Anne-Claude Bernard-Bonnin

Home safety measures and the risk of unintentional injury among young children: a multicentre case–control study

Background: Young children may sustain injuries when exposed to certain hazards in the home. To better understand the relation between several childproofing strategies and the risk of injuries to children in the home, we undertook a multicentre case–control study in which we compared hazards in the homes of children with and without injuries. Methods: We conducted this case-control study using records from 5 pediatric hospital emergency departments for the 2-year period 1995–1996. The 351 case subjects were children aged 7 years and less who presented with injuries from falls, burns or scalds, ingestions or choking. The matched control subjects were children who presented during the same period with acute non-injury-related conditions. A home visitor, blinded to case-control status, assessed 19 injury hazards at the childrens homes. Results: Hazards found in the homes included baby walkers (21% of homes with infants), no functioning smoke alarm (17% of homes) and no fire extinguisher (51% of homes). Cases did not differ from controls in the mean proportion of home hazards. After controlling for siblings, maternal education and employment, we found that cases differed from controls for 5 hazards: the presence of a baby walker (odds ratio [OR] 9.0, 95% confidence interval [CI] 1.1–71.0), the presence of choking hazards within a childs reach (OR 2.0, 95% CI 1.0–3.7), no child-resistant lids in bathroom (OR 1.6, 95% CI 1.0–2.5), no smoke alarm (OR 3.2, 95% CI 1.4–7.7) and no functioning smoke alarm (OR 1.7, 95% CI 1.0–2.8). Interpretation: Homes of children with injuries differed from those of children without injuries in the proportions of specific hazards for falls, choking, poisoning and burns, with a striking difference noted for the presence of a baby walker. In addition to counselling parents about specific hazards, clinicians should consider that the presence of some hazards may indicate an increased risk for home injuries beyond those directly related to the hazard found. Families with any home hazard may be candidates for interventions to childproof against other types of home hazards.

Pattern of child sexual abuse by young aggressors

OBJECTIVE The aim of the study was to determine whether sexual victimization of children by young aggressors differs from adult aggressors. METHOD A case review was performed on medical records of children less than 12 years of age referred in 1992 to the Child Protection Clinic at a tertiary care pediatric hospital. RESULTS Medical evaluation for sexual abuse was carried out on 316 children, 79% girls, 21% boys, mean age 6 +/- 2.7 years. Among known perpetrators, 39 were less than 16 years and 15 were between 16 and 19 years old. Young aggressors were more likely to abuse older female victims (p = .0009). They also were reported to engage in more genital/genital and genital/anal acts (p < .001). The aggressors young age was found to be an important determinant related to a history of penetrative forms of sexual abuse (OR = 4.015, 95% C.I. 2.0581; 7.8319). Genital examination was specific for abuse (Adams Class IV or V) in only 6.3% of victims, but significantly more often when the perpetrator was between 16-19 years old (p = .003). CONCLUSIONS Adolescent aggressors appear to engage in more genital/genital and genital/anal sexual abuse than older aggressors. Victims of aggressors age 16 to 19 had a higher risk of having specific findings on the anal/genital examination.

Sleep problems over a year in sexually abused preschoolers

Objectives The aim of the present study was to explore sleep problems in sexually abused preschoolers over a year. Methods The sample consisted of 224 abused children and 83 nonabused children aged 3 to 6 years old at enrolment into the study (T1), and 85 abused children and 73 nonabused children at the second evaluation, approximately 1 year later (T2). Sleep problems were assessed using parental reports on the Child Behavior Checklist - Preschool Version. Results Multivariate analysis of covariance revealed that sexually abused preschoolers presented higher scores of sleep problems than nonabused children on all items related to sleep problems at T1. Results from a regression analysis revealed that sexual abuse remained associated with higher levels of sleep problems after controlling for sociodemographical variables. At T2, abused preschoolers still presented more sleep problems than nonabused children on all but one of the sleep items. Results from a repeated measure one-way analysis of covariance revealed that abused preschoolers presented higher total sleep scores at both measurement times. Time was not associated with levels of sleep problems and sleep problems did not evolve differently for abused and nonabused children. Conclusions Sexually abused preschoolers are at risk of presenting with sleep problems. These results are worrisome given the negative impacts of sleep problems on child development. Research and clinical implications are discussed.

Re: L’examen génital de l’enfant

En tant que groupe de pediatres oeuvrant regulierement aupres d’enfants victimes ou soupconnes etre victimes d’un abus sexuel, nous desirons vous faire part de certains commentaires sur l’enonce «Approche deontologique de l’examen genital de l’enfant» (Paediatr Child Health 1999;4[1]:72). Le point 3 (ne jamais utiliser la force pour un examen genital) nous apparait primordial et devrait constituer le sujet principal de l’enonce. Nous ne sommes cependant pas en accord avec votre avant-dernier paragraphe: “En cas de violence sexuelle (surtout chez les jeunes enfants), un examen physique sous anesthesie generale represente souvent la methode d’evaluation des lesions la moins traumatisante. Il est preferable qu’un gynecologue chevronne s’en charge”. L’examen sous anesthesie generale doit etre exceptionnel; nous examinons a notre clinique plus de 300 a 400 enfants par annee pour suspicion d’un abus sexuel et nous n’avons recours a l’examen sous anesthesie qu’une ou deux fois tout au plus par an et nous n’estimons pas que nos examens sont traumatisants (1)! Lorsqu’on y met le temps, qu’on demande le consentement de l’enfant pour examiner ses parties genitales, meme dans les cas d’agression sexuelle, on reussit a obtenir un examen adequat dans plus de 99% des cas. Seuls ceux qui ont besoin d’un examen urgent (saignements par exemple) et chez qui on ne reussit pas a proceder, seront vus par un gynecologue et subiront un examen sous anesthesie generale. La lecture de votre enonce laisse plutot croire que la majorite des victimes d’un abus sexuel devrait etre examinee sous anesthesie; c’est du moins ce que certains de nos confreres ont compris. Nous desirons egalement souligner qu’en particulier lorsqu’il y a soupcons d’un abus sexuel, le medecin devrait toujours se faire accompagner d’une autre personne lors de l’examen genital, une infirmiere par exemple.