RESUMEN
OBJECTIVE: To describe the components of an approach to the consultation for suspected child physical abuse beyond the history, physical findings, and laboratory and radiographic data. METHOD: Description of both a baseline organizational structure and recommended behaviors. RESULTS: We describe four domains of the approach to the consultation for suspected child physical abuse by child abuse clinicians: (1)components to have in place before a consultation, (2) components of a quality consultation, (3) sharing a final opinion, and (4) inevitable pitfalls. CONCLUSION: In proposing this approach, we aim both to make transparent and spark discussion about the way we work and to answer questions about the role of child abuse clinicians raised by recent interest in this subject by the mass media.
Asunto(s)
Maltrato a los Niños/diagnóstico , Abuso Físico , Niño , Humanos , Examen Físico , Derivación y ConsultaRESUMEN
This article highlights five important aspects of the clinical problem of evaluating young children who are suspected of having abusive head trauma: 1) the clinical questions to be addressed, 2) challenges when evaluating young children with suspected abuse, 3) key aspects of clinical practice and data collection, 4) a framework for decision-making and 5) key articles in the literature that can help inform a sound clinical decision about the likelihood of abuse.
Asunto(s)
Maltrato a los Niños/diagnóstico , Traumatismos Craneocerebrales/diagnóstico , Diagnóstico por Imagen/métodos , Documentación/métodos , Medicina Legal/métodos , Niño , Maltrato a los Niños/prevención & control , Preescolar , Traumatismos Craneocerebrales/prevención & control , Toma de Decisiones , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Anamnesis/métodos , Estados UnidosRESUMEN
Methadone exposures in children have increased as the drug has gained more prevalence in the treatment of adult narcotic dependency. Previous literature concerning pediatric methadone ingestion has focused primarily on unintentional ingestions. We describe a 2-month-old male infant presenting with respiratory failure from suspected intentional methadone administration. The infant was born to a mother with narcotic dependency and at birth was treated for neonatal abstinence syndrome. After discharge for neonatal abstinence syndrome treatment, the infant continued to be fussy and persistently irritable. We believe the infant was intentionally given methadone at home by his mother for these symptoms. It is important for pediatric providers to be vigilant of households with methadone present. Family-centered education on prevention of methadone ingestion (eg, safe storage) and anticipatory guidance on the signs, symptoms, and treatment of toxicity are key.