONS:Medical neglect recurs within 5 years despite referrals to most services. Those trying to stop its recurrence should focus on mental health needs and families with children who are older, Black, or have complex medical problems.

After a sudden infant death, parents and caregivers need accurate and open communication about why their infant died. Communicating tragic news about a child's death to families and caregivers is difficult. Shared and consistent terminology is essential for pediatricians, other physicians, and nonphysician clinicians to improve communication with families and among themselves. When families do not have complete information about why their child died, pediatricians will not be able to support them through the process and make appropriate referrals for pediatric specialty and mental health care. Families can only speculate about the cause and may blame themselves or others for the infant's death. The terminology used to describe infant deaths that occur suddenly and unexpectedly includes an assortment of terms that vary across and among pediatrician, other physician, or nonphysician clinician disciplines. Having consistent terminology is critical to improve the understanding of the etiology, pathophysiology, and epidemiology of these deaths and communicate with families. A lack of consistent terminology also makes it difficult to reliably monitor trends in mortality and hampers the ability to develop effective interventions. This report describes the history of sudden infant death terminology and summarizes the debate over the terminology and the resulting diagnostic shift of these deaths. This information is to assist pediatricians, other physicians, and nonphysician clinicians in caring for families during this difficult time. The importance of consistent terminology is outlined, followed by a summary of progress toward consensus. Recommendations for pediatricians, other physicians, and nonphysician clinicians are proposed.