Faculty Bibliography

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature.

The history of child abuse pediatrics reflects the development of medicine as a profession influenced by social movements reacting to poverty, economic exploitation, and child maltreatment. As physicians began to specialize in caring for children, egregious cases led them to recognize children were affected by special medical problems and diseases which were compounded by poor conditions and abuse and neglect. They developed the fields of pediatrics and child abuse pediatrics to advocate for their needs in courts and communities. Using a history of prominent physicians and cases, the objectives of this article are to: (1) rediscover the founding of pediatrics in NYC in the context of the environment which served as the setting for its development; (2) highlight our early understanding of the medical issues surrounding child maltreatment, with advocacy and forensic medicine becoming a growing part of medical care for children; and (3) explore the development of child abuse pediatrics in light of prominent physicians making major contributions to child protection. Timelines show the early interplay among social problems, publicized cases, private and governmental agencies, and the development of child abuse pediatrics. The article concludes with potential lessons to be learned and further questions about this interplay of child protection systems and the development of child abuse pediatrics.

In the 19th century more understanding for children's rights was acknowledged and in the 20th century child abuse was discovered in 1962 after many years of "looking with the blind eye." The number of reported cases of child abuse worldwide has ever since exploded into a public health epidemic with a much higher incidence than for example cancer. Child abuse and neglect is a complex field, where many professionals and agencies are involved, which can be one of the reasons, why the field has not been able to attract enough resources for prevention, treatment, education and research. Child abuse must be looked upon as a major public health problem and professionals must make the 21st century a "century for the child."

Teen pregnancy is a significant social, political and economic issue, and potential adverse outcomes for children of adolescent mothers include a higher incidence of low birth weight, prematurity, developmental delays, cognitive and behavioural deficits, and school failure. These children are also at a greater risk for abuse and neglect as well as intentional injury by their adolescent mothers. We evaluated child abuse reporting and the health outcomes for infants and their adolescent parents in Bellevue Hospital's Adolescent Parenting Program to assess whether better outcomes were achieved for mother-baby dyads in our adolescent mothers' groups compared to the general clinic and New York City populations. We found that those who completed a full year of the programme during 2011-12 had some significantly improved measures compared to those who did not, with fewer child abuse reports and more well-baby visits, more immunisations and earlier referral for developmental delays. There were additional health benefits for the adolescent mothers noted as well. We concluded that a specialised programme for high-risk adolescent mothers and their babies offers a number of benefits compared to standard separate care, but more research and funding are needed to tailor programmes to the unique needs of adolescent mothers in diverse social and educational contexts

This paper reviews abuse and neglect among children with disabilities and highlights the impact of disability on child abuse and neglect in the United States and internationally. Children with various disabilities have variable increases in their risk for maltreatment because of their increased vulnerability, difficulties in communication, and potential for ongoing victimization. Patterns of victimization are defined and discussed in categories of different types of maltreatment, including physical and sexual abuse, psychologic maltreatment, and neglect. The effects of disabilities of various types on this epidemiology are discussed, serving as an introduction to the problem of child abuse and neglect as well as describing potentially intervenable risk factors among the population of disabled children. Recommendations are given to improve our understanding of how to best identify child maltreatment among children with disabilities so they may maximize their developmental and intellectual potentials.