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  1. Article ; Online: Struggling to Stem the Tide of Child Maltreatment.

    Schilling, Samantha / Wood, Joanne N / Christian, Cindy W

    JAMA

    2024  Volume 331, Issue 11, Page(s) 918–919

    MeSH term(s) Child ; Humans ; Child Abuse/prevention & control ; Child Abuse/trends
    Language English
    Publishing date 2024-03-19
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2024.0899
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    In stock of ZB MED Cologne/Königswinter

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  2. Article ; Online: How Should Clinicians and Students Cope With Secondary Trauma When Caring for Children Traumatized by Abuse or Neglect?

    Bennett, Colleen E / Christian, Cindy W

    AMA journal of ethics

    2023  Volume 25, Issue 2, Page(s) E109–115

    Abstract: When health care professionals encounter child abuse and neglect, they can experience a range of emotions, such as anger, sadness, and frustration. Such feelings can cloud judgment, compromise care, or even undermine one's capacity to complete evaluation ...

    Abstract When health care professionals encounter child abuse and neglect, they can experience a range of emotions, such as anger, sadness, and frustration. Such feelings can cloud judgment, compromise care, or even undermine one's capacity to complete evaluation of a child. This article discusses key ethical values of honesty, objectivity, compassion, professionalism, respect for persons, and justice, which can be used to guide one's approaches to navigating secondary trauma during and after clinical interactions with children who have suffered abuse or neglect. Strategies for coping with intense feelings, especially during interactions with abused and neglected children's families, are also offered herein.
    MeSH term(s) Child ; Humans ; Compassion Fatigue ; Child Abuse ; Emotions ; Students ; Empathy
    Language English
    Publishing date 2023-02-01
    Publishing country United States
    Document type Journal Article
    ISSN 2376-6980
    ISSN (online) 2376-6980
    DOI 10.1001/amajethics.2023.109
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  3. Article ; Online: The eye in child abuse.

    Christian, Cindy W / Binenbaum, Gil

    Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

    2022  Volume 38, Issue 12, Page(s) 2335–2344

    Abstract: Child physical abuse may result in a range of injuries to the globe and surrounding tissues. These injuries have varying degrees of specificity for abuse, and no pattern of injury is unique to abuse. Easily overlooked eye injuries in non-ambulatory ... ...

    Abstract Child physical abuse may result in a range of injuries to the globe and surrounding tissues. These injuries have varying degrees of specificity for abuse, and no pattern of injury is unique to abuse. Easily overlooked eye injuries in non-ambulatory infants often portend more severe abuse and require careful evaluation for occult injury when they are unexplained. Retinal hemorrhages are most often a sign of significant trauma and the severity of the hemorrhages generally parallels the severity of neurological trauma. Ophthalmologists contribute important data that more easily distinguish medical disease from trauma, but caution is needed in differentiating accidental from inflicted trauma. This distinction requires careful consideration of the complete clinical data and occasionally on additional law enforcement or child welfare investigation.
    MeSH term(s) Infant ; Child ; Humans ; Craniocerebral Trauma ; Child Abuse/diagnosis ; Retinal Hemorrhage/etiology ; Retinal Hemorrhage/diagnosis ; Eye Injuries
    Language English
    Publishing date 2022-07-23
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 605988-0
    ISSN 1433-0350 ; 0302-2803 ; 0256-7040
    ISSN (online) 1433-0350
    ISSN 0302-2803 ; 0256-7040
    DOI 10.1007/s00381-022-05610-8
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2036: Show issues Location:
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  4. Article ; Online: Clinical evaluation and management of children with suspected physical abuse.

    Bennett, Colleen E / Christian, Cindy W

    Pediatric radiology

    2021  Volume 51, Issue 6, Page(s) 853–860

    Abstract: Evaluating and managing children with suspected physical abuse is challenging. Few single injuries are pathognomonic for abuse and, as a result, child abuse is easily missed. As such, a healthy bit of skepticism is needed to recognize and protect abused ... ...

