RESUMEN
This introduction provides an overview to the special issues on medical neglect in childhood guest edited by Barbara L. Knox, MD, FAAP, Clinical Professor of Pediatrics, University of Washington School of Medicine, The Children's Hospital at Providence, Medical Director of Alaska Child Abuse Response and Evaluation Services; Randell C. Alexander, MD, PhD, FAAP, Professor and Chief, Division of Child Protection and Forensic Pediatrics at the University of Florida-Jacksonville; Francois M. Luyet, MD, Clinical Assistant Professor, University of Wisconsin School of Medicine and Public Health; and Debra D. Esernio-Jenssen, Professor of Pediatrics at the Morsani College of Medicine USF Health in Tampa, Florida and the Chief of Child Protection Medicine at Lehigh Valley Reilly Children's Hospital. Ten articles are included in this special edition aiming to explore the role of medical neglect in situations commonly encountered by practitioners.
RESUMEN
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: 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 result 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.
RESUMEN
The aim of this study was to investigate the relationship between crying of an infant and inflicted head injury by shaking and/or impact. During the period between January 1, 1997 and December 31, 2003, 26 cases of shaken baby syndrome (SBS) were identified in Estonia. The incidence of SBS was 28.7 per 100,000 children under 1 year of age during the whole study period. In this group there were four children from twin pairs: two twin boys and a girl from a twin pair and a boy from another twin pair. This represents 15.4% of the 26 cases. Twins in Estonia represent 2.12% of infant births. The mean age on admission was 3.9 months. According to outpatient records almost all parents (88.5%) in the study group (23/26) had contacted their family physicians and other specialists because of excessive crying or irritability of the baby prior to the admission to the hospital with SBS or death. We found that the time curve of crying was similar to the curve of highest incidence of cases of SBS except the crying curve began earlier. CONCLUSION. Our data confirm that the families with twins are at additional risk for SBS and parent's complaints of excessive crying of their infants should be taken as signal that parents need to be carefully counselled.