Head injury secondary to suspected child maltreatment: results of a prospective Canadian national surveillance program

Objective

We sought to determine the incidence, clinical features, and demographic profile of head injury secondary to suspected child maltreatment (abuse or neglect) in Canada to help inform the development and evaluation of prevention programs for abusive head injuries.

Methods

From March 1, 2005 to February 28, 2008, an average of 2,545 paediatricians and paediatric subspecialists were surveyed monthly through the established network of the Canadian Paediatric Surveillance Program. We calculated incidence rates using the number of confirmed cases over the product of the duration of the study (3 years) and population estimates by age group.

Results

There were 220 confirmed cases of head injury from suspected child maltreatment. The annual incidence rate was 14.1 per 100,000 for children less than 1 year of age and 1.4 per 100,000 for those less than 15 years. Seventy three percent (141) of cases involved infants less than 12 months of age and 52% (100) of cases involved infants less than 6 months of age. Seventy-five percent (165) of cases presented to the emergency room. With regard to outcome, 12% (27) of cases resulted in death and 45% (75) of survivors had neurological sequelae at discharge. Thirty percent (67) of all cases, as well as 30% (8) of deaths were previously known to child welfare authorities.

Conclusion

This study provides an estimate of the rate of head injury secondary to suspected child maltreatment in Canada. The young age and poor medical outcomes of those involved highlights the need for prevention efforts that are implemented early in life. Given that a significant percentage of injured infants and children were already known to child welfare authorities, the study also highlights the need to establish and evaluate additional preventive efforts for parents and caregivers already in the child welfare system.     

Identifying and predicting problem behavior trajectories among pre-school children investigated for child abuse and neglect

Objective

Young children involved with child welfare services are at high risk for behavior problems. This study aims to identify externalizing behavior paths that preschoolers in this high-risk population follow over a 6 year period, and the predictors of membership in normative and problematic pathways.

Methods

Using data from the National Study of Child and Adolescent Well-being (NSCAW), the sample included 246 4-year-olds who remained home after investigation. Latent class growth analysis (LCGA) was used to estimate the number, size, and shape of subgroups of preschoolers following distinct behavioral pathways. Early predictors of membership in the resulting groups were then examined.

Results

Four groups of preschool children following distinct behavior trajectories over 6 years were identified. Weighted results show that more than half (61%) of the children followed a low/normal problem behavior trajectory while just over one tenth (12%) were on a persistent high trajectory, remaining in the clinical range throughout the study. Improving (23%) and worsening (4%) problem behavior groups were also identified. Internalizing problems, attention problems, child ethnicity, and maltreatment type reported at age 4 predicted membership in the trajectory groups.

Conclusions

Internalizing behavior problems and maltreatment type may distinguish preschool children who are more likely to experience worsening or persistent problematic externalizing behaviors from those likely to follow a normal behavior trajectory.

Practice implications

Identifying early indicators of externalizing behavior problems and addressing them with evidence-based interventions to reduce negative behaviors may avert long-term negative outcomes.     

大学和社会经济发展的关系

在发言开始前,我想对受邀参加本次校长会议表示感谢,并代表开普敦大学以及南非向清华大学表达诚挚的祝贺和良好的祝愿。如同中国大学一样,我国的大学也正逐步融入世界大学群体。由于数十年的种族隔离制度作祟,来自学术界的杯葛接踵而至,南非的大学与国外同行间的合作或交换关系发展得异常困难与复杂。即使在     

扑克游戏

一张牌可以睡个懒觉,一张牌可以逃学一次,一张牌可以不做作业……这可不是一个天真又懒惰的学生写出来的愿望清单,而是乌伯特·盛旦老师发明的扑克游戏。     

万事俱备

课文大不同 你是否好奇过大洋彼岸的孩子们在读着怎样的课文？你是否遥想过父辈们当年所念的书本？本栏目就带你去瞧瞧那些曾经或正在与你同龄的伙伴们都在学习着怎样的课文．探寻精彩纷呈的语文世界。     

诗人华斯沃斯先生

有一天下午四点钟,来了一位奇／怪的人。那时我已经从学校回来,那个人对我说：“索尼,我可以进你们家的院子吗？”