    Abstract Evaluating and managing children with suspected physical abuse is challenging. Few single injuries are pathognomonic for abuse and, as a result, child abuse is easily missed. As such, a healthy bit of skepticism is needed to recognize and protect abused children. The medical history and clinical presentation should guide evaluation. Medical providers must consider the differential diagnosis, epidemiology of injuries, and child development to inform the assessment. In this review, we address evidence-based recommendations to inform child physical abuse evaluations. We also discuss the role of medical providers in communicating with families, mandated reporting and interpreting medical information for investigative agencies and other non-medical colleagues entrusted with protecting children.
    MeSH term(s) Child ; Child Abuse/diagnosis ; Child Abuse/prevention & control ; Diagnosis, Differential ; Humans ; Physical Abuse ; Physical Examination
    Language English
    Publishing date 2021-05-17
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-020-04864-1
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    Zs.A 927: Show issues Location:
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  5. Article: Recognizing medical child abuse in children presenting with chronic pain.

    Sherry, David D / Gmuca, Sabrina / Christian, Cindy W

    British journal of pain

    2022  Volume 16, Issue 4, Page(s) 433–438

    Abstract: Medical child abuse (MCA), previously referred to as Munchausen by proxy, can present as chronic pain. We report the presentation of five children seeking treatment for chronic pain who we identified as victims of MCA. The index case had essentially not ... ...

    Abstract Medical child abuse (MCA), previously referred to as Munchausen by proxy, can present as chronic pain. We report the presentation of five children seeking treatment for chronic pain who we identified as victims of MCA. The index case had essentially not eaten for the 6 years of her life due to alleged allergies to all foods, developed severe pain, used a wheelchair for ambulation beyond a few blocks, and was alleged to have dysautonomia requiring oxygen monitoring at night. Other cases posed as arthritis that resulted in foot amputation and total body pain, fibromyalgia with alleged mutation negative Stickler syndrome who had symptoms only in her mother's presence, severe incapacitating intermittent pains along with abdominal pain that resulted in appendectomy, cholecystectomy, and pancreatectomy, and alleged disabling hypermobile Ehlers-Danlos in a non-hypermobile child for which the mother sought a power wheelchair. The unusual pattern to the pain, the presence of multiple additional, atypical symptoms and diagnoses, and a generally well appearing child are characteristic. The perpetrator is typically over-invested in the symptoms, derives tangible and intangible secondary gain from the child's alleged illnesses, and is able to present the child in such a fashion to enlist the physician to aid in perpetuating the abuse. These children are highly over-medicalized and suffer significant morbidity. Multiple barriers exist to identifying and reporting these children to Child Protective Services, which need to be recognized and overcome in order to protect these vulnerable children.
    Language English
    Publishing date 2022-02-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2670872-3
    ISSN 2049-4645 ; 2049-4637
    ISSN (online) 2049-4645
    ISSN 2049-4637
    DOI 10.1177/20494637221075186
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  6. Article ; Online: A baby carrier fall leading to intracranial bleeding and multilayered retinal hemorrhages.

    Raj, Anish / Christian, Cindy W / Reid, Julia E / Binenbaum, Gil

    Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus

    2022  Volume 26, Issue 2, Page(s) 84–86

    Abstract: Significant intracranial and retinal hemorrhages are often seen in infants with abusive head trauma, although accidental injury and previously undiagnosed medical disorders are important considerations in the differential diagnosis. We present the case ... ...

