Faculty Bibliography

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.

We searched the US National Library of Medicine's PubMed, Google Scholar and the American Psychological Association's Psychinfo databases during September 2019 for citations and abstracts on abusive head trauma (AHT) and shaken baby syndrome prevention dated 1 January 2000 to 31 August 2019. We identified 53 empirical studies and performed a structured review to identify the effects of prevention, if any, on AHT. We identified three lines of investigation that have focused on: (i) strategies which teach parents how to respond to newborn crying and the dangers of shaking babies; (ii) community and public health factors; and (iii) professional education and practice. Most studies were observational, although a small number used sophisticated designs such as prospective or randomised controlled trials. We note other strengths and weaknesses of these articles and suggest future directions for research in each of these areas based on the current level of scientific inquiry. "˜Identified 53 empirical studies and performed a structured review to identify the effects of prevention"¦ on AHT"™. Key Practitioner Messages: Research on AHT prevention is limited, although a growing research base supports teaching parents how to respond to newborn crying and about the dangers of shaking babies. Social care systems addressing provision of material and other support have positive effects on AHT rates. Professional education should improve practitioners' identification of families with increased risk and enhance AHT identification and treatment. Those wishing to prevent AHT should consider multilevel approaches and their own community needs, practice setting, and patient/client risk profiles when designing strategies.

Child Abuse Pediatrics is a small and geographically dispersed specialty. This article reports on an intervention to improve written and photodocumentation quality and uniformity in suspected child physical abuse cases, using a remote, de-identified case review system.