    Abstract Significant intracranial and retinal hemorrhages are often seen in infants with abusive head trauma, although accidental injury and previously undiagnosed medical disorders are important considerations in the differential diagnosis. We present the case of an infant with confirmed accidental trauma sustained from an adult-worn baby carrier fall with superimposed head crush injury, which resulted in significant cranial, intracranial, and retinal findings.
    MeSH term(s) Child ; Child Abuse/diagnosis ; Craniocerebral Trauma/complications ; Craniocerebral Trauma/diagnosis ; Diagnosis, Differential ; Humans ; Infant ; Retina ; Retinal Hemorrhage/diagnosis ; Retinal Hemorrhage/etiology ; Shaken Baby Syndrome/complications ; Shaken Baby Syndrome/diagnosis
    Language English
    Publishing date 2022-01-26
    Publishing country United States
    Document type Case Reports
    ZDB-ID 1412476-2
    ISSN 1528-3933 ; 1091-8531
    ISSN (online) 1528-3933
    ISSN 1091-8531
    DOI 10.1016/j.jaapos.2021.10.008
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 5188: Show issues Location:
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    Jg. 1995 - 2021: Lesesall (2.OG)
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  7. Article ; Online: Prevalence and Causes of Subconjunctival Hemorrhage in Children.

    Parikh, Alomi O / Christian, Cindy W / Forbes, Brian J / Binenbaum, Gil

    Pediatric emergency care

    2022  Volume 38, Issue 8, Page(s) e1428–e1432

    Abstract: Objective: Subconjunctival hemorrhage (SCH) is a reported sign of occult abusive injury, but there are limited published data about SCH during childhood. We sought to determine the prevalence and causes of SCH in children.: Methods: This is a ... ...

    Abstract Objective: Subconjunctival hemorrhage (SCH) is a reported sign of occult abusive injury, but there are limited published data about SCH during childhood. We sought to determine the prevalence and causes of SCH in children.
    Methods: This is a retrospective cross-sectional study of children seen by pediatric ophthalmologists in an outpatient setting over 4 years. Primary outcomes were prevalence and causes of SCH, based on history, physical ocular and nonocular findings, and laboratory and imaging studies. Subconjunctival hemorrhage prevalence was determined including and excluding eye surgery to reduce bias in the prevalence estimate.
    Results: We studied 33,990 children, who underwent 86,277 examinations (median age, 5 years; range, 2 days to 18 years; 9282 younger than 2 years, 13,447 age 2-7 years, 11,261 age 8-18 years). There were 949 cases of SCH (1.1%; 95% confidence interval, 1.0-1.2). When surgery was excluded, there were 313 cases (prevalence, 0.4%; 95% confidence interval, 0.3-0.4), of which 261 (83%) were due to trauma; 40 (13%) ocular surface inflammation, including infectious conjunctivitis; 7 (2%) orbital or conjunctival lesion; 3 (1%) vessel rupture from choking or cough; and 2 (1%) coagulopathy related. Across all ages, including less than 2 years, trauma and inflammation together accounted for 94% to 97% of all cases of SCH.
    Conclusions: Subconjunctival hemorrhage is uncommon in children. The great majority of cases are due to trauma. All children with SCH, including infants and young children, should be closely examined to identify other ocular or nonocular signs of trauma.
    MeSH term(s) Adolescent ; Child ; Child, Preschool ; Conjunctival Diseases/complications ; Conjunctival Diseases/etiology ; Cross-Sectional Studies ; Eye Hemorrhage/diagnosis ; Eye Hemorrhage/epidemiology ; Eye Hemorrhage/etiology ; Humans ; Infant ; Inflammation/complications ; Prevalence ; Retrospective Studies
    Language English
    Publishing date 2022-06-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632588-9
    ISSN 1535-1815 ; 0749-5161
    ISSN (online) 1535-1815
    ISSN 0749-5161
    DOI 10.1097/PEC.0000000000002795
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    Zs.A 2083: Show issues Location:
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  8. Article ; Online: Abusive head trauma: evidence, obfuscation, and informed management.

    Duhaime, Ann-Christine / Christian, Cindy W

    Journal of neurosurgery. Pediatrics

    2019  Volume 24, Issue 5, Page(s) 481–488

    Abstract: Abusive head trauma remains the major cause of serious head injury in infants and young children. A great deal of research has been undertaken to inform the recognition, evaluation, differential diagnosis, management, and legal interventions when ... ...

    Abstract Abusive head trauma remains the major cause of serious head injury in infants and young children. A great deal of research has been undertaken to inform the recognition, evaluation, differential diagnosis, management, and legal interventions when children present with findings suggestive of inflicted injury. This paper reviews the evolution of current practices and controversies, both with respect to medical management and to etiological determination of the variable constellations of signs, symptoms, and radiological findings that characterize young injured children presenting for neurosurgical care.
    MeSH term(s) Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/therapy ; Child ; Child Abuse/diagnosis ; Child Abuse/legislation & jurisprudence ; Child Protective Services ; Child, Preschool ; Craniocerebral Trauma/diagnosis ; Craniocerebral Trauma/therapy ; Hematoma, Subdural, Intracranial/diagnosis ; Hematoma, Subdural, Intracranial/therapy ; Humans ; Infant ; Law Enforcement ; Neurosurgical Procedures ; Radiography ; Shaken Baby Syndrome/diagnosis ; Shaken Baby Syndrome/therapy ; Tomography, X-Ray Computed
    Language English
    Publishing date 2019-11-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2403985-8
    ISSN 1933-0715 ; 1933-0707
    ISSN (online) 1933-0715
    ISSN 1933-0707
    DOI 10.3171/2019.7.PEDS18394
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    Uk I Zs.135 -Pediatrics-: Show issues Location:
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  9. Article ; Online: Vitamin D, rickets and child abuse: controversies and evidence.

    Aldana Sierra, Maria C / Christian, Cindy W

    Pediatric radiology

    2021  Volume 51, Issue 6, Page(s) 1014–1022

    Abstract: Suboptimal vitamin D status is a global health issue that affects children and adults worldwide. The prevalence of vitamin D deficiency and insufficiency has been well documented in the pediatric population in the United States. Although vitamin D ... ...

    Abstract Suboptimal vitamin D status is a global health issue that affects children and adults worldwide. The prevalence of vitamin D deficiency and insufficiency has been well documented in the pediatric population in the United States. Although vitamin D deficiency is common, radiographic findings are uncommon and can be subtle. Additionally, because of the high prevalence of pediatric vitamin D insufficiency, it is commonly identified in young children with fractures. However, the majority of pediatric fractures are caused by trauma to healthy bones. Some, especially in infants and toddlers, are caused by non-accidental trauma. A small percentage is related to medical disease, including those associated with disorders of collagen, disorders of mineralization, and non-fracture mimics. Despite the scientific evidence, among disorders of mineralization, non-rachitic disorders of vitamin D have become a popular non-scientific theory to explain the fractures identified in abused children. Although infants and young children with rickets can fracture bones, the vast majority of fractures identified in abused infants are not caused by bone disease. Here we present a review of the literature on bone disease in the setting of accidental and non-accidental trauma. This context can help physicians remain vigilant about identifying vulnerable young children whose injuries are caused by non-accidental trauma.
    MeSH term(s) Child ; Child Abuse/diagnosis ; Child, Preschool ; Fractures, Bone/diagnostic imaging ; Fractures, Bone/epidemiology ; Humans ; Infant ; Rickets/diagnostic imaging ; Rickets/epidemiology ; Vitamin D ; Vitamin D Deficiency
    Chemical Substances Vitamin D (1406-16-2)
    Language English
    Publishing date 2021-05-17
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-020-04893-w
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    Zs.A 927: Show issues Location:
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  10. Article ; Online: The evaluation of suspected child physical abuse.

    Christian, Cindy W

    Pediatrics

    2015  Volume 135, Issue 5, Page(s) e1337–54

    Abstract: Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, ... ...

    Abstract Child physical abuse is an important cause of pediatric morbidity and mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children.
    MeSH term(s) Child ; Child Abuse/diagnosis ; Child Abuse/prevention & control ; Humans ; Mandatory Reporting ; Medical History Taking ; Physical Examination ; Physician's Role ; Risk Factors ; Wounds and Injuries/diagnosis ; Wounds and Injuries/etiology
    Language English
    Publishing date 2015-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2015-0356
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    Zs.MO 357: Show issues

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